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Cuda S. Special considerations for the child with obesity: An Obesity Medicine Association (OMA) clinical practice statement (CPS) 2024. OBESITY PILLARS 2024; 11:100113. [PMID: 38953014 PMCID: PMC11216014 DOI: 10.1016/j.obpill.2024.100113] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/16/2024] [Revised: 05/21/2024] [Accepted: 05/22/2024] [Indexed: 07/03/2024]
Abstract
Background This Obesity Medicine Association (OMA) Clinical Practice Statement (CPS) details assessment and management of the child with overweight or obesity. The term "child" is defined as the child between 2 and 12 years of age. Because children are in a continual state of development during this age range, we will specify when our discussion applies to subsets within this age range. For the purposes of this CPS, we will use the following definitions: overweight in the child is a body mass index (BMI) ≥ 85th and <95th percentile, obesity in the child is a BMI ≥95th percentile, and severe obesity is a BMI ≥120% of the 95th percentile. Methods The information and clinical guidance in this OMA Clinical Practice Statement are based on scientific evidence, supported by medical literature, and derived from the clinical perspectives of the authors. Results This OMA Clinical Practice Statement provides an overview of prevalence of disease in this population, reviews precocious puberty in the child with obesity, discusses the current and evolving landscape of the use of anti-obesity medications in children in this age range, discusses the child with obesity and special health care needs, and reviews hypothalamic obesity in the child. Conclusions This OMA Clinical Practice Statement on the child with obesity is an evidence based review of the literature and an overview of current recommendations. This CPS is intended to provide a roadmap to the improvement of the health of children with obesity, especially those with metabolic, physiological, psychological complications and/or special healthcare needs. This CPS addresses treatment recommendations and is designed to help the clinician with clinical decision making.
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Affiliation(s)
- Suzanne Cuda
- Alamo City Healthy Kids and Families, 1919 Oakwell Farms Parkway, Ste 145, San Antonio, TX, 78218, USA
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Tocan V, Nakamura-Utsunomiya A, Sonoda Y, Matsuoka W, Mizuguchi S, Muto Y, Hijioka T, Nogami M, Sasaoka D, Nagamatsu F, Oba U, Kawakubo N, Hamada H, Mushimoto Y, Chong PF, Kaku N, Koga Y, Sakai Y, Oda Y, Tajiri T, Ohga S. High-Titer Anti-ZSCAN1 Antibodies in a Toddler Clinically Diagnosed with Apparent Rapid-Onset Obesity with Hypothalamic Dysfunction, Hypoventilation, and Autonomic Dysregulation Syndrome. Int J Mol Sci 2024; 25:2820. [PMID: 38474067 DOI: 10.3390/ijms25052820] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2023] [Revised: 02/24/2024] [Accepted: 02/25/2024] [Indexed: 03/14/2024] Open
Abstract
Severe obesity in young children prompts for a differential diagnosis that includes syndromic conditions. Rapid-Onset Obesity with Hypothalamic Dysfunction, Hypoventilation, and Autonomic Dysregulation (ROHHAD) syndrome is a potentially fatal disorder characterized by rapid-onset obesity associated with hypoventilation, neural crest tumors, and endocrine and behavioral abnormalities. The etiology of ROHHAD syndrome remains to be established, but recent research has been focusing on autoimmunity. We report on a 2-year-old girl with rapid-onset obesity during the first year of life who progressed to hypoventilation and encephalitis in less than four months since the start of accelerated weight gain. The patient had a high titer of anti-ZSCAN1 antibodies (348; reference range < 40), and the increased values did not decline after acute phase treatment. Other encephalitis-related antibodies, such as the anti-NDMA antibody, were not detected. The rapid progression from obesity onset to central hypoventilation with encephalitis warns about the severe consequences of early-onset ROHHAD syndrome. These data indicate that serial measurements of anti-ZSCAN1 antibodies might be useful for the diagnosis and estimation of disease severity. Further research is needed to determine whether it can predict the clinical course of ROHHAD syndrome and whether there is any difference in antibody production between patients with and without tumors.
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Affiliation(s)
- Vlad Tocan
- Department of Pediatrics, Graduate School of Medical Sciences, Kyushu University, Fukuoka 812-8582, Japan
| | - Akari Nakamura-Utsunomiya
- Department of Genetic Medicine/Pediatrics, Graduate School of Biomedical and Health Sciences, Hiroshima University, Hiroshima 734-8511, Japan
- Department of Pediatrics, Hiroshima City North Medical Center Asa Citizens Hospital, Hiroshima 731-0293, Japan
- Division of Neonatal Screening, National Center for Child Health and Development, Tokyo 157-8535, Japan
| | - Yuri Sonoda
- Department of Pediatrics, Graduate School of Medical Sciences, Kyushu University, Fukuoka 812-8582, Japan
| | - Wakato Matsuoka
- Department of Pediatrics, Graduate School of Medical Sciences, Kyushu University, Fukuoka 812-8582, Japan
- Emergency and Critical Care Center, Kyushu University Hospital, Fukuoka 812-8582, Japan
| | - Soichi Mizuguchi
- Department of Pediatrics, Graduate School of Medical Sciences, Kyushu University, Fukuoka 812-8582, Japan
- Emergency and Critical Care Center, Kyushu University Hospital, Fukuoka 812-8582, Japan
| | - Yuichiro Muto
- Department of Pediatrics, Japanese Red Cross Kumamoto Hospital, Kumamoto 861-8520, Japan
| | - Takaaki Hijioka
- Department of Pediatrics, Japanese Red Cross Kumamoto Hospital, Kumamoto 861-8520, Japan
- Department of Pediatrics, Graduate School of Medical Sciences, Kumamoto University, Kumamoto 860-8556, Japan
| | - Masao Nogami
- Department of Pediatrics, Japanese Red Cross Kumamoto Hospital, Kumamoto 861-8520, Japan
| | - Daiki Sasaoka
- Department of Pediatrics, Graduate School of Medical Sciences, Kumamoto University, Kumamoto 860-8556, Japan
| | - Fusa Nagamatsu
- Department of Pediatrics, Graduate School of Medical Sciences, Kumamoto University, Kumamoto 860-8556, Japan
| | - Utako Oba
- Department of Pediatrics, Graduate School of Medical Sciences, Kyushu University, Fukuoka 812-8582, Japan
| | - Naonori Kawakubo
- Department of Pediatric Surgery, Graduate School of Medical Sciences, Kyushu University, Fukuoka 812-8582, Japan
| | - Hiroshi Hamada
- Department of Pediatric Surgery, Graduate School of Medical Sciences, Kyushu University, Fukuoka 812-8582, Japan
- Department of Anatomic Pathology, Graduate School of Medical Sciences, Kyushu University, Fukuoka 812-8582, Japan
| | - Yuichi Mushimoto
- Department of Pediatrics, Graduate School of Medical Sciences, Kyushu University, Fukuoka 812-8582, Japan
| | - Pin Fee Chong
- Department of Pediatrics, Graduate School of Medical Sciences, Kyushu University, Fukuoka 812-8582, Japan
| | - Noriyuki Kaku
- Department of Pediatrics, Graduate School of Medical Sciences, Kyushu University, Fukuoka 812-8582, Japan
- Emergency and Critical Care Center, Kyushu University Hospital, Fukuoka 812-8582, Japan
| | - Yuhki Koga
- Department of Pediatrics, Graduate School of Medical Sciences, Kyushu University, Fukuoka 812-8582, Japan
| | - Yasunari Sakai
- Department of Pediatrics, Graduate School of Medical Sciences, Kyushu University, Fukuoka 812-8582, Japan
| | - Yoshinao Oda
- Department of Anatomic Pathology, Graduate School of Medical Sciences, Kyushu University, Fukuoka 812-8582, Japan
| | - Tatsuro Tajiri
- Department of Pediatric Surgery, Graduate School of Medical Sciences, Kyushu University, Fukuoka 812-8582, Japan
| | - Shouichi Ohga
- Department of Pediatrics, Graduate School of Medical Sciences, Kyushu University, Fukuoka 812-8582, Japan
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3
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Nakamura-Utsunomiya A, Yamaguchi K, Goshima N. Anti-ZSCAN1 Autoantibodies Are a Feasible Diagnostic Marker for ROHHAD Syndrome Not Associated with a Tumor. Int J Mol Sci 2024; 25:1794. [PMID: 38339072 PMCID: PMC10855538 DOI: 10.3390/ijms25031794] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2023] [Revised: 01/28/2024] [Accepted: 01/30/2024] [Indexed: 02/12/2024] Open
Abstract
Recent studies have reported the presence of autoantibodies against zinc finger and SCAN domain-containing protein 1 (ZSCAN1) in the sera of patients with rapid-onset obesity with hypoventilation, hypothalamic and autonomic dysregulation (ROHHAD) syndrome associated with neuroendocrine tumors, suggesting immunologic and paraneoplastic processes as the pathologic underpinnings. Moreover, several hypothalamic regions, including the subfornical organ (SFO), were reported to exhibit antibody reactivity in a patient with ROHHAD syndrome not associated with a tumor. Whether ROHHAD syndrome not associated with a tumor is associated with anti-ZSCAN1 autoantibodies remains unclear. We used a comprehensive protein array analysis to identify candidate molecules in the sera of patients with ROHHAD syndrome and identified ZSCAN1 as a target antigen. We also found that ZSCAN1 was co-expressed at the site of antibody reactivity to the IgG in the patient serum observed in mouse SFOs and an enzyme-linked immunosorbent assay showed that >85% of the patients with ROHHAD syndrome were positive for anti-ZSCAN1 autoantibodies. These results suggest anti-ZSCAN1 autoantibodies as a feasible diagnostic marker in ROHHAD syndrome regardless of the presence of a tumor.
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Affiliation(s)
- Akari Nakamura-Utsunomiya
- Department of Pediatrics/Medical Genetics, Graduate School of Biomedical and Health Sciences, Hiroshima University, Hiroshima 734-8551, Japan
- Department of Pediatrics, Hiroshima Medical Center, Asa Citizens Hospital, Hiroshima 731-0293, Japan
- Division of Neonatal Screening, National Center for Child Health and Development, Tokyo 157-8535, Japan
| | - Kei Yamaguchi
- Molecular Profiling Research Center for Drug Discovery, National Institute of Advanced Industrial Science and Technology, Tokyo 135-0064, Japan
- ProteoBridge Corporation, Tokyo 135-0064, Japan
| | - Naoki Goshima
- Molecular Profiling Research Center for Drug Discovery, National Institute of Advanced Industrial Science and Technology, Tokyo 135-0064, Japan
- ProteoBridge Corporation, Tokyo 135-0064, Japan
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Concepción-Zavaleta MJ, Quiroz-Aldave JE, Durand-Vásquez MDC, Gamarra-Osorio ER, Valencia de la Cruz JDC, Barrueto-Callirgos CM, Puelles-León SL, Alvarado-León EDJ, Leiva-Cabrera F, Zavaleta-Gutiérrez FE, Concepción-Urteaga LA, Paz-Ibarra J. A comprehensive review of genetic causes of obesity. World J Pediatr 2024; 20:26-39. [PMID: 37725322 DOI: 10.1007/s12519-023-00757-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/24/2023] [Accepted: 08/16/2023] [Indexed: 09/21/2023]
Abstract
BACKGROUND Obesity is a multifactorial chronic disease with a high, increasing worldwide prevalence. Genetic causes account for 7% of the cases in children with extreme obesity. DATA SOURCES This narrative review was conducted by searching for papers published in the PubMed/MEDLINE, Embase and SciELO databases and included 161 articles. The search used the following search terms: "obesity", "obesity and genetics", "leptin", "Prader-Willi syndrome", and "melanocortins". The types of studies included were systematic reviews, clinical trials, prospective cohort studies, cross-sectional and prospective studies, narrative reviews, and case reports. RESULTS The leptin-melanocortin pathway is primarily responsible for the regulation of appetite and body weight. However, several important aspects of the pathophysiology of obesity remain unknown. Genetic causes of obesity can be grouped into syndromic, monogenic, and polygenic causes and should be assessed in children with extreme obesity before the age of 5 years, hyperphagia, or a family history of extreme obesity. A microarray study, an analysis of the melanocortin type 4 receptor gene mutations and leptin levels should be performed for this purpose. There are three therapeutic levels: lifestyle modifications, pharmacological treatment, and bariatric surgery. CONCLUSIONS Genetic study technologies are in constant development; however, we are still far from having a personalized approach to genetic causes of obesity. A significant proportion of the affected individuals are associated with genetic causes; however, there are still barriers to its approach, as it continues to be underdiagnosed. Video Abstract (MP4 1041807 KB).
