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Veltra D, Marinakis NM, Kotsios I, Delaporta P, Kekou K, Kosma K, Traeger-Synodinos J, Sofocleous C. Lethal Complications and Complex Genotypes in Shwachman Diamond Syndrome: Report of a Family with Recurrent Neonatal Deaths and a Case-Based Brief Review of the Literature. CHILDREN (BASEL, SWITZERLAND) 2024; 11:705. [PMID: 38929284 PMCID: PMC11201973 DOI: 10.3390/children11060705] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/12/2024] [Revised: 05/31/2024] [Accepted: 06/04/2024] [Indexed: 06/28/2024]
Abstract
Shwachman Diamond Syndrome (SDS) is a multi-system disease characterized by exocrine pancreatic insufficiency with malabsorption, infantile neutropenia and aplastic anemia. Life-threatening complications include progression to acute myeloid leukemia (AML) or myelodysplastic syndrome (MDS), critical deep-tissue infections and asphyxiating thoracic dystrophy. In most patients, SDS results from biallelic pathogenic variants in the SBDS gene, different combinations of which contribute to heterogenous clinical presentations. Null variants are not well tolerated, supporting the theory that the loss of SBDS expression is likely lethal in both mice and humans. A novel complex genotype (SBDS:c.[242C>G;258+2T>C];[460-1G>A]/WFS1:c.[2327A>T];[1371G>T]) was detected in a family with recurrent neonatal deaths. A female neonate died three hours after birth with hemolytic anemia, and a male neonate with severe anemia, thrombocytopenia and neutropenia succumbed on day 40 after Staphylococcus epidermidis infection. A subsequent review of the literature focused on fatal complications, complex SBDS genotypes and/or unusual clinical presentations and disclosed rare cases, of which some had unexpected combinations of genetic and clinical findings. The impact of pathogenic variants and associated phenotypes is discussed in the context of data sharing towards expanding scientific expert networks, consolidating knowledge and advancing an understanding of novel underlying genotypes and complex phenotypes, facilitating informed clinical decisions and disease management.
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Affiliation(s)
- Danai Veltra
- Laboratory of Medical Genetics, School of Medicine, National and Kapodistrian University of Athens, “Agia Sophia” Children’s Hospital, 11527 Athens, Greece; (D.V.); (N.M.M.); (K.K.); (K.K.); (C.S.)
- Research University Institute for the Study of Genetic and Malignant Disease of Childhood, “Agia Sophia” Children’s Hospital, 11527 Athens, Greece
| | - Nikolaos M. Marinakis
- Laboratory of Medical Genetics, School of Medicine, National and Kapodistrian University of Athens, “Agia Sophia” Children’s Hospital, 11527 Athens, Greece; (D.V.); (N.M.M.); (K.K.); (K.K.); (C.S.)
- Research University Institute for the Study of Genetic and Malignant Disease of Childhood, “Agia Sophia” Children’s Hospital, 11527 Athens, Greece
| | - Ioannis Kotsios
- Neonatal Intensive Care Unit, “Hippocration” General Hospital, 54642 Thessaloniki, Greece
| | - Polyxeni Delaporta
- Thalassemia Unit, First Department of Pediatrics, National and Kapodistrian University of Athens, “Agia Sophia” Children’s Hospital, 11527 Athens, Greece;
| | - Kyriaki Kekou
- Laboratory of Medical Genetics, School of Medicine, National and Kapodistrian University of Athens, “Agia Sophia” Children’s Hospital, 11527 Athens, Greece; (D.V.); (N.M.M.); (K.K.); (K.K.); (C.S.)
| | - Konstantina Kosma
- Laboratory of Medical Genetics, School of Medicine, National and Kapodistrian University of Athens, “Agia Sophia” Children’s Hospital, 11527 Athens, Greece; (D.V.); (N.M.M.); (K.K.); (K.K.); (C.S.)
| | - Joanne Traeger-Synodinos
- Laboratory of Medical Genetics, School of Medicine, National and Kapodistrian University of Athens, “Agia Sophia” Children’s Hospital, 11527 Athens, Greece; (D.V.); (N.M.M.); (K.K.); (K.K.); (C.S.)
| | - Christalena Sofocleous
- Laboratory of Medical Genetics, School of Medicine, National and Kapodistrian University of Athens, “Agia Sophia” Children’s Hospital, 11527 Athens, Greece; (D.V.); (N.M.M.); (K.K.); (K.K.); (C.S.)
