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Ochoa B, Weidler EM, Parks MA, Speck KE, van Leeuwen K. Novel Approaches to Patients with Differences of Sex Development. Adv Pediatr 2024; 71:151-167. [PMID: 38944480 DOI: 10.1016/j.yapd.2024.04.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/01/2024]
Abstract
Patients with differences of sex development (DSDs) have complex anatomy and surgical needs related to both Mullerian and non-Mullerian structures. Approaches to vaginal reconstruction for these conditions are guided by individual anatomy, with the goal of establishing unobstructed outflow for the reproductive, urinary, and gastrointestinal tracts. Patients may have anatomy requiring vaginoplasty for either outflow tract obstruction or chosen sexual function. In this article, the authors focus on management of differences in vaginal anatomy with delayed vaginoplasty for the newborn with DSD.
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Affiliation(s)
- Brielle Ochoa
- Department of Surgery, Phoenix Children's, 1919 E. Thomas Road, Phoenix, AZ 85016, USA
| | - Erica M Weidler
- Department of Surgery, Phoenix Children's, 1919 E. Thomas Road, Phoenix, AZ 85016, USA
| | - Melissa A Parks
- Department of Gynecology, Phoenix Children's, 1919 E. Thomas Road, Phoenix, AZ 85016, USA
| | - Karen Elizabeth Speck
- Department of Surgery, Division of Pediatric Surgery, University of Michigan, 1540 E. Hospital Drive, SPC 4211, Ann Arbor, MI 48109, USA
| | - Kathleen van Leeuwen
- Department of Surgery, Phoenix Children's, 1919 E. Thomas Road, Phoenix, AZ 85016, USA.
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Olivera-Bernal GC, De Ita-Ley M, Ricárdez-Marcial EF, Garduño-Zarazúa LM, González-Cuevas ÁR, Sepúlveda-Robles OA, Huicochea-Montiel JC, Cárdenas-Conejo A, Santana-Díaz L, Rosas-Vargas H. Cytogenomic description of a Mexican cohort with differences in sex development. Mol Cytogenet 2024; 17:16. [PMID: 39010086 PMCID: PMC11251293 DOI: 10.1186/s13039-024-00685-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2024] [Accepted: 06/26/2024] [Indexed: 07/17/2024] Open
Abstract
BACKGROUND Differences in Sex Development (DSD) is a heterogeneous group of congenital alterations that affect inner and/or outer primary sex characters. Although these conditions do not represent a mortality risk, they can have a severe psycho-emotional impact if not appropriately managed. The genetic changes that can give rise to DSD are diverse, from chromosomal alterations to single base variants involved in the sexual development network. Epidemiological studies about DSD indicate a global frequency of 1:4500-5500, which can increase to 1:200-300, including isolated anatomical defects. To our knowledge, this study is the first to describe epidemiological and genetic features of DSD in a cohort of Mexican patients of a third-level care hospital. METHODS Descriptive and retrospective cross-sectional study that analyzed DSD patients from 2015 to 2021 attended a Paediatric Hospital from Mexico City. RESULTS One hundred one patients diagnosed with DSD were registered and grouped into different entities according to the Chicago consensus statement and the diagnosis defined by the multidisciplinary group. Of the total, 54% of them belong to the chromosomal DSD classification, 16% belongs to 46, XX and 30% of them belongs to the 46, XY classification. CONCLUSION The frequency for chromosomal DSDs was consistent with the literature; however, we found that DSD 46, XY is more frequent in our cohort, which may be due to the age of the patients captured, the characteristics of our study population, or other causes that depend on the sample size.