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Affiliation(s)
| | | | | | | | | | | | | | | | | | | | | | - José Paz-Ibarra
- Department of Medicine, School of Medicine, Universidad Nacional Mayor de San Marcos, Lima, Peru
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Roby P, Smith Beltran G, Finch C, Malhotra S, Reiling K, Dayyat E, Birkemeier K, Raju M, Macmurdo C, Hernandez E, Sagar M. The Perfect Storm: A Case of Rapid-Onset Obesity With Hypoventilation, Hypothalamic, Autonomic Dysregulation, Neuroendocrine Tumor (ROHHADNET) With Heart Failure, Narcolepsy, and a Rare Location of a Pelvic Neuroendocrine Tumor. Cureus 2023; 15:e50341. [PMID: 38205461 PMCID: PMC10777333 DOI: 10.7759/cureus.50341] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/08/2023] [Indexed: 01/12/2024] Open
Abstract
Rapid-onset obesity with hypothalamic dysfunction, hypoventilation, and autonomic dysregulation (ROHHAD) syndrome is a rare disease of concurrent respiratory dysfunction and autonomic dysregulation with endocrine abnormalities. ROHHADNET includes ROHHAD plus coexisting neuroendocrine tumors (NETs). We describe an eight-year-old boy, who originally presented at four years of age with rapid weight gain and hyperhidrosis and who developed mild obstructive sleep apnea (OSA). His clinical course was eventually complicated by hypoxic respiratory failure requiring admission to the pediatric intensive care unit (PICU). Echocardiogram at that time demonstrated dilated cardiomyopathy left ventricular ejection fraction (LVEF) of 28% at time of admission. His respiratory failure persisted despite average volume-assured pressure support (AVAPS) around the clock leading to tracheostomy placement for cardiopulmonary support. He also demonstrated autonomic instability with multiple pituitary hormone deficiencies. Computed tomography (CT) imaging of the abdomen and pelvis demonstrated a presacral soft tissue mass consistent with a tumor of neural crest origin. Daytime somnolence and confusion progressed and a low cerebrospinal fluid hypocretin level revealed a diagnosis of narcolepsy type 1.
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Affiliation(s)
- Paul Roby
- Internal Medicine, Baylor Scott & White Health, Temple, USA
| | | | - Casey Finch
- Pediatrics, Baylor Scott & White Health, Temple, USA
| | | | | | - Ehab Dayyat
- Pediatric Neurology, Baylor Scott & White Health, Temple, USA
| | | | - Muppala Raju
- Neonatology, Baylor Scott & White Health, Temple, USA
| | | | | | - Malvika Sagar
- Pediatric Pulmonary, Baylor Scott & White Health, Temple, USA
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Grossi A, Rusmini M, Cusano R, Massidda M, Santamaria G, Napoli F, Angelelli A, Fava D, Uva P, Ceccherini I, Maghnie M. Whole genome sequencing in ROHHAD trios proved inconclusive: what's beyond? Front Genet 2023; 14:1031074. [PMID: 37609037 PMCID: PMC10440434 DOI: 10.3389/fgene.2023.1031074] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2022] [Accepted: 07/27/2023] [Indexed: 08/24/2023] Open
Abstract
Rapid-onset Obesity with Hypothalamic dysfunction, Hypoventilation and Autonomic Dysregulation (ROHHAD) is a rare, life-threatening, pediatric disorder of unknown etiology, whose diagnosis is made difficult by poor knowledge of clinical manifestation, and lack of any confirmatory tests. Children with ROHHAD usually present with rapid onset weight gain which may be followed, over months or years, by hypothalamic dysfunction, hypoventilation, autonomic dysfunction, including impaired bowel motility, and tumors of neural crest origin. Despite the lack of evidence of inheritance in ROHHAD, several studies have been conducted in recent years that have explored possible genetic origins, with unsuccessful results. In order to broaden the search for possible genetic risk factors, an attempt was made to analyse the non-coding variants in two trios (proband with parents), recruited in the Gaslini Children's Hospital in Genoa (Italy). Both patients were females, with a typical history of ROHHAD. Gene variants (single nucleotide variants, short insertions/deletions, splice variants or in tandem expansion of homopolymeric tracts) or altered genomic regions (copy number variations or structural variants) shared between the two probands were searched. Currently, we have not found any potentially pathogenic changes, consistent with the ROHHAD clinical phenotype, and involving genes, regions or pathways shared between the two trios. To definitively rule out the genetic etiology, third-generation sequencing technologies (e.g., long-reads sequencing, optical mapping) should be applied, as well as other pathways, including those associated with immunological and autoimmune disorders, should be explored, making use not only of genomics but also of different -omic datasets.
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Affiliation(s)
- A. Grossi
- Laboratory of Genetics and Genomics of Rare Diseases, IRCCS Istituto Giannina Gaslini, Genova, Italy
| | - M. Rusmini
- Laboratory of Genetics and Genomics of Rare Diseases, IRCCS Istituto Giannina Gaslini, Genova, Italy
- Clinical Bioinformatics, IRCCS Istituto Giannina Gaslini, Genova, Italy
| | - R. Cusano
- CRS4, Science and Technology Park Polaris, Pula, Italy
| | - M. Massidda
- CRS4, Science and Technology Park Polaris, Pula, Italy
| | - G. Santamaria
- Laboratory of Genetics and Genomics of Rare Diseases, IRCCS Istituto Giannina Gaslini, Genova, Italy
| | - F. Napoli
- Pediatric Clinic and Endocrinology, IRCCS Istituto Giannina Gaslini, Genova, Italy
| | - A. Angelelli
- D.I.N.O.G.M.I, Università degli Studi di Genova, Genova, Italy
| | - D. Fava
- D.I.N.O.G.M.I, Università degli Studi di Genova, Genova, Italy
| | - P. Uva
- Clinical Bioinformatics, IRCCS Istituto Giannina Gaslini, Genova, Italy
| | - I. Ceccherini
- Laboratory of Genetics and Genomics of Rare Diseases, IRCCS Istituto Giannina Gaslini, Genova, Italy
| | - M. Maghnie
- Pediatric Clinic and Endocrinology, IRCCS Istituto Giannina Gaslini, Genova, Italy
- D.I.N.O.G.M.I, Università degli Studi di Genova, Genova, Italy
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Aldirawi M, Yavuz L, Ghoweba Y, Mohamedali S, Chencheri N, Thalange N. Rapid-Onset Obesity With Hypothalamic Dysfunction, Hypoventilation, Autonomic Dysregulation, and Neuroendocrine Tumor (ROHHADNET) Syndrome: A Case Report. Cureus 2023; 15:e41413. [PMID: 37546061 PMCID: PMC10403153 DOI: 10.7759/cureus.41413] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/04/2023] [Indexed: 08/08/2023] Open
Abstract
Here, we report the case of a rare and complex disorder, rapid-onset obesity with hypothalamic dysfunction, hypoventilation, autonomic dysregulation, and neuroendocrine tumor (ROHHADNET) syndrome, in a three-year-old girl with no significant medical history. This is the first such case reported from the UAE. ROHHADNET is a rare disorder of respiratory control and autonomic nervous system regulation with endocrine abnormalities. It typically presents in children older than 18 months with rapid weight gain. This is a challenging diagnosis as there is no clear diagnostic test, and treatment is essentially supportive. This report describes a case of ROHHADNET syndrome in a previously well child who presented with rapid weight gain followed by ophthalmoplegia, dysphagia, electrolyte disturbance, and other comorbidities. The paper outlines in detail the clinical course, investigations, and management of ROHHADNET syndrome. Cerebrospinal fluid analysis revealed oligoclonal bands, which have been reported in only two other cases of ROHHADNET syndrome. Our goal in reporting this case is to increase awareness of this condition among clinicians to facilitate early diagnosis and timely management.
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Affiliation(s)
| | - Lemis Yavuz
- Pediatrics, Al Jalila Children's Specialty Hospital, Dubai, ARE
| | - Yousra Ghoweba
- Pediatrics, Al Jalila Children's Specialty Hospital, Dubai, ARE
| | | | - Nidheesh Chencheri
- Pediatric Neurology, Al Jalila Children's Specialty Hospital, Dubai, ARE
| | - Nandu Thalange
- Medicine, Mohammed Bin Rashid University, Dubai, ARE
- Endocrinology, Al Jalila Children's Specialty Hospital, Dubai, ARE
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Biernacka KM, Giri D, Hawton K, Segers F, Perks CM, Hamilton-Shield JP. Case report: Molecular characterisation of adipose-tissue derived cells from a patient with ROHHAD syndrome. Front Pediatr 2023; 11:1128216. [PMID: 37456561 PMCID: PMC10348915 DOI: 10.3389/fped.2023.1128216] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/20/2022] [Accepted: 06/07/2023] [Indexed: 07/18/2023] Open
Abstract
There have been over 100 cases of Rapid-onset obesity with hypothalamic dysfunction, hypoventilation, and autonomic dysregulation (ROHHAD) syndrome reported, but there is currently no curative treatment for children with this condition. We aimed to better characterise adipose cells from a child with ROHHAD syndrome. We isolated pre-adipocytes from a 4 year-old female patient with ROHHAD syndrome and assessed proliferation rate of these cells. We evaluated levels of DLP-Pref-1(pre-adipocyte marker) using western blotting, and concentrations of interleukin-6(IL-6) using ELISA. We performed next-generation sequencing (NGS) and bioinformatic analyses on these cells compared to tissue from an age/sex-matched control. The two most up-/down-regulated genes were validated using QPCR. We successfully isolated pre-adipocytes from a fat biopsy, by confirming the presence of Pref-1 and differentiated them to mature adipocytes. Interleukin 6, (Il-6) levels were 5.6-fold higher in ROHHAD cells compared to a control age/sex-matched biopsy. NGS revealed 25,703 differentially expressed genes (DEGs) from ROHHAD cells vs. control of which 2,237 genes were significantly altered. The 20 most significantly up/down-regulated genes were selected for discussion. This paper describes the first transcriptomic analysis of adipose cells from a child with ROHHAD vs. normal control adipose tissue as a first step in identifying targetable pathways/mechanisms underlying this condition with novel therapeutic interventions.
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Affiliation(s)
- Kalina M. Biernacka
- Cancer Endocrinology Group, Bristol Medical School, Translational Health Sciences, Southmead Hospital, Bristol, United Kingdom
| | - Dinesh Giri
- Department of Paediatric Endocrinology and Diabetes, Bristol Royal Hospital for Children, Bristol, United Kingdom
| | - Katherine Hawton
- Department of Paediatric Endocrinology and Diabetes, Bristol Royal Hospital for Children, Bristol, United Kingdom
| | - Francisca Segers
- School of Biological Sciences, University of Bristol, Bristol, United Kingdom
| | - Claire M. Perks
- Cancer Endocrinology Group, Bristol Medical School, Translational Health Sciences, Southmead Hospital, Bristol, United Kingdom
| | - Julian P. Hamilton-Shield
- Department of Translational Health Sciences, Nutrition Theme, NIHR Bristol Biomedical Research Centre, Bristol Medical School, University of Bristol, UBHT Education Centre, Bristol, United Kingdom
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Zelko FA, Welbel RZ, Rand CM, Stewart T, Fadl-Alla A, Khaytin I, Slattery SM, Weese-Mayer DE. Neurocognition as a biomarker in the rare autonomic disorders of CCHS and ROHHAD. Clin Auton Res 2023; 33:217-230. [PMID: 36289132 DOI: 10.1007/s10286-022-00901-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2022] [Accepted: 09/26/2022] [Indexed: 11/03/2022]
Abstract
PURPOSE Congenital central hypoventilation syndrome (CCHS) and rapid-onset obesity with hypothalamic dysfunction, hypoventilation, and autonomic dysregulation (ROHHAD) are rare disorders of autonomic regulation with risk for disrupted neurocognitive development. Our aim is to summarize research on neurocognitive outcomes in these conditions, advance understanding of how to best support these individuals throughout development, and facilitate future research. METHODS We conducted a narrative review of literature on neurocognitive outcomes in CCHS and ROHHAD, supplemented with previously unpublished data from patients with CCHS and ROHHAD at our Center for Autonomic Medicine in Pediatrics (CAMP). RESULTS Individuals with CCHS and ROHHAD experience a wide range of neurocognitive functioning ranging from above average to below average, but are at particular risk for difficulties with working memory, processing speed, perceptual reasoning, and visuographic skills. An assessment framework emphasizing fluid cognition seems especially appropriate for these conditions. Owing to small cohorts and varied methods of data collection, it has been difficult to identify associations between disease factors (including CCHS PHOX2B genotypes) and cognitive outcomes. However, results suggest that early childhood is a period of particular vulnerability, perhaps due to the disruptive impact of recurrent intermittent hypoxic episodes on brain and cognitive development. CONCLUSION Neurocognitive monitoring is recommended as a component of routine clinical care in CCHS and ROHHAD as a marker of disease status and to ensure that educational support and disability accommodations are provided as early as possible. Collaborative efforts will be essential to obtain samples needed to enhance our understanding of neurocognitive outcomes in CCHS and ROHHAD.
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Affiliation(s)
- Frank A Zelko
- Pritzker Department of Psychiatry and Behavioral Health, Ann & Robert H. Lurie Children's Hospital of Chicago, Box 10B, 225 East Chicago, Chicago, IL, 60611, USA.