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Billich N, O'Brien K, Fredwall SO, Lee M, Savarirayan R, Davidson ZE. A scoping review of nutrition issues and management strategies in individuals with skeletal dysplasia. Genet Med 2023; 25:100920. [PMID: 37330695 DOI: 10.1016/j.gim.2023.100920] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2023] [Revised: 06/11/2023] [Accepted: 06/12/2023] [Indexed: 06/19/2023] Open
Abstract
PURPOSE Skeletal dysplasia are heterogeneous conditions affecting the skeleton. Common nutrition issues include feeding difficulties, obesity, and metabolic complications. This systematic scoping review aimed to identify key nutrition issues, management strategies, and gaps in knowledge regarding nutrition in skeletal dysplasia. METHODS The databases Ovid MEDLINE, Ovid EMBASE, Ebsco CINAHL, Scopus, and Cochrane Central Register of Controlled Trials and Database of Systematic Reviews were searched. Reference lists and citing literature for included studies were searched. Eligible studies included participants with skeletal dysplasia and described: anthropometry, body composition, nutrition-related biochemistry, clinical issues, dietary intake, measured energy or nutrition requirements, or nutrition interventions. RESULTS The literature search identified 8509 references from which 138 studies were included (130 observational, 3 intervention, 2 systematic reviews, and 3 clinical guidelines). Across 17 diagnoses identified, most studies described osteogenesis imperfecta (n = 50) and achondroplasia or hypochondroplasia (n = 47). Nutrition-related clinical issues, biochemistry, obesity, and metabolic complications were most commonly reported, and few studies measured energy requirements (n = 5). CONCLUSION Nutrition-related comorbidities are documented in skeletal dysplasia; yet, evidence to guide management is scarce. Evidence describing nutrition in rarer skeletal dysplasia conditions is lacking. Advances in skeletal dysplasia nutrition knowledge is needed to optimize broader health outcomes.
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Affiliation(s)
- Natassja Billich
- Murdoch Children's Research Institute, Parkville, VIC, Australia; The University of Queensland, St Lucia, QLD, Australia.
| | - Katie O'Brien
- Royal Children's Hospital, Parkville, VIC, Australia; Monash University, Clayton, VIC, Australia
| | - Svein O Fredwall
- Murdoch Children's Research Institute, Parkville, VIC, Australia; TRS National Resource Centre for Rare Disorders, Sunnaas Rehabiliation Hospital, Nesodden, Norway
| | | | - Ravi Savarirayan
- Murdoch Children's Research Institute, Parkville, VIC, Australia; University of Melbourne, Parkville, VIC, Australia
| | - Zoe E Davidson
- Murdoch Children's Research Institute, Parkville, VIC, Australia; Monash University, Clayton, VIC, Australia
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Navasardyan LV, Furlan I, Brandt S, Schulz A, Wabitsch M, Denzer C. Spectrum of diabetes mellitus in patients with Shwachman-Diamond syndrome: case report and review of the literature. Ital J Pediatr 2023; 49:98. [PMID: 37580732 PMCID: PMC10424348 DOI: 10.1186/s13052-023-01501-z] [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: 02/21/2023] [Accepted: 07/20/2023] [Indexed: 08/16/2023] Open
Abstract
BACKGROUND Shwachman-Diamond syndrome (SDS) is a rare congenital disorder caused by mutations in the SBDS gene and characterized by exocrine pancreatic deficiency, hematologic dysfunction, and skeletal growth failure. Although the hematologic features and characteristics of the somatic disorders commonly associated with SDS are well known, emerging data from case reports and patient registries suggest that SDS may also be associated with an increased risk of diabetes mellitus. However, currently available data on SDS-associated diabetes are limited and do not allow conclusions regarding prevalence and incidence rates, clinical course, and outcomes. CASE PRESENTATION Here we report the case of a 5-year-old girl with SDS who underwent bone marrow transplantation at the age of 3 months and developed autoantibody-positive type 1 diabetes mellitus at the age of 1.8 years. The manifestation and course of diabetes development were mild, complicated by concurrent spontaneous episodes of hypoglycemia even before the onset of antidiabetic treatment. Currently, adequate metabolic control can be achieved by dietary intervention. CONCLUSIONS Considering that the SBDS protein regulates mitosis and ribosomal biosynthesis and that its suppression may cause immunologic instability and chronic inflammation, this case provides insight into the phenotype of rare Shwachman-Diamond syndrome-associated diabetes mellitus, which may be characterized by significant age-dependent differences in clinical course.
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Affiliation(s)
- Lusine V Navasardyan
- Department of Endocrinology, Arabkir Medical Center, Yerevan State Medical University, Yerevan, Armenia
| | - Ingrid Furlan
- Department of Pediatrics and Adolescent Medicine, University Medical Center Ulm, Ulm, Germany
| | - Stephanie Brandt
- Division of Pediatric Endocrinology and Diabetes, Department of Pediatrics and Adolescent Medicine, University Medical Center Ulm, Eythstr. 24, 89075, Ulm, Germany
| | - Ansgar Schulz
- Department of Pediatrics and Adolescent Medicine, University Medical Center Ulm, Ulm, Germany
| | - Martin Wabitsch
- Division of Pediatric Endocrinology and Diabetes, Department of Pediatrics and Adolescent Medicine, University Medical Center Ulm, Eythstr. 24, 89075, Ulm, Germany
| | - Christian Denzer
- Division of Pediatric Endocrinology and Diabetes, Department of Pediatrics and Adolescent Medicine, University Medical Center Ulm, Eythstr. 24, 89075, Ulm, Germany.
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González MM, Hualpa JCP, Moreno DM, Albarrán OG. A case of type 1 diabetes mellitus in a woman with
Shwachman‐Diamond
syndrome. PRACTICAL DIABETES 2021. [DOI: 10.1002/pdi.2370] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Affiliation(s)
| | | | - Diego Muñoz Moreno
- Endocrinology Service, Gregorio Marañón General University Hospital, Madrid, Spain
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Shimano KA, Narla A, Rose MJ, Gloude NJ, Allen SW, Bergstrom K, Broglie L, Carella BA, Castillo P, Jong JLO, Dror Y, Geddis AE, Huang JN, Lau BW, McGuinn C, Nakano TA, Overholt K, Rothman JA, Sharathkumar A, Shereck E, Vlachos A, Olson TS, Bertuch AA, Wlodarski MW, Shimamura A, Boklan J. Diagnostic work-up for severe aplastic anemia in children: Consensus of the North American Pediatric Aplastic Anemia Consortium. Am J Hematol 2021; 96:1491-1504. [PMID: 34342889 DOI: 10.1002/ajh.26310] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2021] [Revised: 07/26/2021] [Accepted: 07/27/2021] [Indexed: 12/19/2022]
Abstract
The North American Pediatric Aplastic Anemia Consortium (NAPAAC) is a group of pediatric hematologist-oncologists, hematopathologists, and bone marrow transplant physicians from 46 institutions in North America with interest and expertise in aplastic anemia, inherited bone marrow failure syndromes, and myelodysplastic syndromes. The NAPAAC Bone Marrow Failure Diagnosis and Care Guidelines Working Group was established with the charge of harmonizing the approach to the diagnostic workup of aplastic anemia in an effort to standardize best practices in the field. This document outlines the rationale for initial evaluations in pediatric patients presenting with signs and symptoms concerning for severe aplastic anemia.