- Northwestern University Feinberg School of Medicine, Chicago, IL, USA.
| | - Remi Z Welbel
- Department of Pediatrics, Division of Autonomic Medicine, Ann & Robert H. Lurie Children's Hospital of Chicago and Stanley Manne Children's Research Institute, Chicago, IL, USA
| | - Casey M Rand
- Department of Pediatrics, Division of Autonomic Medicine, Ann & Robert H. Lurie Children's Hospital of Chicago and Stanley Manne Children's Research Institute, Chicago, IL, USA
| | - Tracey Stewart
- Department of Pediatrics, Division of Autonomic Medicine, Ann & Robert H. Lurie Children's Hospital of Chicago and Stanley Manne Children's Research Institute, Chicago, IL, USA
| | - Allaa Fadl-Alla
- Department of Pediatrics, Division of Autonomic Medicine, Ann & Robert H. Lurie Children's Hospital of Chicago and Stanley Manne Children's Research Institute, Chicago, IL, USA
| | - Ilya Khaytin
- Department of Pediatrics, Division of Autonomic Medicine, Ann & Robert H. Lurie Children's Hospital of Chicago and Stanley Manne Children's Research Institute, Chicago, IL, USA
| | - Susan M Slattery
- Department of Pediatrics, Division of Autonomic Medicine, Ann & Robert H. Lurie Children's Hospital of Chicago and Stanley Manne Children's Research Institute, Chicago, IL, USA
| | - Debra E Weese-Mayer
- Department of Pediatrics, Division of Autonomic Medicine, Ann & Robert H. Lurie Children's Hospital of Chicago and Stanley Manne Children's Research Institute, Chicago, IL, USA
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10
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Khaytin I, Victor AK, Barclay SF, Benson LA, Slattery SM, Rand CM, Kurek KC, Weese-Mayer DE. Rapid-onset obesity with hypothalamic dysfunction, hypoventilation, and autonomic dysregulation (ROHHAD): a collaborative review of the current understanding. Clin Auton Res 2023; 33:251-268. [PMID: 37162653 DOI: 10.1007/s10286-023-00936-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2022] [Accepted: 03/01/2023] [Indexed: 05/11/2023]
Abstract
PURPOSE To provide an overview of the discovery, presentation, and management of Rapid-onset Obesity with Hypothalamic dysfunction, Hypoventilation, and Autonomic Dysregulation (ROHHAD). To discuss a search for causative etiology spanning multiple disciplines and continents. METHODS The literature (1965-2022) on the diagnosis, management, pathophysiology, and potential etiology of ROHHAD was methodically reviewed. The experience of several academic centers with expertise in ROHHAD is presented, along with a detailed discussion of scientific discovery in the search for a cause. RESULTS ROHHAD is an ultra-rare syndrome with fewer than 200 known cases. Although variations occur, the acronym ROHHAD is intended to alert physicians to the usual sequence or unfolding of the phenotypic presentation, including the full phenotype. Nearly 60 years after its first description, more is known about the pathophysiology of ROHHAD, but the etiology remains enigmatic. The search for a genetic mutation common to patients with ROHHAD has not, to date, demonstrated a disease-defining gene. Similarly, a search for the autoimmune basis of ROHHAD has not resulted in a definitive answer. This review summarizes current knowledge and potential future directions. CONCLUSION ROHHAD is a poorly understood, complex, and potentially devastating disorder. The search for its cause intertwines with the search for causes of obesity and autonomic dysregulation. The care for the patient with ROHHAD necessitates collaborative international efforts to advance our knowledge and, thereby, treatment, to decrease the disease burden and eventually to stop, and/or reverse the unfolding of the phenotype.
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Affiliation(s)
- Ilya Khaytin
- Center for Autonomic Medicine in Pediatrics (CAMP), Division of Autonomic Medicine, Ann and Robert H. Lurie Children's Hospital of Chicago, Chicago, IL, USA.
- Department of Pediatrics, Northwestern University Feinberg School of Medicine, Chicago, IL, USA.
- Stanley Manne Children's Research Center, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, IL, USA.
| | - A Kaitlyn Victor
- College of Graduate Health Sciences, The University of Tennessee Health Science Center, Memphis, TN, USA
| | - Sarah F Barclay
- Alberta Children's Hospital Research Institute, University of Calgary, Calgary, AB, Canada
| | - Leslie A Benson
- Department of Neurology, Boston Children's Hospital, Boston, MA, USA
| | - Susan M Slattery
- Center for Autonomic Medicine in Pediatrics (CAMP), Division of Autonomic Medicine, Ann and Robert H. Lurie Children's Hospital of Chicago, Chicago, IL, USA
- Department of Pediatrics, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
- Stanley Manne Children's Research Center, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, IL, USA
| | - Casey M Rand
- Center for Autonomic Medicine in Pediatrics (CAMP), Division of Autonomic Medicine, Ann and Robert H. Lurie Children's Hospital of Chicago, Chicago, IL, USA
- Stanley Manne Children's Research Center, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, IL, USA
| | - Kyle C Kurek
- Alberta Children's Hospital Research Institute, University of Calgary, Calgary, AB, Canada
| | - Debra E Weese-Mayer
- Center for Autonomic Medicine in Pediatrics (CAMP), Division of Autonomic Medicine, Ann and Robert H. Lurie Children's Hospital of Chicago, Chicago, IL, USA
- Department of Pediatrics, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
- Stanley Manne Children's Research Center, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, IL, USA
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11
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Hawton K, Hilliard T, Langton-Hewer SC, Burren C, Crowne EC, Hamilton-Shield JP, Giri D. Rapid-onset obesity, hypothalamic dysfunction, hypoventilation, and autonomic dysregulation syndrome - neuro-endocrine tumours (ROHHAD-NET): case series and learning points. J Pediatr Endocrinol Metab 2023; 36:418-423. [PMID: 36696572 DOI: 10.1515/jpem-2022-0376] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/29/2022] [Accepted: 01/03/2023] [Indexed: 01/27/2023]
Abstract
OBJECTIVES Rapid-onset obesity with hypoventilation, hypothalamic dysfunction, autonomic dysregulation (ROHHAD) is a rare syndrome associated with high morbidity and mortality. Diagnosis is often challenging. We describe three cases of ROHHAD with heterogeneous presentations but some consistent clinical features, including hyperprolactinaemia at diagnosis. We highlight when the diagnosis of ROHHAD should be considered at an early stage. CASE PRESENTATION All three patients presented between 4 and 6 years old with rapid-onset obesity. They all have central hypoventilation requiring nocturnal BiPAP, varying degrees of hypothalamic dysfunction with hyperprolactinaemia being a consistent feature, and autonomic dysfunction. One patient has a neuro-endocrine tumour (NET) and two have glucose dysregulation. CONCLUSIONS High prolactin was a consistent early feature. Central hypoventilation and NET may present later and therefore regular sleep studies and screening for NETs are required. A high suspicion of ROHHAD is warranted in patients with rapid, early-onset obesity and hyperprolactinaemia without structural pituitary abnormality.
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Affiliation(s)
- Katherine Hawton
- Paediatric Endocrinology and Diabetes Department, Bristol Royal Hospital for Children, University Hospitals Bristol and Weston NHS Foundation Trust, Bristol, UK.,NIHR Biomedical Research Centre (Nutrition Theme), University of Bristol, Bristol, UK
| | - Tom Hilliard
- Paediatric Respiratory Department, Bristol Royal Hospital for Children, University Hospitals Bristol and Weston NHS Foundation Trust, Bristol, UK
| | - Simon C Langton-Hewer
- University of Bristol, Bristol, UK.,Paediatric Respiratory Department, Bristol Royal Hospital for Children, University Hospitals Bristol and Weston NHS Foundation Trust, Bristol, UK
| | - Christine Burren
- Paediatric Endocrinology and Diabetes Department, Bristol Royal Hospital for Children, University Hospitals Bristol and Weston NHS Foundation Trust, Bristol, UK.,University of Bristol, Bristol, UK
| | - Elizabeth C Crowne
- Paediatric Endocrinology and Diabetes Department, Bristol Royal Hospital for Children, University Hospitals Bristol and Weston NHS Foundation Trust, Bristol, UK
| | - Julian P Hamilton-Shield
- Paediatric Endocrinology and Diabetes Department, Bristol Royal Hospital for Children, University Hospitals Bristol and Weston NHS Foundation Trust, Bristol, UK.,University of Bristol, Bristol, UK.,NIHR Biomedical Research Centre (Nutrition Theme), University of Bristol, Bristol, UK
| | - Dinesh Giri
- Paediatric Endocrinology and Diabetes Department, Bristol Royal Hospital for Children, University Hospitals Bristol and Weston NHS Foundation Trust, Bristol, UK.,University of Bristol, Bristol, UK
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12
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Hawton KAC, Doffinger R, Ramanan AV, Langton Hewer SC, Evans HJ, Giri D, Hamilton Shield JP. Rituximab therapy in ROHHAD(NET) syndrome. J Pediatr Endocrinol Metab 2022; 35:1102-1106. [PMID: 35470643 DOI: 10.1515/jpem-2022-0085] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/16/2022] [Accepted: 03/17/2022] [Indexed: 11/15/2022]
Abstract
OBJECTIVES Rapid-onset obesity with hypoventilation, hypothalamic dysfunction, autonomic dysregulation, and neural-crest tumour (ROHHAD(NET)) is a rare syndrome presenting in early childhood associated with high morbidity and mortality. There is no specific diagnostic biomarker and diagnosis is based on clinical features. An autoimmune origin has been postulated. CASE PRESENTATION Management is largely supportive. We report a case of a five-year old female who presented in respiratory arrest after 6-months of rapid weight gain. She had central hypoventilation, central diabetes insipidus, growth hormone deficiency and hyperprolactinaemia. She displayed elevated interleukin-6 levels on cytokine serology which normalised after rituximab treatment. After rituximab treatment, her weight reduced significantly from greatly above the 99.6th to the 50th centile in 12 months. CONCLUSIONS This response possibly reflects an underlying, immune-inflammatory pathology driving excess adiposity in this condition. Potentially, other aspects of ROHHAD(NET) may be mediated through autoimmune dysregulation in which case rituximab may provide benefits for prognosis and survival.
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Affiliation(s)
- Katherine A C Hawton
- Bristol Royal Hospital for Children, Bristol, UK.,University of Bristol, Bristol, UK
| | - Rainer Doffinger
- Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK
| | | | - Simon C Langton Hewer
- Bristol Royal Hospital for Children, Bristol, UK.,University of Bristol, Bristol, UK
| | - Hazel J Evans
- Department of Respiratory Paediatrics, Southampton Children's Hospital, Southampton, UK
| | - Dinesh Giri
- Bristol Royal Hospital for Children, Bristol, UK.,University of Bristol, Bristol, UK
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13
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Mandel‐Brehm C, Benson LA, Tran B, Kung AF, Mann SA, Vazquez SE, Retallack H, Sample HA, Zorn KC, Khan LM, Kerr LM, McAlpine PL, Zhang L, McCarthy F, Elias JE, Katwa U, Astley CM, Tomko S, Dalmau J, Seeley WW, Pleasure SJ, Wilson MR, Gorman MP, DeRisi JL. ZSCAN1 Autoantibodies Are Associated with Pediatric Paraneoplastic ROHHAD. Ann Neurol 2022; 92:279-291. [PMID: 35466441 PMCID: PMC9329235 DOI: 10.1002/ana.26380] [Citation(s) in RCA: 18] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2021] [Revised: 04/18/2022] [Accepted: 04/21/2022] [Indexed: 11/27/2022]
Abstract
OBJECTIVE Rapid-onset Obesity with Hypothalamic Dysfunction, Hypoventilation and Autonomic Dysregulation (ROHHAD), is a severe pediatric disorder of uncertain etiology resulting in hypothalamic dysfunction and frequent sudden death. Frequent co-occurrence of neuroblastic tumors have fueled suspicion of an autoimmune paraneoplastic neurological syndrome (PNS); however, specific anti-neural autoantibodies, a hallmark of PNS, have not been identified. Our objective is to determine if an autoimmune paraneoplastic etiology underlies ROHHAD. METHODS Immunoglobulin G (IgG) from pediatric ROHHAD patients (n = 9), non-inflammatory individuals (n = 100) and relevant pediatric controls (n = 25) was screened using a programmable phage display of the human peptidome (PhIP-Seq). Putative ROHHAD-specific autoantibodies were orthogonally validated using radioactive ligand binding and cell-based assays. Expression of autoantibody targets in ROHHAD tumor and healthy brain tissue was assessed with immunohistochemistry and mass spectrometry, respectively. RESULTS Autoantibodies to ZSCAN1 were detected in ROHHAD patients by PhIP-Seq and orthogonally validated in 7/9 ROHHAD patients and 0/125 controls using radioactive ligand binding and cell-based assays. Expression of ZSCAN1 in ROHHAD tumor and healthy human brain tissue was confirmed. INTERPRETATION Our results support the notion that tumor-associated ROHHAD syndrome is a pediatric PNS, potentially initiated by an immune response to peripheral neuroblastic tumor. ZSCAN1 autoantibodies may aid in earlier, accurate diagnosis of ROHHAD syndrome, thus providing a means toward early detection and treatment. This work warrants follow-up studies to test sensitivity and specificity of a novel diagnostic test. Last, given the absence of the ZSCAN1 gene in rodents, our study highlights the value of human-based approaches for detecting novel PNS subtypes. ANN NEUROL 2022;92:279-291.
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Affiliation(s)
- Caleigh Mandel‐Brehm
- Department of Biochemistry and BiophysicsUniversity of CaliforniaSan FranciscoCAUSA
| | | | - Baouyen Tran
- Weill Institute for Neurosciences, Department of NeurologyUniversity of CaliforniaSan FranciscoCAUSA
| | - Andrew F. Kung
- Department of Biochemistry and BiophysicsUniversity of CaliforniaSan FranciscoCAUSA
| | - Sabrina A. Mann
- Department of Biochemistry and BiophysicsUniversity of CaliforniaSan FranciscoCAUSA
| | - Sara E. Vazquez
- Department of Biochemistry and BiophysicsUniversity of CaliforniaSan FranciscoCAUSA
| | - Hanna Retallack
- Department of Biochemistry and BiophysicsUniversity of CaliforniaSan FranciscoCAUSA
| | - Hannah A. Sample
- Department of Biochemistry and BiophysicsUniversity of CaliforniaSan FranciscoCAUSA
| | - Kelsey C. Zorn
- Department of Biochemistry and BiophysicsUniversity of CaliforniaSan FranciscoCAUSA
| | - Lillian M. Khan
- Department of Biochemistry and BiophysicsUniversity of CaliforniaSan FranciscoCAUSA
| | - Lauren M. Kerr
- Department of NeurologyBoston Children's HospitalBostonMAUSA
| | - Patrick L. McAlpine
- Otolaryngology Head and Neck Surgery Research DivisionStanford UniversityStanfordCAUSA
| | | | | | | | - Umakanth Katwa
- Department of Pulmonary MedicineSleep Center, Boston Children's HospitalBostonMAUSA
| | - Christina M. Astley
- Division of Endocrinology & Computational EpidemiologyBoston Children's HospitalBostonMAUSA
| | - Stuart Tomko
- Department of NeurologyWashington UniversitySt. LouisMOUSA
| | - Josep Dalmau
- Catalan Institution for Research and Advanced Studies (ICREA), Hospital Clinic‐IdibapsUniversity of BarcelonaBarcelonaSpain
| | - William W. Seeley
- Memory and Aging Center, Department of NeurologyUniversity of CaliforniaSan FranciscoCAUSA
| | - Samuel J. Pleasure
- Weill Institute for Neurosciences, Department of NeurologyUniversity of CaliforniaSan FranciscoCAUSA
| | - Michael R. Wilson
- MAS, Weill Institute for Neurosciences, Department of NeurologyUniversity of CaliforniaSan FranciscoCAUSA
| | - Mark P. Gorman
- Department of NeurologyHarvard Medical SchoolBostonMAUSA
| | - Joseph L. DeRisi
- Chan Zuckerberg Biohub, Department of Biochemistry and BiophysicsUniversity of CaliforniaSan FranciscoCAUSA
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14
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Nakamura-Utsunomiya A, Goda S, Hayakawa S, Sonoko S, Hoorn EJ, Blanchard A, Saito-Hakoda A, Kakimoto H, Hachiya R, Kamimura M, Kawakita R, Higuchi S, Fujimaru R, Shirai Y, Miyaoka D, Nagata Y, Kishi Y, Wada A, Mitsuboshi A, Ozaki K, Komatsu N, Niizuma H, Kanno J, Fujiwara I, Hasegawa Y, Yorifuji T, Brickman W, Vantyghem MC, Yamaguchi K, Goshima N, Hiyama TY. Identification of clinical factors related to antibody-mediated immune response to the subfornical organ. Clin Endocrinol (Oxf) 2022; 97:72-80. [PMID: 35419873 DOI: 10.1111/cen.14737] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/15/2021] [Revised: 02/28/2022] [Accepted: 04/06/2022] [Indexed: 11/30/2022]
Abstract
OBJECTIVE We recently reported cases of adipsic hypernatremia caused by autoantibodies against the subfornical organ in patients with hypothalamic-pituitary lesions. This study aimed to clarify the clinical features of newly identified patients with adipsic hypernatremia whose sera displayed immunoreactivity to the mouse subfornical organ. DESIGN Observational cohort study of patients diagnosed with adipsic hypernatremia in Japan, United States, and Europe. METHODS The study included 22 patients with adipsic hypernatremia but without overt structural changes in the hypothalamic-pituitary region and congenital disease. Antibody response to the mouse subfornical organ was determined using immunohistochemistry. The clinical characteristics were compared between the patients with positive and negative antibody responses. RESULTS Antibody response to the mouse subfornical organ was detected in the sera of 16 patients (72.7%, female/male ratio, 1:1, 12 pediatric and 4 adult patients). The prolactin levels at the time of diagnosis were significantly higher in patients with positive subfornical organ (SFO) immunoreactivity than in those with negative SFO immunoreactivity (58.9 ± 33.5 vs. 22.9 ± 13.9 ng/ml, p < .05). Hypothalamic disorders were found in 37.5% of the patients with positive SFO immunoreactivity. Moreover, six patients were diagnosed with rapid-onset obesity with hypothalamic dysfunction, hypoventilation, and autonomic dysregulation/neural tumor syndrome after the diagnosis of adipsic hypernatremia. Plasma renin activity levels were significantly higher in patients with serum immunoreactivity to the Nax channel. CONCLUSIONS The patients with serum immunoreactivity to the SFO had higher prolactin levels and hypothalamic disorders compared to those without the immunoreactivity. The clinical characteristics of patients with serum immunoreactivity to the subfornical organ included higher prolactin levels and hypothalamic disorders, which were frequently associated with central hypothyroidism and the presence of retroperitoneal tumors.
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Affiliation(s)
- Akari Nakamura-Utsunomiya
- Department of Pediatrics, Hiroshima University Graduate School of Biomedical and Health Sciences, Hiroshima, Japan
- Department of Pediatrics, Hiroshima Prefectural Hospital, Hiroshima, Japan
| | - Satoshi Goda
- Department of Pediatrics, Hiroshima University Graduate School of Biomedical and Health Sciences, Hiroshima, Japan
| | - Seiichi Hayakawa
- Department of Pediatrics, Hiroshima University Hospital, Hiroshima, Japan
| | - Sakata Sonoko
- Department of Pediatrics, Hiroshima University Graduate School of Biomedical and Health Sciences, Hiroshima, Japan
| | - Ewout J Hoorn
- Division of Nephrology and Transplantation, Department of Internal Medicine, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - Anne Blanchard
- Center of Clinical investigation, Faculty of Medicine, Hospital European George Pompidou Paris, Paris, France
| | | | - Haruna Kakimoto
- Department of Pediatrics, Kagoshima University Hospital, Kagoshima, Japan
| | - Rumi Hachiya
- Division of Endocrinology and Metabolism, Tokyo Metropolitan Children's Medical Center, Tokyo, Japan
| | - Miki Kamimura
- Department of Pediatrics, Tohoku University Hospital, Sendai, Japan
| | - Rie Kawakita
- Division of Pediatric Endocrinology and Metabolism, Children's Medical Center, Osaka City General Hospital, Osaka, Japan
| | - Shinji Higuchi
- Division of Pediatric Endocrinology and Metabolism, Children's Medical Center, Osaka City General Hospital, Osaka, Japan
| | - Rika Fujimaru
- Department of Pediatrics, Osaka City General Hospital, Osaka, Japan
| | - Yoko Shirai
- Department of Pediatric Nephrology, Tokyo Women's Medical University, Tokyo, Japan
| | - Daichi Miyaoka
- Department of Metabolism, Endocrinology and Molecular Medicine, Osaka City University Graduate School of Medicine, Osaka, Japan
| | - Yuki Nagata
- Department of Vascular Medicine, Osaka City University Graduate School of Medicine, Osaka, Japan
- Department of vascular medicine, Vascular Science Center for Translational Research, Osaka City University Graduate School of Medicine, Osaka, Japan
| | - Yutaro Kishi
- Department of Endocrinology and Metabolism, Niigata University Medical and Dentist Hospital, Niigata, Japan
| | - Aya Wada
- Department of Pediatrics, Gunma University Hospital, Tochigi, Japan
| | - Akari Mitsuboshi
- Division of Endocrinology and Metabolism, Hyogo Prefectural Kobe children's Hospital, Kobe, Japan
| | - Kayo Ozaki
- Division of Endocrinology and Metabolism, Hyogo Prefectural Kobe children's Hospital, Kobe, Japan
| | - Nagisa Komatsu
- Department of Pediatrics, Kumamoto Chuo Hospital, Kumamoto, Japan
| | - Hidetaka Niizuma
- Department of Pediatrics, Tohoku University Hospital, Sendai, Japan
| | - Junko Kanno
- Department of Pediatrics, Tohoku University Hospital, Sendai, Japan
| | - Ikuma Fujiwara
- Department of Pediatrics, Tohoku University Hospital, Sendai, Japan
| | - Yukihiro Hasegawa
- Division of Endocrinology and Metabolism, Tokyo Metropolitan Children's Medical Center, Tokyo, Japan
| | - Tohru Yorifuji
- Division of Pediatric Endocrinology and Metabolism, Children's Medical Center, Osaka City General Hospital, Osaka, Japan
| | - Wendy Brickman
- Department of Pediatrics, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
- Division of Endocrinology, Ann and Robert H. Lurie Children's Hospital of Chicago, Chicago, Illinois, USA
| | - Marie-Christine Vantyghem
- Department of Endocrinology, Diabetology, Metabolism and Nutrition, Lille University Hospital, Lille, France
| | - Kei Yamaguchi
- Molecular Profiling Research Center for Drug Discovery, National Institute of Advanced Industrial Science and Technology, Tokyo, Japan
- ProteoBridge Corporation, Tokyo, Japan
| | - Naoki Goshima
- Molecular Profiling Research Center for Drug Discovery, National Institute of Advanced Industrial Science and Technology, Tokyo, Japan
- ProteoBridge Corporation, Tokyo, Japan
| | - Takeshi Y Hiyama
- Department of Cellular Physiology, Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama University, Okayama, Japan
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15
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Nakamura-Utsunomiya A. Autoimmunity Related to Adipsic Hypernatremia and ROHHAD Syndrome. Int J Mol Sci 2022; 23:ijms23136899. [PMID: 35805903 PMCID: PMC9266522 DOI: 10.3390/ijms23136899] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2022] [Revised: 06/18/2022] [Accepted: 06/20/2022] [Indexed: 11/16/2022] Open
Abstract
Specific antibody responses to subfornical organs, including Nax antibody, have been reported in patients with adipsic hypernatremia of unknown etiology who do not have structural lesions in the hypothalamic–pituitary gland. The subfornical organ, also referred to as the window of the brain, is a sensing site that monitors sodium and osmotic pressure levels. On the other hand, ROHHAD syndrome is a rare disease for which the etiology of the hypothalamic disorder is unknown, and there have been some reports in recent years describing its association with autoimmune mechanisms. In addition, abnormal Na levels, including hypernatremia, are likely to occur in this syndrome. When comparing the clinical features of adipsic hypernatremia due to autoimmune mechanisms and ROHHAD syndrome, there are similar hypothalamic–pituitary dysfunction symptoms in addition to abnormal Na levels. Since clinical diagnoses of autoimmunological adipsic hypernatremia and ROHAD syndrome might overlap, we need to understand the essential etiology and carry out precise assessments to accurately diagnose patients and provide effective treatment. In this review, I review the literature on the autoimmune mechanism reported in recent years and describe the findings obtained so far and future directions.
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Affiliation(s)
- Akari Nakamura-Utsunomiya
- Department of Genetic Medicine, Hiroshima University Graduate School, 1-2-3 Kasumi, Minami-ku, Hiroshima 734-8511, Japan;
- Department of Pediatrics, Hiroshima University Graduate School, 1-2-3 Kasumi, Minami-ku, Hiroshima 734-8511, Japan
- Division of Neonatal Screening, National Center for Child Health and Development, 2 Chome-10-1 Okura, Setagaya, Tokyo 157-8535, Japan
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16
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Tiwari S, Arimbrakkunnan M, Yadav T, Vyas V, Rathod KK, Vishwajeet V. Thoracic Ganglioneuroma Presenting with Paraneoplastic Cerebellitis and ROHHAD-NET Syndrome. Ann Indian Acad Neurol 2022; 25:307-309. [PMID: 35693680 PMCID: PMC9175397 DOI: 10.4103/aian.aian_372_21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2021] [Revised: 08/07/2021] [Accepted: 08/25/2021] [Indexed: 11/08/2022] Open
Affiliation(s)
- Sarbesh Tiwari
- Department of Diagnostic and Interventional Radiology, All India Institute of Medical Sciences, Jodhpur, Rajasthan, India
| | - Mufeed Arimbrakkunnan
- Department of Diagnostic and Interventional Radiology, All India Institute of Medical Sciences, Jodhpur, Rajasthan, India
| | - Taruna Yadav
- Department of Diagnostic and Interventional Radiology, All India Institute of Medical Sciences, Jodhpur, Rajasthan, India
| | - Varuna Vyas
- Department of Pediatrics, All India Institute of Medical Sciences, Jodhpur, Rajasthan, India
| | - Kirti K Rathod
- Department of Pediatric Surgery, All India Institute of Medical Sciences, Jodhpur, Rajasthan, India
| | - Vikarn Vishwajeet
- Department of Pathology, All India Institute of Medical Sciences, Jodhpur, Rajasthan, India
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17
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Ghosh R, Malik M, Daley TC, Kasi AS. Images: Sleep-disordered breathing and hypoventilation in a child with obesity and hypothalamic dysfunction. J Clin Sleep Med 2022; 18:339-342. [PMID: 34534067 PMCID: PMC8807918 DOI: 10.5664/jcsm.9636] [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: 01/03/2023]
Abstract
Rapid-onset obesity with hypothalamic dysfunction, hypoventilation, and autonomic dysregulation (ROHHAD) is a rare and potentially lethal disorder of respiratory control, autonomic, and hypothalamic dysfunction of unknown etiology. We report a 15-year-old girl with ROHHAD who developed hyperphagia and rapid weight gain of 16 kg between 2.5 and 4 years of age and cardiorespiratory arrest at 4 years. Initial polysomnography showed central sleep apnea and severe oxygen desaturations without hypoventilation. Mild obstructive sleep apnea and intermittent hypoxemia were identified at 4.5 years, following which nocturnal bilevel positive airway pressure therapy was initiated. At 6 years, she developed sleep-related hypoventilation, and subsequent polysomnograms continued to show obstructive sleep apnea and hypoventilation requiring bilevel positive airway pressure. Clinicians interpreting polysomnograms should become familiar with the evolution of sleep-disordered breathing in ROHHAD and that hypoventilation may develop over time. Our case highlights the importance of serial polysomnography in patients with ROHHAD and optimal ventilatory management. CITATION Ghosh R, Malik M, Daley TC, Kasi AS. Images: Sleep-disordered breathing and hypoventilation in a child with obesity and hypothalamic dysfunction. J Clin Sleep Med. 2022;18(1):339-342.