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Affiliation(s)
- Kristin A. Shimano
- Department of Pediatrics University of California San Francisco Benioff Children's Hospital San Francisco California USA
| | - Anupama Narla
- Department of Pediatrics Stanford University School of Medicine Stanford California USA
| | - Melissa J. Rose
- Division of Hematology, Oncology, and Bone Marrow Transplant Nationwide Children's Hospital, The Ohio State University College of Medicine Columbus Ohio USA
| | - Nicholas J. Gloude
- Department of Pediatrics University of California San Diego, Rady Children's Hospital San Diego California USA
| | - Steven W. Allen
- Pediatric Hematology/Oncology University of Pittsburgh School of Medicine, UPMC Children's Hospital of Pittsburgh Pittsburgh Pennsylvania USA
| | - Katie Bergstrom
- Cancer and Blood Disorders Center Seattle Children's Hospital Seattle Washington USA
| | - Larisa Broglie
- Department of Pediatric Hematology, Oncology, Blood and Marrow Transplantation Medical College of Wisconsin Milwaukee Wisconsin USA
| | - Beth A. Carella
- Department of Pediatrics Kaiser Permanente Washington District of Columbia USA
| | - Paul Castillo
- Division of Pediatric Hematology Oncology UF Health Shands Children's Hospital Gainesville Florida USA
| | - Jill L. O. Jong
- Section of Hematology‐Oncology, Department of Pediatrics University of Chicago Chicago Illinois USA
| | - Yigal Dror
- Marrow Failure and Myelodysplasia Program, Division of Hematology and Oncology, Department of Paediatrics The Hospital for Sick Children Toronto Ontario Canada
| | - Amy E. Geddis
- Cancer and Blood Disorders Center Seattle Children's Hospital Seattle Washington USA
| | - James N. Huang
- Department of Pediatrics University of California San Francisco Benioff Children's Hospital San Francisco California USA
| | - Bonnie W. Lau
- Pediatric Hematology‐Oncology Dartmouth‐Hitchcock Lebanon New Hampshire USA
| | - Catherine McGuinn
- Department of Pediatrics Weill Cornell Medicine New York New York USA
| | - Taizo A. Nakano
- Center for Cancer and Blood Disorders Children's Hospital Colorado Aurora Colorado USA
| | - Kathleen Overholt
- Pediatric Hematology and Oncology Riley Hospital for Children at Indiana University Indianapolis Indiana USA
| | - Jennifer A. Rothman
- Division of Pediatric Hematology and Oncology Duke University Medical Center Durham North Carolina USA
| | - Anjali Sharathkumar
- Stead Family Department of Pediatrics University of Iowa Carver College of Medicine Iowa City Iowa USA
| | - Evan Shereck
- Department of Pediatrics Oregon Health and Science University Portland Oregon USA
| | - Adrianna Vlachos
- Hematology, Oncology and Cellular Therapy Cohen Children's Medical Center New Hyde Park New York USA
| | - Timothy S. Olson
- Cell Therapy and Transplant Section, Division of Oncology and Bone Marrow Failure, Division of Hematology, Department of Pediatrics Children's Hospital of Philadelphia and University of Pennsylvania Philadelphia Pennsylvania USA
| | | | | | - Akiko Shimamura
- Cancer and Blood Disorders Center Boston Children's Hospital and Dana Farber Cancer Institute Boston Massachusetts USA
| | - Jessica Boklan
- Center for Cancer and Blood Disorders Phoenix Children's Hospital Phoenix Arizona USA
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Bogusz-Wójcik A, Kołodziejczyk H, Klaudel-Dreszler M, Oracz G, Pawłowska J, Szalecki M. Somatic development in children with Shwachman-Diamond syndrome. Ital J Pediatr 2020; 46:151. [PMID: 33046118 PMCID: PMC7552354 DOI: 10.1186/s13052-020-00919-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/16/2020] [Accepted: 10/05/2020] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND Shwachman-Diamond syndrome (SDS) is a rare genetic, multi-systemic disease characterized by exocrine pancreatic insufficiency, immune deficiency, bone marrow failure and skeletal abnormalities. Most patients present with failure in somatic development and short stature, but systematic data concerning those features are limited. The aim of the study was to assess the prevalence of failure in somatic development in the children with SDS. METHODS An analysis of anthropometric measurements of 21 patients (14 girls and 7 boys),aged 2 to 17 years (mean age 6.3 years) with SDS diagnosed in The Children's Memorial Health Institute in Warsaw, Poland was performed. The patients were measured using a Holtain Limited stadiometer, an electronic scale, a Harpenden anthropometer, a metric tape and a spreading caliper. The assessed anthropometric parameters were expressed as standard deviation scores in relation to the reference values in Poland, suitable for sex as well as calendar and growth age. RESULTS A total of 66 measurements was collected and analyzed with a median number of 3 observations per patient. The group of boys presented with a significantly lower height (- 3.0 SD, p < 0.0001) and BMI (- 1.4 SD, p < 0.00001), and in the relation to the growth age a lower weight (- 1.0 SD, p < 0.001) as well as a smaller chest width (- 0.9 SD, p < 0.05), hip width (- 0,5 SD, p < 0,05) and lower limb length (- 0,5 SD, p < 0,05). The group of girls also showed significantly lower height (- 2.6 SD, p < 0.00001) and BMI (- 0.8 SD, p < 0.00001), and in relation to the growth age, lower weight (- 0.5 SD, p < 0.001) as well as decreased width of the chest (- 1.7 SD, p < 0.0001) and shoulder (- 1.0 SD, p < 0.001) were observed. Boys and girls were also characterized by significantly decreased circumference and width of head, additionally, girls had also smaller head length. CONCLUSIONS Patients with SDS have abnormal somatic development. Both boys and girls are characterized by short stature, decreased weight, BMI, leg length, chest width as well as circumference and width of head. Anthropometric measurements provide important data on the process of growth and body proportions in children with SDS.