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Affiliation(s)
- Radhika Ghosh
- Division of Pediatric Pulmonology and Sleep Medicine, Emory University, Children’s Healthcare of Atlanta, Atlanta, Georgia,Address correspondence to: Radhika Ghosh, MD, Fellow in Pediatric Pulmonology, Emory University School of Medicine, 1400 Tullie Road NE, Atlanta, GA 30329; Tel: (404) 785-5437; Fax: (404) 785-9087;
| | - Manisha Malik
- Division of Pediatric Pulmonology and Sleep Medicine, Emory University, Children’s Healthcare of Atlanta, Atlanta, Georgia
| | - Tanicia C. Daley
- Division of Pediatric Endocrinology, Emory University, Children’s Healthcare of Atlanta, Atlanta, Georgia
| | - Ajay S. Kasi
- Division of Pediatric Pulmonology and Sleep Medicine, Emory University, Children’s Healthcare of Atlanta, Atlanta, Georgia
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18
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Zhao R, Dong X, Gao Z, Han F. Case Report: Considerations of nocturnal ventilator support in ROHHAD syndrome in chronic care of childhood central hypoventilation with hypothalamus dysfunction. Front Pediatr 2022; 10:919921. [PMID: 36120657 PMCID: PMC9470944 DOI: 10.3389/fped.2022.919921] [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: 04/14/2022] [Accepted: 08/04/2022] [Indexed: 11/13/2022] Open
Abstract
Rapid-onset obesity with hypothalamic dysfunction, hypoventilation, and autonomic dysregulation (ROHHAD) is a rare life-threatening disorder that can occur during childhood. All children with ROHHAD develop alveolar hypoventilation during wakefulness and sleep. The key treatment for these patients is the optimization of oxygenation and ventilation. Here, we report the case of a 5-year-old girl with suspected ROHHAD, with rapid weight gain, breathing cessation, decreased height, hypoventilation, central hypothyroidism, hyperprolactinemia, and absolute deficiency of growth hormone, and negative PHOX2B sequencing results. The presentation met the diagnostic criteria for ROHHAD syndrome. During the 5-year follow-up, she presented with progressive deterioration of the function of the hypothalamus and respiratory center, hypoxemia (PO2 < 60 mmHg), and hypercapnia [transcutaneous carbon dioxide (TcPCO2) > 70 mmHg] during the first two cycles of N3 sleep with a poor response to ventilatory support. Early diagnosis and application of non-invasive positive pressure ventilation during sleep can improve the quality of life and outcomes of patients with ROHHAD, and polysomnography and TcPCO2 should be repeated every 3-6 months to follow the progress and regulate ventilator support. Multidisciplinary care is crucial for the successful management of these patients.
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Affiliation(s)
- Rui Zhao
- Department of Pulmonary and Critical Care Medicine, Peking University People's Hospital, Beijing, China
| | - Xiaosong Dong
- Department of Pulmonary and Critical Care Medicine, Peking University People's Hospital, Beijing, China
| | - Zhancheng Gao
- Department of Pulmonary and Critical Care Medicine, Peking University People's Hospital, Beijing, China
| | - Fang Han
- Department of Pulmonary and Critical Care Medicine, Peking University People's Hospital, Beijing, China
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19
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Desse B, Tran A, Butori M, Marchal S, Afanetti M, Barthélemy S, Bérard E, Baechler E, Debelleix S, Lampin ME, Macey J, Massenavette B, Harvengt J, Trang H, Giovannini-Chami L. ROHHAD syndrome without rapid-onset obesity: A diagnosis challenge. Front Pediatr 2022; 10:910099. [PMID: 36120648 PMCID: PMC9471950 DOI: 10.3389/fped.2022.910099] [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: 03/31/2022] [Accepted: 07/30/2022] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND ROHHAD syndrome (Rapid-onset Obesity with Hypothalamic dysfunction, Hypoventilation and Autonomic Dysregulation) is rare. Rapid-onset morbid obesity is usually the first recognizable sign of this syndrome, however a subset of patients develop ROHHAD syndrome without obesity. The prevalence of this entity is currently unknown. Alteration of respiratory control as well as dysautonomic disorders often have a fatal outcome, thus early recognition of this syndrome is essential. MATERIAL AND METHODS A retrospective, observational, multicenter study including all cases of ROHHAD without rapid-onset obesity diagnosed in France from 2000 to 2020. RESULTS Four patients were identified. Median age at diagnosis was 8 years 10 months. Median body mass index was 17.4 kg/m2. Signs of autonomic dysfunction presented first, followed by hypothalamic disorders. All four patients had sleep apnea syndrome. Hypoventilation led to the diagnosis. Three of the four children received ventilatory support, all four received hormone replacement therapy, and two received psychotropic treatment. One child in our cohort died at 2 years 10 months old. For the three surviving patients, median duration of follow-up was 7.4 years. CONCLUSION ROHHAD syndrome without rapid-onset obesity is a particular entity, appearing later than ROHHAD with obesity. This entity should be considered in the presence of dysautonomia disorders without brain damage. Likewise, the occurrence of a hypothalamic syndrome with no identified etiology requires a sleep study to search for apnea and hypoventilation. The identification of ROHHAD syndrome without rapid-onset obesity is a clinical challenge, with major implications for patient prognosis.
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Affiliation(s)
- Blandine Desse
- Pediatric and Neonatology Department, Hopital de Grasse, Grasse, France
| | - Antoine Tran
- Pediatric Emergency Department, Hôpitaux pédiatriques de Nice CHU-Lenval, Nice, France
| | - Mathilde Butori
- Pediatric Gastroenterology Department, Hôpitaux pédiatriques de Nice CHU-Lenval, Nice, France
| | - Sarah Marchal
- Pediatric Pulmonology and Allergology Department, Hôpitaux pédiatriques de Nice CHU-Lenval, Nice, France
| | - Michael Afanetti
- Pediatric Intensive Care Unit, Hôpitaux pédiatriques de Nice CHU-Lenval, Nice, France
| | - Sébastien Barthélemy
- Pediatric Intensive Care Unit, Hôpitaux pédiatriques de Nice CHU-Lenval, Nice, France
| | - Etienne Bérard
- Pediatric Nephrology Department, Hôpitaux pédiatriques de Nice CHU-Lenval, Nice, France
| | - Elisabeth Baechler
- Pediatric Endocrinology Department, Hôpitaux pédiatriques de Nice CHU-Lenval, Nice, France
| | - Stéphane Debelleix
- Pediatric Pulmonology Department and Cystic Fibrosis Center, CHU de Bordeaux, Bordeaux, France
| | | | - Julie Macey
- Respiratory Medicine and Cystic Fibrosis Center, CHU de Bordeaux, Bordeaux, France
| | - Bruno Massenavette
- Intensive Care Unit, Hospices Civils de Lyon, Hopital Femme Mere Enfant, Bron, France
| | - Julie Harvengt
- Department of Human Genetics, Sart-Tilman, Liège, Belgium
| | - Ha Trang
- Pediatric Sleep Center, Hopital Universitaire Robert Debre, Paris, France
| | - Lisa Giovannini-Chami
- Pediatric Pulmonology and Allergology Department, Hôpitaux pédiatriques de Nice CHU-Lenval, Nice, France.,Université Côte d'Azur, Nice, France
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20
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Artamonova IN, Petrova NA, Lyubimova NA, Kolbina NY, Bryzzhin AV, Borodin AV, Levko TA, Mamaeva EA, Pervunina TM, Vasichkina ES, Nikitina IL, Zlotina AM, Efimtsev AY, Kostik MM. Case Report: COVID-19-Associated ROHHAD-Like Syndrome. Front Pediatr 2022; 10:854367. [PMID: 35433531 PMCID: PMC9009510 DOI: 10.3389/fped.2022.854367] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/13/2022] [Accepted: 02/18/2022] [Indexed: 11/19/2022] Open
Abstract
It is known that the SARS-CoV-2 virus may cause neurologic damage. Rapid-onset obesity, hypoventilation, hypothalamus dysfunction, and autonomic dysregulation (ROHHAD) syndrome is a disease of unknown etiology with a progressive course and unclear outcomes. The etiology of ROHHAD syndrome includes genetic, epigenetic, paraneoplastic, and immune-mediated theories, but to our knowledge, viral-associated cases of the disease have not been described yet. Here we present the case of a 4-year-old girl who developed a ROHHAD syndrome-like phenotype after a COVID-19 infection and the results of 5 months of therapy. She had COVID-19 pneumonia, followed by electrolyte disturbances (hypernatremia and hyperchloremia), hypocorticism and hypothyroidism, central hypoventilation-requiring prolonged assisted lung ventilation-bulimia, and progressive obesity with hypertriglyceridemia, dyslipidemia, hyperuricemia, and hyperinsulinemia. The repeated MRI of the brain and hypothalamic-pituitary region with contrast enhancement showed mild post-hypoxic changes. Prader-Willi/Angelman syndrome as well as PHOX2B-associated variants was ruled out. Treatment with non-steroidal anti-inflammatory drugs and monthly courses of intravenous immunoglobulin led to a dramatic improvement. Herein the first description of ROHHAD-like syndrome is timely associated with a previous COVID-19 infection with possible primarily viral or immune-mediated hypothalamic involvement.
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Affiliation(s)
| | | | | | | | | | | | - Tatyana A Levko
- Almazov National Medical Research Centre, Saint Petersburg, Russia
| | | | | | | | - Irina L Nikitina
- Almazov National Medical Research Centre, Saint Petersburg, Russia
| | - Anna M Zlotina
- Almazov National Medical Research Centre, Saint Petersburg, Russia
| | | | - Mikhail M Kostik
- Almazov National Medical Research Centre, Saint Petersburg, Russia.,Saint-Petersburg State Pediatric Medical University, Saint Petersburg, Russia
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21
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Enner S, Pavkovic I, Kothare SV. Sudden unexpected death in children: myth or reality? Curr Opin Pediatr 2021; 33:471-479. [PMID: 34226427 DOI: 10.1097/mop.0000000000001032] [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] [Indexed: 11/26/2022]
Abstract
PURPOSE OF REVIEW Despite many years of study, sudden unexplained death remains a tenuous diagnosis of exclusion. Here, we discuss the current science behind the uncertainties of sudden death, as well as the questions that still remain. RECENT FINDINGS Failure in any part of the complex interplay between peripheral sensors and central cardiorespiratory regulation can result in sudden death. Diagnostic testing with electrocardiograms, electroencephalogram, sleep studies, or even genetic studies have increased our ability to identify patients at the highest risk. SUMMARY Advances in the understanding of sudden unexplained death in children may show common pathways leading to sudden death from multiple different diseases. Although rare, the devastating implication prioritizes the importance in educating patients about how to live with the risk of sudden death.
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Affiliation(s)
- Stephanie Enner
- Division of Pediatric Neurology, Department of Pediatrics, Cohen Children's Medical Center, Zucker School of Medicine at Hofstra/Northwell, Lake Success, New York, USA
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22
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Amjadipour A, Shahkar L, Hanafi F. A Case Report of ROHHAD Syndrome in an 8-year-old Iranian Boy. Int J Endocrinol Metab 2021; 19:e111571. [PMID: 34567137 PMCID: PMC8453650 DOI: 10.5812/ijem.111571] [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: 12/21/2020] [Revised: 03/04/2021] [Accepted: 04/18/2021] [Indexed: 11/16/2022] Open
Abstract
INTRODUCTION Rapid-onset obesity concurrently with hypoventilation, hypothalamic, autonomic dysregulation (ROHHAD) is an uncommon disease that presents with multiorgan disorders during early childhood, with fewer than 100 cases reported around the world. We aim to present a case of ROHHAD syndrome admitting with rare neurologic symptoms. We also present our treatment regimen. CASE PRESENTATION An 8-year-old boy was admitted to our department with ataxia and gait disturbance that led us to the final diagnosis after a thorough investigation. He had multiple admissions and was treated for other diagnoses. His first symptoms started from age 5 with obstructive apnea. He underwent an adenectomy surgery at that time, but the symptoms continued. A year after the surgery, he was admitted again due to his somnolence but was diagnosed only with hypothyroidism and anemia. At the age of 7 years and 8 months, he was admitted to our department with ataxia and abnormal gait from the past year with instability and numerous falls. He also had shown hyperphagia that had been resulted in 10 kilograms of weight gain in six months. He was experiencing gradual behavioral symptoms, including episodes of self and hetero aggression and impulsivity. His other symptoms included fatigue, somnolence, gastrointestinal dysmotility, hyperhidrosis, central hypothyroidism, polyuria, precocious puberty, and rapid obesity. His laboratory investigation revealed hyperprolactinemia. CONCLUSIONS Our case indicates that ROHHAD is a complex disease with divergent signs and symptoms that needs to be kept in mind for diagnosis and should be treated with a high level of collaboration of various medical specialties. Since late diagnosis of this syndrome leads to a magnificent increase in morbidity and mortality rates, it is vital to pay extreme attention to this syndrome. The diagnosis should be considered even more in children over two years old with rapid-onset obesity, which is accompanied by other symptoms. Here, our patient's complaint was ataxia that revealed the underlying cause after investigation.
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Affiliation(s)
- Abolfazl Amjadipour
- Student Research Committee, Medicine Faculty, Golestan University of Medical Sciences, Gorgan, Iran
| | - Lobat Shahkar
- Neonatal and Children's Health Research Center, School of Medicine, Golestan University of Medical Sciences, Gorgan, Iran
- Corresponding Author: Taleghani Hospital, Gorgan, Iran.
| | - Faridreza Hanafi
- Taleghani Hospital, Golestan University of Medical Sciences, Gorgan, Iran
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23
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Goldbart AD, Arazi A, Golan-Tripto I, Levinsky Y, Scheuerman O, Tarasiuk A. Altered slow-wave sleep activity in children with rapid-onset obesity with hypothalamic dysregulation, hypoventilation, and autonomic dysregulation syndrome. J Clin Sleep Med 2021; 16:1731-1735. [PMID: 32638701 DOI: 10.5664/jcsm.8678] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
STUDY OBJECTIVES Rapid-onset obesity with hypothalamic dysregulation, hypoventilation, and autonomic dysregulation (ROHHAD) is a rare condition. Little is known about sleep/wake and slow-wave activity in this condition, although the central hypothalamic dysfunction associated with autonomic dysregulation would make the occurrence of SWA deregulation most likely. METHODS Two children with clinical presentation of ROHHAD syndrome were evaluated, diagnosed, and treated. Their polysomnographic studies were compared with 4 matched children with obstructive sleep apnea and 6 controls. RESULTS Children that were clinically diagnosed with ROHHAD exhibited significantly weaker slow-wave activity power and shallower slow-wave activity slopes during the first 2 sleep cycles compared with children with obstructive sleep apnea or controls. CONCLUSIONS This study shows that children with ROHHAD have suppressed slow-wave activity, possibly because of hypothalamic dysregulation that may contribute to their rapid-onset obesity and excessive daytime sleepiness.
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Affiliation(s)
- Aviv D Goldbart
- Department of Pediatrics B, Soroka University Medical Center, Beer-Sheva, Israel.,Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva, Israel
| | - Ayelet Arazi
- Department of Brain and Cognitive Sciences, Ben-Gurion University, Beer-Sheva, Israel
| | - Inbal Golan-Tripto
- Department of Pediatrics B, Soroka University Medical Center, Beer-Sheva, Israel.,Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva, Israel
| | - Yoel Levinsky
- Department of Pediatrics B, Schneider Children's Medical Center of Israel, Petach Tikva, Israel.,Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Oded Scheuerman
- Department of Pediatrics B, Schneider Children's Medical Center of Israel, Petach Tikva, Israel.,Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Ariel Tarasiuk
- Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva, Israel.,Sleep-Wake Disorders Unit, Soroka Medical Center, Beer-Sheva, Israel
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24
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田 茂, 雷 文, 郎 长, 李 娟, 谭 君, 束 晓. [Fever for 2 months and disturbance of consciousness for 1 week in a preschool-aged girl]. ZHONGGUO DANG DAI ER KE ZA ZHI = CHINESE JOURNAL OF CONTEMPORARY PEDIATRICS 2021; 23:519-523. [PMID: 34020744 PMCID: PMC8140330 DOI: 10.7499/j.issn.1008-8830.2101101] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Received: 01/19/2021] [Accepted: 03/10/2021] [Indexed: 06/12/2023]
Abstract
Rapid-onset obesity with hypothalamic dysfunction, hypoventilation, and autonomic dysregulation syndrome (ROHHADS) is a rare multi-system disease, and delayed diagnosis and treatment may lead to catastrophic cardiopulmonary complications. As far as we know, no patient with ROHHADS has been reported in China, and this article reports a child with ROHHADS to improve the awareness of this disease among clinicians. A girl, aged 3 years, had the clinical manifestations of rapid weight gain, fever, disturbance of consciousness, and convulsion. The physical examination showed a body weight of 20 kg, somnolence, irregular breathing, and stiff neck. She had increased blood levels of prolactin and follicle-stimulating hormone and hyponatremia. The lumbar puncture showed an increased intracranial pressure. The brain MRI and magnetic resonance venography showed symmetrical lesions in the periventricular region and venous thrombosis in the right transverse sinus and the superior sagittal sinus. The sleep monitoring showed hypopnea. The girl was finally diagnosed with ROHHADS and intracranial venous thrombosis. She recovered after symptomatic treatment including decreasing intracranial pressure, anticoagulation, and respiratory support. The possibility of ROHHADS should be considered for patients with unexplained obesity, fever, and hypoventilation, with or without central nervous system symptoms. Early diagnosis and standardized follow-up can improve the prognosis of children with ROHHADS.
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Affiliation(s)
- 茂强 田
- />遵义医大学附属医院小儿内科, 贵州遵义 563003Department of Pediatric, Affiliated Hospital of Zunyi Medical University, Zunyi, Guizhou 563003, China
| | - 文婷 雷
- />遵义医大学附属医院小儿内科, 贵州遵义 563003Department of Pediatric, Affiliated Hospital of Zunyi Medical University, Zunyi, Guizhou 563003, China
| | - 长会 郎
- />遵义医大学附属医院小儿内科, 贵州遵义 563003Department of Pediatric, Affiliated Hospital of Zunyi Medical University, Zunyi, Guizhou 563003, China
| | - 娟 李
- />遵义医大学附属医院小儿内科, 贵州遵义 563003Department of Pediatric, Affiliated Hospital of Zunyi Medical University, Zunyi, Guizhou 563003, China
| | - 君梅 谭
- />遵义医大学附属医院小儿内科, 贵州遵义 563003Department of Pediatric, Affiliated Hospital of Zunyi Medical University, Zunyi, Guizhou 563003, China
| | - 晓梅 束
- />遵义医大学附属医院小儿内科, 贵州遵义 563003Department of Pediatric, Affiliated Hospital of Zunyi Medical University, Zunyi, Guizhou 563003, China
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25
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Selvadurai S, Benzon D, Voutsas G, Hamilton J, Yeh A, Cifra B, Narang I. Sleep-disordered breathing, respiratory patterns during wakefulness and functional capacity in pediatric patients with rapid-onset obesity with hypothalamic dysfunction, hypoventilation and autonomic dysregulation syndrome. Pediatr Pulmonol 2021; 56:479-485. [PMID: 33270379 DOI: 10.1002/ppul.25199] [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] [Received: 07/15/2020] [Revised: 11/05/2020] [Accepted: 11/19/2020] [Indexed: 11/11/2022]
Abstract
OBJECTIVE To characterize the clinical presentation of sleep-disordered breathing and respiratory patterns at rest and during a 6-min walk test (6MWT) in children with rapid-onset obesity, hypothalamic dysfunction, hypoventilation, and autonomic dysregulation (ROHHAD) syndrome. METHODS Retrospective study of children with ROHHAD who had a diagnostic baseline polysomnography, daytime cardiorespiratory monitoring at rest and a 6MWT. Polysomnography data were also compared with body mass index-, age-, and sex-matched controls. RESULTS Of the eight children with ROHHAD, all eight (100%) had obstructive sleep apnea (OSA) and 2/8 (25%) had nocturnal hypoventilation (NH) on their baseline polysomnography. Comparing the ROHHAD group to the control group, there were no significant differences in the median (interquartile range [IQR]) obstructive apnea-hypopnea index (11.1 [4.3-58.4] vs. 14.4 [10.3-23.3] events/h, respectively; p = .78). However, children with ROHHAD showed a significantly higher desaturation index compared to the control group (37.9 [13.7-59.8] vs. 14.7 [4.3-27.6] events/h; p = .05). While awake at rest, some children with ROHHAD experienced significant desaturations associated with central pauses. During the 6MWT, no significant desaturations were observed, but two children showed moderate functional limitation. CONCLUSIONS Among children with ROHHAD, respiratory instability may be demonstrated by a significant number and severity of oxygen desaturations during sleep in the presence of OSA, with or without NH, and oxygen desaturations with central pauses at rest during wakefulness. Interestingly, during daily activities that require submaximal effort, children may not experience oxygen desaturations. Early recognition of respiratory abnormalities and targeted therapeutic interventions are important to limit associated morbidity and mortality in ROHHAD.
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Affiliation(s)
- Sarah Selvadurai
- Translational Medicine, Research Institute, Hospital for Sick Children, Toronto, Ontario, Canada
| | - David Benzon
- Translational Medicine, Research Institute, Hospital for Sick Children, Toronto, Ontario, Canada.,McMaster University, Hamilton, Ontario, Canada
| | - Giorge Voutsas
- Translational Medicine, Research Institute, Hospital for Sick Children, Toronto, Ontario, Canada.,University of Toronto, Toronto, Ontario, Canada
| | - Jill Hamilton
- University of Toronto, Toronto, Ontario, Canada.,Division of Endocrinology, Hospital for Sick Children, Toronto, Ontario, Canada
| | - Ann Yeh
- University of Toronto, Toronto, Ontario, Canada.,Division of Neurology, Hospital for Sick Children, Toronto, Ontario, Canada
| | - Barbara Cifra
- University of Toronto, Toronto, Ontario, Canada.,Division of Cardiology, Hospital for Sick Children, Toronto, Ontario, Canada
| | - Indra Narang
- Translational Medicine, Research Institute, Hospital for Sick Children, Toronto, Ontario, Canada.,University of Toronto, Toronto, Ontario, Canada.,Division of Respiratory Medicine, Hospital for Sick Children, Toronto, Ontario, Canada
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26
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Lazea C, Sur L, Florea M. ROHHAD (Rapid-onset Obesity with Hypoventilation, Hypothalamic Dysfunction, Autonomic Dysregulation) Syndrome-What Every Pediatrician Should Know About the Etiopathogenesis, Diagnosis and Treatment: A Review. Int J Gen Med 2021; 14:319-326. [PMID: 33542648 PMCID: PMC7853626 DOI: 10.2147/ijgm.s293377] [Citation(s) in RCA: 19] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2020] [Accepted: 12/31/2020] [Indexed: 12/14/2022] Open
Abstract
Rapid-onset obesity with hypoventilation, hypothalamic dysfunction, autonomic dysregulation (ROHHAD) syndrome is a rare disease with unknown and debated etiology, characterized by precipitous obesity in young children, hypoventilation and autonomic dysregulation with various endocrine abnormalities. Neuroendocrine tumors can be associated in more than half of the cases. This rare condition has a severe outcome because of high morbidity and mortality. We provide a comprehensive description of the etiopathogenetic theories of the disease, clinical presentation, diagnostic workup and treatment possibilities.
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Affiliation(s)
- Cecilia Lazea
- Department Pediatrics I, Emergency Pediatric Hospital, University of Medicine and Pharmacy "Iuliu Hatieganu", Cluj-Napoca, Romania
| | - Lucia Sur
- Department Pediatrics I, Emergency Pediatric Hospital, University of Medicine and Pharmacy "Iuliu Hatieganu", Cluj-Napoca, Romania
| | - Mira Florea
- Community Medicine Department, University of Medicine and Pharmacy "Iuliu Hatieganu", Cluj-Napoca, Romania
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27
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Praud JP. Long-Term Non-invasive Ventilation in Children: Current Use, Indications, and Contraindications. Front Pediatr 2020; 8:584334. [PMID: 33224908 PMCID: PMC7674588 DOI: 10.3389/fped.2020.584334] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/17/2020] [Accepted: 09/22/2020] [Indexed: 01/15/2023] Open
Abstract
This review focuses on the delivery of non-invasive ventilation-i.e., intermittent positive-pressure ventilation-in children lasting more than 3 months. Several recent reviews have brought to light a dramatic escalation in the use of long-term non-invasive ventilation in children over the last 30 years. This is due both to the growing number of children receiving care for complex and severe diseases necessitating respiratory support and to the availability of LT-NIV equipment that can be used at home. While significant gaps in availability persist for smaller children and especially infants, home LT-NIV for children with chronic respiratory insufficiency has improved their quality of life and decreased the overall cost of care. While long-term NIV is usually delivered during sleep, it can also be delivered 24 h a day in selected patients. Close collaboration between the hospital complex-care team, the home LT-NIV program, and family caregivers is of the utmost importance for successful home LT-NIV. Long-term NIV is indicated for respiratory disorders responsible for chronic alveolar hypoventilation, with the aim to increase life expectancy and maximize quality of life. LT-NIV is considered for conditions that affect respiratory-muscle performance (alterations in central respiratory drive or neuromuscular function) and/or impose an excessive respiratory load (airway obstruction, lung disease, or chest-wall anomalies). Relative contraindications for LT-NIV include the inability of the local medical infrastructure to support home LT-NIV and poor motivation or inability of the patient/caregivers to cooperate or understand recommendations. Anatomic abnormalities that interfere with interface fitting, inability to protect the lower airways due to excessive airway secretions and/or severely impaired swallowing, or failure of LT-NIV to support respiration can lead to considering invasive ventilation via tracheostomy. Of note, providing home LT-NIV during the COVID 19 pandemic has become more challenging. This is due both to the disruption of medical systems and the fear of contaminating care providers and family with aerosols generated by a patient positive for SARS-CoV-2 during NIV. Delay in initiating LT-NIV, decreased frequency of home visits by the home ventilation program, and decreased availability of polysomnography and oximetry/transcutaneous PCO2 monitoring are observed. Teleconsultations and telemonitoring are being developed to mitigate these challenges.