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Affiliation(s)
- Agnieszka Bogusz-Wójcik
- Department of Endocrinology and Diabetology, The Children's Memorial Health Institute, Av. Dzieci Polskich 20, 04-736, Warsaw, Poland.
| | | | - Maja Klaudel-Dreszler
- Department of Gastroenterology, Hepatology, Feeding Disorders and Paediatrics, The Children's Memorial Health Institute, Warsaw, Poland
| | - Grzegorz Oracz
- Department of Gastroenterology, Hepatology, Feeding Disorders and Paediatrics, The Children's Memorial Health Institute, Warsaw, Poland
| | - Joanna Pawłowska
- Department of Gastroenterology, Hepatology, Feeding Disorders and Paediatrics, The Children's Memorial Health Institute, Warsaw, Poland
| | - Mieczysław Szalecki
- Department of Endocrinology and Diabetology, The Children's Memorial Health Institute, Av. Dzieci Polskich 20, 04-736, Warsaw, Poland
- Collegium Medicum, University of Jan Kochanowski, Kielce, Poland
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Long-term outcome after allogeneic hematopoietic stem cell transplantation for Shwachman-Diamond syndrome: a retrospective analysis and a review of the literature by the Severe Aplastic Anemia Working Party of the European Society for Blood and Marrow Transplantation (SAAWP-EBMT). Bone Marrow Transplant 2020; 55:1796-1809. [PMID: 32203264 DOI: 10.1038/s41409-020-0863-z] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2019] [Revised: 03/02/2020] [Accepted: 03/04/2020] [Indexed: 01/01/2023]
Abstract
Allogeneic hematopoietic stem cell transplantation (HSCT) is a curative procedure in patients with Shwachman-Diamond syndrome (SDS) with bone marrow abnormalities. The results of 74 patients with SDS (6 acute myeloid leukemia, 7 myelodysplastic syndrome, and 61 bone marrow failure) treated with HSCT between 1988 and 2016 are reported. The donor source was: 24% sibling, 8% parent, and 68% unrelated donor. The stem cell source was: 70% bone marrow, 19% peripheral blood stem cells, and 11% cord blood. The conditioning regimen was myeloablative in 54% and reduced intensity in 46%. Neutrophil engraftment was achieved in 84% of patients after a median time of 17.5 days. Graft failure occurred in 15% of HSCTs. Grades I-IV acute and chronic GVHD were observed in 55% and 20% of patients, respectively. After a median follow-up of 7.3 years (95% CI 4.8-10.2), 28 patients died for progression/relapse (7) or toxicity (21). The 5-year overall survival and nonrelapse mortality were 63.3% (95% CI 50.8-73.4) and 19.8% (95% CI 10.8-30.8), respectively. In conclusion, this is the largest series so far reported and confirms that HSCT is a suitable option for patients with SDS. Further efforts are needed to lower transplant-related toxicity and reduce graft failure.
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Delaporta P, Sofocleous C, Economou M, Makis A, Kostaridou S, Kattamis A. The Greek Registry of Shwachman Diamond-Syndrome: Molecular and clinical data. Pediatr Blood Cancer 2017; 64. [PMID: 28509441 DOI: 10.1002/pbc.26630] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/21/2016] [Revised: 04/06/2017] [Accepted: 04/10/2017] [Indexed: 01/14/2023]
Abstract
This study presents the clinical phenotype and molecular analysis findings from 11 patients recorded in the Greek Shwachman-Diamond syndrome (SDS) Registry. The most severely affected patient in our registry was diagnosed at birth and is the first patient reported to require bone marrow transplantation so early in life. Severe psoriasis, a feature not previously reported in SDS, was observed in one patient. Mutations in the Shwachman-Bodian-Diamond syndrome gene (SBDS) were found in all patients. Cytogenetic analyses revealed clonal abnormalities, one novel, in two patients.
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Affiliation(s)
- Polyxeni Delaporta
- First Department of Pediatrics, National and Kapodistrian University of Athens, Athens, Greece
| | - Christalena Sofocleous
- Department of Medical Genetics, National and Kapodistrian University of Athens, Athens, Greece.,Research Institute for the Study of Genetic and Malignant Disorders in Childhood, "Aghia Sophia" Children's Hospital, Athens, Greece
| | - Marina Economou
- First Department of Pediatrics, University of Thessaloniki, Greece
| | - Alexandros Makis
- Department of Pediatrics, University Hospital of Ioannina, Greece
| | - Stavroula Kostaridou
- First Department of Pediatrics, National and Kapodistrian University of Athens, Athens, Greece
| | - Antonis Kattamis
- First Department of Pediatrics, National and Kapodistrian University of Athens, Athens, Greece
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Jivani N, Torrado-Jule C, Vaiselbuh S, Romanos-Sirakis E. A unique case of Shwachman-Diamond syndrome presenting with congenital hypopituitarism. J Pediatr Endocrinol Metab 2016; 29:1325-1327. [PMID: 27754968 DOI: 10.1515/jpem-2016-0299] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/26/2016] [Accepted: 09/08/2016] [Indexed: 11/15/2022]
Abstract
Shwachman-Diamond syndrome (SDS) is an autosomal recessive bone marrow failure syndrome typically characterized by neutropenia and pancreatic dysfunction, although phenotypic presentations vary, and the endocrine phenotype is not well-described. We report a unique case of a patient with SDS who initially presented with hypoglycemia and micropenis in the newborn period and was diagnosed with congenital hypopituitarism. We are not aware of any other cases of SDS documented with this combination of complex endocrinopathies.
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10
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Raman S, Grimberg A, Waguespack SG, Miller BS, Sklar CA, Meacham LR, Patterson BC. Risk of Neoplasia in Pediatric Patients Receiving Growth Hormone Therapy--A Report From the Pediatric Endocrine Society Drug and Therapeutics Committee. J Clin Endocrinol Metab 2015; 100:2192-203. [PMID: 25839904 PMCID: PMC5393518 DOI: 10.1210/jc.2015-1002] [Citation(s) in RCA: 70] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
CONTEXT GH and IGF-1 have been shown to affect tumor growth in vitro and in some animal models. This report summarizes the available evidence on whether GH therapy in childhood is associated with an increased risk of neoplasia during treatment or after treatment is completed. EVIDENCE ACQUISITION A PubMed search conducted through February 2014 retrieved original articles written in English addressing GH therapy and neoplasia risk. Subsequent searches were done to include additional relevant publications. EVIDENCE SYNTHESIS In children without prior cancer or known risk factors for developing cancer, the clinical evidence does not affirm an association between GH therapy during childhood and neoplasia. GH therapy has not been reported to increase the risk for neoplasia in this population, although most of these data are derived from postmarketing surveillance studies lacking rigorous controls. In patients who are at higher risk for developing cancer, current evidence is insufficient to conclude whether or not GH further increases cancer risk. GH treatment of pediatric cancer survivors does not appear to increase the risk of recurrence but may increase their risk for subsequent primary neoplasms. CONCLUSIONS In children without known risk factors for malignancy, GH therapy can be safely administered without concerns about an increased risk for neoplasia. GH use in children with medical diagnoses predisposing them to the development of malignancies should be critically analyzed on an individual basis, and if chosen, appropriate surveillance for malignancies should be undertaken. GH can be used to treat GH-deficient childhood cancer survivors who are in remission with the understanding that GH therapy may increase their risk for second neoplasms.