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Affiliation(s)
- Jean-Paul Praud
- Division of Pediatric Pulmonology, University of Sherbrooke, Sherbrooke, QC, Canada
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28
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Lefebvre M, Bruel AL, Tisserant E, Bourgon N, Duffourd Y, Collardeau-Frachon S, Attie-Bitach T, Kuentz P, Assoum M, Schaefer E, El Chehadeh S, Antal MC, Kremer V, Girard-Lemaitre F, Mandel JL, Lehalle D, Nambot S, Jean-Marçais N, Houcinat N, Moutton S, Marle N, Lambert L, Jonveaux P, Foliguet B, Mazutti JP, Gaillard D, Alanio E, Poirisier C, Lebre AS, Aubert-Lenoir M, Arbez-Gindre F, Odent S, Quélin C, Loget P, Fradin M, Willems M, Bigi N, Perez MJ, Blesson S, Francannet C, Beaufrere AM, Patrier-Sallebert S, Guerrot AM, Goldenberg A, Brehin AC, Lespinasse J, Touraine R, Capri Y, Saint-Frison MH, Laurent N, Philippe C, Tran Mau-Them F, Thevenon J, Faivre L, Thauvin-Robinet C, Vitobello A. Genotype-first in a cohort of 95 fetuses with multiple congenital abnormalities: when exome sequencing reveals unexpected fetal phenotype-genotype correlations. J Med Genet 2020; 58:400-413. [PMID: 32732226 DOI: 10.1136/jmedgenet-2020-106867] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2020] [Revised: 05/04/2020] [Accepted: 05/21/2020] [Indexed: 11/03/2022]
Abstract
PURPOSE Molecular diagnosis based on singleton exome sequencing (sES) is particularly challenging in fetuses with multiple congenital abnormalities (MCA). Indeed, some studies reveal a diagnostic yield of about 20%, far lower than in live birth individuals showing developmental abnormalities (30%), suggesting that standard analyses, based on the correlation between clinical hallmarks described in postnatal syndromic presentations and genotype, may underestimate the impact of the genetic variants identified in fetal analyses. METHODS We performed sES in 95 fetuses with MCA. Blind to phenotype, we applied a genotype-first approach consisting of combined analyses based on variants annotation and bioinformatics predictions followed by reverse phenotyping. Initially applied to OMIM-morbid genes, analyses were then extended to all genes. We complemented our approach by using reverse phenotyping, variant segregation analysis, bibliographic search and data sharing in order to establish the clinical significance of the prioritised variants. RESULTS sES rapidly identified causal variant in 24/95 fetuses (25%), variants of unknown significance in OMIM genes in 8/95 fetuses (8%) and six novel candidate genes in 6/95 fetuses (6%). CONCLUSIONS This method, based on a genotype-first approach followed by reverse phenotyping, shed light on unexpected fetal phenotype-genotype correlations, emphasising the relevance of prenatal studies to reveal extreme clinical presentations associated with well-known Mendelian disorders.
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Affiliation(s)
- Mathilde Lefebvre
- UFR Des Sciences de Santé, INSERM-Université de Bourgogne UMR1231 GAD « Génétique des Anomalies du Développement », FHU-TRANSLAD, Dijon, France.,Laboratoire d'Anatomo-Pathologie, Plateforme de Biologie Hospitalo-Universitaire, CHU de Dijon Bourgogne, Dijon, France
| | - Ange-Line Bruel
- UFR Des Sciences de Santé, INSERM-Université de Bourgogne UMR1231 GAD « Génétique des Anomalies du Développement », FHU-TRANSLAD, Dijon, France.,Unité Fonctionnelle d'Innovation diagnostique des maladies rares, FHU-TRANSLAD, CHU Dijon Bourgogne, Dijon, France
| | - Emilie Tisserant
- UFR Des Sciences de Santé, INSERM-Université de Bourgogne UMR1231 GAD « Génétique des Anomalies du Développement », FHU-TRANSLAD, Dijon, France
| | - Nicolas Bourgon
- UFR Des Sciences de Santé, INSERM-Université de Bourgogne UMR1231 GAD « Génétique des Anomalies du Développement », FHU-TRANSLAD, Dijon, France
| | - Yannis Duffourd
- UFR Des Sciences de Santé, INSERM-Université de Bourgogne UMR1231 GAD « Génétique des Anomalies du Développement », FHU-TRANSLAD, Dijon, France
| | | | - Tania Attie-Bitach
- Laboratoire d'Embryologie et de Génétique des Malformations Congénitales, Hopital Necker, APHP, Paris Cedex 15, France
| | - Paul Kuentz
- UFR Des Sciences de Santé, INSERM-Université de Bourgogne UMR1231 GAD « Génétique des Anomalies du Développement », FHU-TRANSLAD, Dijon, France
| | - Mirna Assoum
- UFR Des Sciences de Santé, INSERM-Université de Bourgogne UMR1231 GAD « Génétique des Anomalies du Développement », FHU-TRANSLAD, Dijon, France
| | - Elise Schaefer
- Service de Génétique Médicale, CHU de Strasbourg, Hôpital de Hautepierre, Strasbourg, France
| | - Salima El Chehadeh
- Service de Génétique Médicale, CHU de Strasbourg, Hôpital de Hautepierre, Strasbourg, France
| | - Maria Cristina Antal
- Service de Fœtopathologie, CHU de Strasbourg, Hôpital de Hautepierre, Strasbourg, France
| | - Valérie Kremer
- Laboratoire de Cytogénétique constitutionnelle et prénatale, CHU de Strasbourg, Strasbourg, France
| | - Françoise Girard-Lemaitre
- Département Médecine translationnelle et neurogénétique, Institut de génétique et de biologie moléculaire et cellulaire, Strasbourg, France
| | - Jean-Louis Mandel
- Département Médecine translationnelle et neurogénétique, Institut de génétique et de biologie moléculaire et cellulaire, Strasbourg, France
| | - Daphne Lehalle
- Centre de Référence Maladies Rares « Anomalies du Développement et Syndrome Malformatifs » de L'Est, Hôpital D'Enfants, FHU-TRANSLAD, CHU Dijon Bourgogne, Dijon, France
| | - Sophie Nambot
- Centre de Référence Maladies Rares « Anomalies du Développement et Syndrome Malformatifs » de L'Est, Hôpital D'Enfants, FHU-TRANSLAD, CHU Dijon Bourgogne, Dijon, France
| | - Nolwenn Jean-Marçais
- Centre de Référence Maladies Rares « Anomalies du Développement et Syndrome Malformatifs » de L'Est, Hôpital D'Enfants, FHU-TRANSLAD, CHU Dijon Bourgogne, Dijon, France
| | - Nada Houcinat
- Centre de Référence Maladies Rares « Anomalies du Développement et Syndrome Malformatifs » de L'Est, Hôpital D'Enfants, FHU-TRANSLAD, CHU Dijon Bourgogne, Dijon, France
| | - Sébastien Moutton
- UFR Des Sciences de Santé, INSERM-Université de Bourgogne UMR1231 GAD « Génétique des Anomalies du Développement », FHU-TRANSLAD, Dijon, France.,Centre de Référence Maladies Rares « Anomalies du Développement et Syndrome Malformatifs » de L'Est, Hôpital D'Enfants, FHU-TRANSLAD, CHU Dijon Bourgogne, Dijon, France
| | - Nathalie Marle
- Laboratoire de Génétique chromosomique et moléculaire, CHU de Dijon Bourgogne, Dijon, France
| | - Laetita Lambert
- UF de Génétique médicale, Maternité régionale, CHU de Nancy, Nancy, France
| | | | - Bernard Foliguet
- Laboratoire de Biologie de la Reproduction et du Développement Maternité de Nancy, CHU de Nancy, Nancy, France
| | - Jean-Pierre Mazutti
- Laboratoire de Biologie de la Reproduction et du Développement Maternité de Nancy, CHU de Nancy, Nancy, France
| | | | | | | | - Anne-Sophie Lebre
- Service de Génétique et Biologie de la Reproduction, CHU de Reims, Reims, France
| | | | | | - Sylvie Odent
- Service de Génétique Clinique, Hôpital Sud, CLAD Ouest, CNRS UMR6290 Génétique et Pathologies du Développement, Université de Rennes, Rennes, France
| | - Chloé Quélin
- Service de Génétique Clinique, Hôpital Sud, CLAD Ouest, CNRS UMR6290 Génétique et Pathologies du Développement, Université de Rennes, Rennes, France.,Service de Fœtopathologie, CHU de Rennes, Rennes, France
| | - Philippe Loget
- Service de Fœtopathologie, CHU de Rennes, Rennes, France
| | - Melanie Fradin
- Service de Génétique Clinique, Hôpital Sud, CLAD Ouest, CNRS UMR6290 Génétique et Pathologies du Développement, Université de Rennes, Rennes, France
| | - Marjolaine Willems
- Equipe Maladies Génétiques de l'Enfant et de l'Adulte, CHU de Montpellier, Montpellier, France
| | - Nicole Bigi
- Service de Fœtopathologie, CHU de Montpellier, Montpellier, France
| | - Marie-José Perez
- Service de Fœtopathologie, CHU de Montpellier, Montpellier, France
| | | | - Christine Francannet
- Service de Génétique médicale, CHU de Clermont-Ferrand, Clermont-Ferrand, France
| | | | | | | | | | | | | | - Renaud Touraine
- Service de Genetique Clinique, C.H.U. De Saint Etienne-Hopital Nord, Saint Etienne Cedex 2, France
| | - Yline Capri
- Service de génétique clinique, Hôpital Robert Debré - APHP, Paris, France
| | | | - Nicole Laurent
- Laboratoire d'Anatomo-Pathologie, Plateforme de Biologie Hospitalo-Universitaire, CHU de Dijon Bourgogne, Dijon, France
| | - Christophe Philippe
- UFR Des Sciences de Santé, INSERM-Université de Bourgogne UMR1231 GAD « Génétique des Anomalies du Développement », FHU-TRANSLAD, Dijon, France.,Unité Fonctionnelle d'Innovation diagnostique des maladies rares, FHU-TRANSLAD, CHU Dijon Bourgogne, Dijon, France
| | - Frederic Tran Mau-Them
- UFR Des Sciences de Santé, INSERM-Université de Bourgogne UMR1231 GAD « Génétique des Anomalies du Développement », FHU-TRANSLAD, Dijon, France.,Unité Fonctionnelle d'Innovation diagnostique des maladies rares, FHU-TRANSLAD, CHU Dijon Bourgogne, Dijon, France
| | - Julien Thevenon
- UFR Des Sciences de Santé, INSERM-Université de Bourgogne UMR1231 GAD « Génétique des Anomalies du Développement », FHU-TRANSLAD, Dijon, France.,Département de Génétique et Procréation, CHU Grenoble Alpes, Université Grenoble Alpes, Grenoble, France
| | - Laurence Faivre
- UFR Des Sciences de Santé, INSERM-Université de Bourgogne UMR1231 GAD « Génétique des Anomalies du Développement », FHU-TRANSLAD, Dijon, France.,Centre de Référence Maladies Rares « Anomalies du Développement et Syndrome Malformatifs » de L'Est, Hôpital D'Enfants, FHU-TRANSLAD, CHU Dijon Bourgogne, Dijon, France
| | - Christel Thauvin-Robinet
- UFR Des Sciences de Santé, INSERM-Université de Bourgogne UMR1231 GAD « Génétique des Anomalies du Développement », FHU-TRANSLAD, Dijon, France .,Unité Fonctionnelle d'Innovation diagnostique des maladies rares, FHU-TRANSLAD, CHU Dijon Bourgogne, Dijon, France.,Centre de Référence Déficiences Intellectuelles de Causes Rares, Hôpital D'Enfants, CHU Dijon Bourgogne, Dijon, France
| | - Antonio Vitobello
- UFR Des Sciences de Santé, INSERM-Université de Bourgogne UMR1231 GAD « Génétique des Anomalies du Développement », FHU-TRANSLAD, Dijon, France .,Unité Fonctionnelle d'Innovation diagnostique des maladies rares, FHU-TRANSLAD, CHU Dijon Bourgogne, Dijon, France
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Harvengt J, Gernay C, Mastouri M, Farhat N, Lebrethon MC, Seghaye MC, Bours V. ROHHAD(NET) Syndrome: Systematic Review of the Clinical Timeline and Recommendations for Diagnosis and Prognosis. J Clin Endocrinol Metab 2020; 105:5837124. [PMID: 32407531 DOI: 10.1210/clinem/dgaa247] [Citation(s) in RCA: 30] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/19/2019] [Accepted: 05/11/2020] [Indexed: 12/19/2022]
Abstract
CONTEXT Rapid-onset obesity with hypothalamic dysfunction, hypoventilation, autonomic dysregulation and neural crest tumor (ROHHHAD[NET]) is a rare and potentially fatal disease. No specific diagnostic biomarker is currently available, making prompt diagnosis challenging. Since its first definition in 2007, a complete clinical analysis leading to specific diagnosis and follow-up recommendations is still missing. OBJECTIVE The purpose of this work is to describe the clinical timeline of symptoms of ROHHAD(NET) and propose recommendations for diagnosis and follow-up. DESIGN We conducted a systematic review of all ROHHAD(NET) case studies and report a new ROHHAD patient with early diagnosis and multidisciplinary care. METHODS All the articles that meet the definition of ROHHAD(NET) and provide chronological clinical data were reviewed according to the Preferred Reporting Items for Systematic Reviews and Meta-Analysis individual patient data guidelines. The data were grouped into 7 categories: hypothalamic dysfunction, autonomic dysregulation, hypoventilation, NET, psychiatric symptoms, other clinical manifestations, and outcome. RESULTS Forty-three individual patient data descriptions were analyzed. The timeline of the disease shows rapid-onset obesity followed shortly by hypothalamic dysfunction. Dysautonomia was reported at a median age of 4.95 years and hypoventilation at 5.33 years, or 2.2 years after the initial obesity. A NET was reported in 56% of the patients, and 70% of these tumors were diagnosed within 2 years after initial weight gain. CONCLUSION Because early diagnosis improves the clinical management and the prognosis in ROHHAD(NET), this diagnosis should be considered for any child with rapid and early obesity. We propose guidance for systematic follow-up and advise multidisciplinary management with the aim of improving prognosis and life expectancy.