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Affiliation(s)
- Sripriya Raman
- Division of Pediatric Endocrinology (S.R.), Children's Mercy Hospital, University of Missouri, Kansas City, Missouri 64111; University of Kansas Medical Center (S.R.), Kansas City, Kansas 66160; Department of Pediatrics (A.G.), Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania 19104; Division of Endocrinology and Diabetes (A.G.), The Children's Hospital of Philadelphia, Philadelphia, Pennsylvania 19104; Department of Endocrine Neoplasia and Hormonal Disorders (S.G.W.), University of Texas MD Anderson Cancer Center, Houston, Texas 77030; Division of Endocrinology (B.S.M.), Department of Pediatrics, University of Minnesota Masonic Children's Hospital, Minneapolis, Minnesota 55455; Memorial Sloan Kettering Cancer Center (C.A.S.), New York, New York 10065; and Emory University/Aflac Cancer and Blood Disorders Center of Children's Healthcare of Atlanta (L.R.M., B.C.P.), Atlanta, Georgia 30322
| | - Adda Grimberg
- Division of Pediatric Endocrinology (S.R.), Children's Mercy Hospital, University of Missouri, Kansas City, Missouri 64111; University of Kansas Medical Center (S.R.), Kansas City, Kansas 66160; Department of Pediatrics (A.G.), Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania 19104; Division of Endocrinology and Diabetes (A.G.), The Children's Hospital of Philadelphia, Philadelphia, Pennsylvania 19104; Department of Endocrine Neoplasia and Hormonal Disorders (S.G.W.), University of Texas MD Anderson Cancer Center, Houston, Texas 77030; Division of Endocrinology (B.S.M.), Department of Pediatrics, University of Minnesota Masonic Children's Hospital, Minneapolis, Minnesota 55455; Memorial Sloan Kettering Cancer Center (C.A.S.), New York, New York 10065; and Emory University/Aflac Cancer and Blood Disorders Center of Children's Healthcare of Atlanta (L.R.M., B.C.P.), Atlanta, Georgia 30322
| | - Steven G Waguespack
- Division of Pediatric Endocrinology (S.R.), Children's Mercy Hospital, University of Missouri, Kansas City, Missouri 64111; University of Kansas Medical Center (S.R.), Kansas City, Kansas 66160; Department of Pediatrics (A.G.), Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania 19104; Division of Endocrinology and Diabetes (A.G.), The Children's Hospital of Philadelphia, Philadelphia, Pennsylvania 19104; Department of Endocrine Neoplasia and Hormonal Disorders (S.G.W.), University of Texas MD Anderson Cancer Center, Houston, Texas 77030; Division of Endocrinology (B.S.M.), Department of Pediatrics, University of Minnesota Masonic Children's Hospital, Minneapolis, Minnesota 55455; Memorial Sloan Kettering Cancer Center (C.A.S.), New York, New York 10065; and Emory University/Aflac Cancer and Blood Disorders Center of Children's Healthcare of Atlanta (L.R.M., B.C.P.), Atlanta, Georgia 30322
| | - Bradley S Miller
- Division of Pediatric Endocrinology (S.R.), Children's Mercy Hospital, University of Missouri, Kansas City, Missouri 64111; University of Kansas Medical Center (S.R.), Kansas City, Kansas 66160; Department of Pediatrics (A.G.), Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania 19104; Division of Endocrinology and Diabetes (A.G.), The Children's Hospital of Philadelphia, Philadelphia, Pennsylvania 19104; Department of Endocrine Neoplasia and Hormonal Disorders (S.G.W.), University of Texas MD Anderson Cancer Center, Houston, Texas 77030; Division of Endocrinology (B.S.M.), Department of Pediatrics, University of Minnesota Masonic Children's Hospital, Minneapolis, Minnesota 55455; Memorial Sloan Kettering Cancer Center (C.A.S.), New York, New York 10065; and Emory University/Aflac Cancer and Blood Disorders Center of Children's Healthcare of Atlanta (L.R.M., B.C.P.), Atlanta, Georgia 30322
| | - Charles A Sklar
- Division of Pediatric Endocrinology (S.R.), Children's Mercy Hospital, University of Missouri, Kansas City, Missouri 64111; University of Kansas Medical Center (S.R.), Kansas City, Kansas 66160; Department of Pediatrics (A.G.), Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania 19104; Division of Endocrinology and Diabetes (A.G.), The Children's Hospital of Philadelphia, Philadelphia, Pennsylvania 19104; Department of Endocrine Neoplasia and Hormonal Disorders (S.G.W.), University of Texas MD Anderson Cancer Center, Houston, Texas 77030; Division of Endocrinology (B.S.M.), Department of Pediatrics, University of Minnesota Masonic Children's Hospital, Minneapolis, Minnesota 55455; Memorial Sloan Kettering Cancer Center (C.A.S.), New York, New York 10065; and Emory University/Aflac Cancer and Blood Disorders Center of Children's Healthcare of Atlanta (L.R.M., B.C.P.), Atlanta, Georgia 30322