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Affiliation(s)
- Julie Harvengt
- Department of Human Genetics, Sart-Tilman (Liège), Belgium
| | - Caroline Gernay
- Department of Paediatrics, Section Endocrinology, Sart-Tilman (Liège), Belgium
| | - Meriem Mastouri
- Department of Paediatrics, Section Pneumology, Sart-Tilman (Liège), Belgium
| | - Nesrine Farhat
- Department of Paediatrics, Section Cardiology, Sart-Tilman (Liège), Belgium
| | | | | | - Vincent Bours
- Department of Human Genetics, Sart-Tilman (Liège), Belgium
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30
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Özcan G, Özsu E, Şiklar Z, Çobanoğlu N. A Rare Cause of Sleep-Disordered Breathing: ROHHAD Syndrome. Front Pediatr 2020; 8:573227. [PMID: 33330273 PMCID: PMC7714909 DOI: 10.3389/fped.2020.573227] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/16/2020] [Accepted: 10/29/2020] [Indexed: 11/29/2022] Open
Abstract
Rapid-onset obesity with hypoventilation, hypothalamic dysfunction, and autonomic dysregulation (ROHHAD) syndrome; is a rare but crucial disorder. Sleep-disordered breathing can occur at the beginning or after of obesity. A disease-specific test for diagnosis is not yet available. Neural crest tumors (ganglioneuroma, ganglioneuroblastoma) have been reported in 40% of patients. In our study, three patients diagnosed as having ROHHAD syndrome are presented from our hospital. In the evaluation of the hypothalamic functions of the patients, one of them had growth hormone deficiency and hyperprolactinemia; recurrent hypernatremia reflecting irregular water balance was detected in another. One of the patients had abnormal pupil reflex and heart rate irregularity while another had excessive sweating as autonomic dysfunction. One of the patients was diagnosed with paravertebral ganglioma accompanying ROHHAD syndrome. Non-invasive ventilation treatment was started in all patients because there was a sleep-disorder breathing clinic diagnosis. ROHHAD syndrome deserves a multidisciplinary team approach as it can affect more than one organ system. In these patients, should be sleep-disorder breathing determined early and appropriate treatment should be initiated immediately to reduce morbidity and mortality.
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Affiliation(s)
- Gizem Özcan
- Department of Pediatric Pulmonology, Faculty of Medicine, Ankara University, Ankara, Turkey
| | - Elif Özsu
- Department of Pediatric Endocrinology, Faculty of Medicine, Ankara University, Ankara, Turkey
| | - Zeynep Şiklar
- Department of Pediatric Endocrinology, Faculty of Medicine, Ankara University, Ankara, Turkey
| | - Nazan Çobanoğlu
- Department of Pediatric Pulmonology, Faculty of Medicine, Ankara University, Ankara, Turkey
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Stowe RC, Afolabi‐Brown O. Pulmonary hypertension and chronic hypoventilation in ROHHAD syndrome treated with average-volume assured pressure support. Pediatr Investig 2019; 3:253-256. [PMID: 32851331 PMCID: PMC7331430 DOI: 10.1002/ped4.12168] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2019] [Accepted: 10/20/2019] [Indexed: 12/20/2022] Open
Abstract
INTRODUCTION Rapid-onset obesity with hypothalamic dysfunction, hypoventilation, and autonomic dysregulation (ROHHAD) syndrome is an exceptionally rare clinical entity with significant morbidity and high mortality with challenging-to-treat hypoventilation. CASE PRESENTATION An 11-year-old morbidly obese Chinese female presented with a putative diagnosis of ROHHAD associated with a left psoas ganglioneuroma. Initial polysomnography showed severe obstructive sleep apnea and hypoventilation. She was not adherent to prescribed non-invasive positive pressure ventilation (NIPPV). Echocardiography demonstrated evidence of pulmonary hypertension, likely secondary to chronic hypoventilation. With behavioral modification and trial of average volume-assured pressure support (AVAPS), adherence improved with eventual improvement of her pulmonary hypertension. CONCLUSION AVAPS may improve ventilation and NIPPV adherence in central hypoventilation disorders such as ROHHAD, reducing risk of morbidity and mortality.
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Affiliation(s)
- Robert C. Stowe
- Division of NeurologyChildren's Hospital of PhiladelphiaPhiladelphiaPAUSA
- Children's Hospital of Philadelphia Sleep CenterPhiladelphiaPAUSA
| | - Olufunke Afolabi‐Brown
- Children's Hospital of Philadelphia Sleep CenterPhiladelphiaPAUSA
- Division of Pulmonary and Sleep MedicineChildren's Hospital of PhiladelphiaPhiladelphiaPAUSA
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Jalal Eldin AW, Tombayoglu D, Butz L, Affinati A, Meral R, Ontan MS, Walkovich K, Westerhoff M, Innis JW, Parikh ND, Oral EA. Natural history of ROHHAD syndrome: development of severe insulin resistance and fatty liver disease over time. Clin Diabetes Endocrinol 2019; 5:9. [PMID: 31333877 PMCID: PMC6617654 DOI: 10.1186/s40842-019-0082-y] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/04/2019] [Accepted: 06/24/2019] [Indexed: 12/31/2022] Open
Abstract
Background Rapid-onset obesity with hypothalamic dysfunction, hypoventilation, and autonomic dysregulation (ROHHAD) is a rare syndrome with unknown etiology. Metabolic abnormalities are not known to be part of the syndrome. We present one of the oldest cases reported in the literature, who developed severe metabolic abnormalities and hepatic disease suggesting that these features may be part of the syndrome. Case presentation A 27-year-old woman, diagnosed with ROHHAD syndrome at age 15, who previously developed diabetes insipidus, growth hormone deficiency, hyperprolactinemia, and hypothyroidism in her first decade of life. This was followed by insulin resistance, NAFLD, liver fibrosis, and splenomegaly before age 14 years. Her regimen included a short course of growth hormone, and cyclic estrogen and progesterone. Her metabolic deterioration continued despite treatment with metformin. Interestingly, she had a favorable response to liraglutide therapy despite having a centrally mediated cause for her obesity. At age 26, a 1.6 cm lesion was found incidentally in her liver. Liver biopsy showed hepatocellular carcinoma which was successfully treated with radiofrequency ablation. Conclusion Metabolic abnormalities, Insulin resistance and fatty liver disease are potentially part of the ROHHAD syndrome that may develop over time. GLP1 agonists were reasonably effective to treat insulin resistance and hyperphagia. Patients with ROHHAD may benefit from close follow up in regards to liver disease. Electronic supplementary material The online version of this article (10.1186/s40842-019-0082-y) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Abdel Wahab Jalal Eldin
- 1Division of Metabolism, Endocrinology and Diabetes (MEND), Department of Internal Medicine Brehm Center for Diabetes, Michigan Medicine, University of Michigan, 1000 Wall Street, Room 5313, Ann Arbor, MI 48105 USA
| | - Dilara Tombayoglu
- 1Division of Metabolism, Endocrinology and Diabetes (MEND), Department of Internal Medicine Brehm Center for Diabetes, Michigan Medicine, University of Michigan, 1000 Wall Street, Room 5313, Ann Arbor, MI 48105 USA.,2Istanbul Faculty of Medicine, Istanbul University, Istanbul, Turkey
| | - Laura Butz
- 1Division of Metabolism, Endocrinology and Diabetes (MEND), Department of Internal Medicine Brehm Center for Diabetes, Michigan Medicine, University of Michigan, 1000 Wall Street, Room 5313, Ann Arbor, MI 48105 USA
| | - Alison Affinati
- 1Division of Metabolism, Endocrinology and Diabetes (MEND), Department of Internal Medicine Brehm Center for Diabetes, Michigan Medicine, University of Michigan, 1000 Wall Street, Room 5313, Ann Arbor, MI 48105 USA
| | - Rasimcan Meral
- 1Division of Metabolism, Endocrinology and Diabetes (MEND), Department of Internal Medicine Brehm Center for Diabetes, Michigan Medicine, University of Michigan, 1000 Wall Street, Room 5313, Ann Arbor, MI 48105 USA
| | - Mehmet Selman Ontan
- 1Division of Metabolism, Endocrinology and Diabetes (MEND), Department of Internal Medicine Brehm Center for Diabetes, Michigan Medicine, University of Michigan, 1000 Wall Street, Room 5313, Ann Arbor, MI 48105 USA
| | - Kelly Walkovich
- 3Division of Pediatric Hematology/Oncology, Department of Pediatrics and Communicable Diseases, Michigan Medicine, University of Michigan, Ann Arbor, MI USA
| | - Maria Westerhoff
- 4Department of Pathology, Michigan Medicine, University of Michigan, Ann Arbor, MI USA
| | - Jeffrey W Innis
- Division of Genetics, Metabolism and Genomic Medicine, Department of Pediatrics,and Departments of Human Genetics and Internal Medicine, Michigan Medicine, University of Michigan, Ann Arbor, MI USA
| | - Neehar D Parikh
- 6Division of Gastroenterology and Hepatology, Department of Internal Medicine, Michigan Medicine, University of Michigan, Ann Arbor, MI USA
| | - Elif A Oral
- 1Division of Metabolism, Endocrinology and Diabetes (MEND), Department of Internal Medicine Brehm Center for Diabetes, Michigan Medicine, University of Michigan, 1000 Wall Street, Room 5313, Ann Arbor, MI 48105 USA
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Single-Case Study of Appetite Control in Prader-Willi Syndrome, Over 12-Years by the Indian Extract Caralluma fimbriata. Genes (Basel) 2019; 10:genes10060447. [PMID: 31212875 PMCID: PMC6627187 DOI: 10.3390/genes10060447] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2019] [Revised: 06/02/2019] [Accepted: 06/05/2019] [Indexed: 12/27/2022] Open
Abstract
This paper reports on the successful management of hyperphagia (exaggerated hunger) in a 14yr-old female with Prader–Willi syndrome (PWS). This child was diagnosed with PWS, (maternal uniparental disomy) at 18 months due to developmental delay, hypertonia, weight gain and extreme eating behaviour. Treatment of a supplement for appetite suppression commenced at 2 years of age. This single-case records ingestion of an Indian cactus succulent Caralluma fimbriata extract (CFE) over 12 years, resulting in anecdotal satiety, free access to food and management of weight within normal range. CFE was administered in a drink daily and dose was slowly escalated by observation for appetite suppression. Rigorous testing determined blood count, vitamins, key minerals, HbA1c, IGF-1 and function of the liver and thyroid all within normal range. The report suggests a strategy for early intervention against hyperphagia and obesity in PWS. This case was the instigator of the successful Australian PWS/CFE pilot and though anecdotal, the adolescent continues to ingest CFE followed by paediatricians at the Royal Children’s Hospital Melbourne, Victoria, Australia. Future clinical trials are worth considering, to determine an appropriate dose for individuals with PWS.
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