| | - Lillian R Meacham
- Division of Pediatric Endocrinology (S.R.), Children's Mercy Hospital, University of Missouri, Kansas City, Missouri 64111; University of Kansas Medical Center (S.R.), Kansas City, Kansas 66160; Department of Pediatrics (A.G.), Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania 19104; Division of Endocrinology and Diabetes (A.G.), The Children's Hospital of Philadelphia, Philadelphia, Pennsylvania 19104; Department of Endocrine Neoplasia and Hormonal Disorders (S.G.W.), University of Texas MD Anderson Cancer Center, Houston, Texas 77030; Division of Endocrinology (B.S.M.), Department of Pediatrics, University of Minnesota Masonic Children's Hospital, Minneapolis, Minnesota 55455; Memorial Sloan Kettering Cancer Center (C.A.S.), New York, New York 10065; and Emory University/Aflac Cancer and Blood Disorders Center of Children's Healthcare of Atlanta (L.R.M., B.C.P.), Atlanta, Georgia 30322
| | - Briana C Patterson
- Division of Pediatric Endocrinology (S.R.), Children's Mercy Hospital, University of Missouri, Kansas City, Missouri 64111; University of Kansas Medical Center (S.R.), Kansas City, Kansas 66160; Department of Pediatrics (A.G.), Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania 19104; Division of Endocrinology and Diabetes (A.G.), The Children's Hospital of Philadelphia, Philadelphia, Pennsylvania 19104; Department of Endocrine Neoplasia and Hormonal Disorders (S.G.W.), University of Texas MD Anderson Cancer Center, Houston, Texas 77030; Division of Endocrinology (B.S.M.), Department of Pediatrics, University of Minnesota Masonic Children's Hospital, Minneapolis, Minnesota 55455; Memorial Sloan Kettering Cancer Center (C.A.S.), New York, New York 10065; and Emory University/Aflac Cancer and Blood Disorders Center of Children's Healthcare of Atlanta (L.R.M., B.C.P.), Atlanta, Georgia 30322
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Terlizzi V, Zito E, Mozzillo E, Raia V, Franzese A. Can continuous subcutaneous insulin infusion improve health-related quality of life in patients with Shwachman-Bodian-Diamond syndrome and diabetes? Diabetes Technol Ther 2015; 17:64-7. [PMID: 25269020 DOI: 10.1089/dia.2014.0184] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
We report the first case of the use of continuous subcutaneous insulin infusion (CSII) in a patient with Shwachman-Bodian-Diamond syndrome (SBDS) and diabetes. An Italian boy received diagnosis of SBDS at the age of 7 months (SBDS gene mutation: c.183-184TA → CT and c.258 + 2 T → C in compound heterozygous). The patient presented an impaired psychosocial functioning with difficulties in mental health, body pain experiences, attention deficit disorder, somatic complaints, behavioral and social problems. Total Intelligence Quotient (T-IQ) was within the normal range for age (T-IQ = 109). The patient developed clinical diabetes at the age of 13 years (glycemia 282 mg/dL at 120 min of oral glucose tolerance test, glycosylated hemoglobin level of 7.5%, anti-β-cell antibodies negative; glucagon test yielding a C peptide level at zero-time of 1.5 ng/mL and at 6 min of 2.0 ng/mL). Multiple daily injection therapy with insulin was started. Nevertheless, because of a relevant needle phobia and the recurrent hypoglycemia due to poor nutrition secondary to depression, after 3 years the patient started CSII. After 12 months a new evaluation showed (1) better social adaptation, (2) meliorated self-esteem and self-efficacy, (3) reduced psychosocial suffering, and (4) improved health-related quality of life, assessed by the Pediatric Quality of Life Inventory version 3.0 Diabetes Module. Thus CSII seems to be crucial to improve health-related quality of life in patients affected by diabetes and genetic disorders.
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Affiliation(s)
- Vito Terlizzi
- Department of Traslational Medical Sciences, Federico II University of Naples , Naples, Italy
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