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Affiliation(s)
- Grecia C Olivera-Bernal
- Medical Research Unit in Human Genetics, Instituto Mexicano del Seguro Social (IMSS)/Hospital de Pediatría, Centro Médico Nacional SXXI, Ave. Cuauhtémoc 330, 06720, Mexico City, Mexico
| | - Marlon De Ita-Ley
- Medical Research Unit in Human Genetics, Instituto Mexicano del Seguro Social (IMSS)/Hospital de Pediatría, Centro Médico Nacional SXXI, Ave. Cuauhtémoc 330, 06720, Mexico City, Mexico
- Department of Genetics and Molecular Biology, Centro de Investigación y de Estudios Avanzados, Instituto Politécnico Nacional, Mexico City, Mexico
| | - Edgar F Ricárdez-Marcial
- Department of Genetics, Instituto Mexicano del Seguro Social (IMSS)/Hospital General Centro Médico Nacional "La Raza", Mexico City, Mexico
| | - Luz María Garduño-Zarazúa
- Medical Research Unit in Human Genetics, Instituto Mexicano del Seguro Social (IMSS)/Hospital de Pediatría, Centro Médico Nacional SXXI, Ave. Cuauhtémoc 330, 06720, Mexico City, Mexico
| | - Ángel Ricardo González-Cuevas
- Medical Research Unit in Human Genetics, Instituto Mexicano del Seguro Social (IMSS)/Hospital de Pediatría, Centro Médico Nacional SXXI, Ave. Cuauhtémoc 330, 06720, Mexico City, Mexico
| | - Omar A Sepúlveda-Robles
- Medical Research Unit in Human Genetics, Instituto Mexicano del Seguro Social (IMSS)/Hospital de Pediatría, Centro Médico Nacional SXXI, Ave. Cuauhtémoc 330, 06720, Mexico City, Mexico
| | - Juan Carlos Huicochea-Montiel
- Department of Paediatric Genetics, Instituto Mexicano del Seguro Social (IMSS)/Hospital de Pediatría, Centro Médico Nacional S XXI, Mexico City, Mexico
| | - Alan Cárdenas-Conejo
- Department of Paediatric Genetics, Instituto Mexicano del Seguro Social (IMSS)/Hospital de Pediatría, Centro Médico Nacional S XXI, Mexico City, Mexico
| | - Laura Santana-Díaz
- Department of Genetics, Instituto Mexicano del Seguro Social (IMSS)/Hospital General Centro Médico Nacional "La Raza", Mexico City, Mexico
| | - Haydeé Rosas-Vargas
- Medical Research Unit in Human Genetics, Instituto Mexicano del Seguro Social (IMSS)/Hospital de Pediatría, Centro Médico Nacional SXXI, Ave. Cuauhtémoc 330, 06720, Mexico City, Mexico.
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Aversa T, De Sanctis L, Faienza MF, Gambineri A, Balducci A, D'Aprile R, Di Somma C, Giavoli C, Grossi A, Meriggiola MC, Profka E, Salerno M, Stagi S, Scarano E, Zatelli MC, Wasniewska M. Transition from pediatric to adult care in patients with Turner syndrome in Italy: a consensus statement by the TRAMITI project. J Endocrinol Invest 2024; 47:1585-1598. [PMID: 38376731 PMCID: PMC11196323 DOI: 10.1007/s40618-024-02315-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/04/2023] [Accepted: 01/11/2024] [Indexed: 02/21/2024]
Abstract
PURPOSE Transition from pediatric to adult care is associated with significant challenges in patients with Turner syndrome (TS). The objective of the TRansition Age Management In Turner syndrome in Italy (TRAMITI) project was to improve the care provided to patients with TS by harnessing the knowledge and expertise of various Italian centers through a Delphi-like consensus process. METHODS A panel of 15 physicians and 1 psychologist discussed 4 key domains: transition and referral, sexual and bone health and oncological risks, social and psychological aspects and systemic and metabolic disorders. RESULTS A total of 41 consensus statements were drafted. The transition from pediatric to adult care is a critical period for patients with TS, necessitating tailored approaches and early disclosure of the diagnosis to promote self-reliance and healthcare autonomy. Fertility preservation and bone health strategies are recommended to mitigate long-term complications, and psychiatric evaluations are recommended to address the increased prevalence of anxiety and depression. The consensus also addresses the heightened risk of metabolic, cardiovascular and autoimmune disorders in patients with TS; regular screenings and interventions are advised to manage these conditions effectively. In addition, cardiac abnormalities, including aortic dissections, require regular monitoring and early surgical intervention if certain criteria are met. CONCLUSIONS The TRAMITI consensus statement provides valuable insights and evidence-based recommendations to guide healthcare practitioners in delivering comprehensive and patient-centered care for patients with TS. By addressing the complex medical and psychosocial aspects of the condition, this consensus aims to enhance TS management and improve the overall well-being and long-term outcomes of these individuals.
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Affiliation(s)
- T Aversa
- Department of Human Pathology of Adulthood and Childhood, University of Messina, Messina, Italy
- Pediatric Unit, University Hospital "G. Martino", Via Consolare Valeria N. 1, 98124, Messina, Italy
| | - L De Sanctis
- Pediatric Endocrinology, Regina Margherita Children Hospital, Turin, Italy
- Department of Public Health and Pediatric Sciences, University of Turin, Turin, Italy
| | - M F Faienza
- Department of Precision and Regenerative Medicine and Ionian Area, University of Bari "Aldo Moro", 70124, Bari, Italy
| | - A Gambineri
- Division of Endocrinology and Diabetes Prevention and Care, Department of Medical and Surgical Sciences (DIMEC), IRCCS Azienda Ospedaliero - Universitaria di Bologna, Bologna, Italy
| | - A Balducci
- Pediatric Cardiology and Adult Congenital Heart Disease Program, Department of Cardio - Thoracic and Vascular Medicine, IRCCS Azienda Ospedaliero - Universitaria Di Bologna, Bologna, Italy
| | - R D'Aprile
- Department of Women's and Children's Health, University of Padua, Padua, Italy
- A.Fa.D.O.C. Association OdV, Vicenza, Italy
| | - C Di Somma
- Unit of Endocrinology, AOU Federico II, Naples, Italy
| | - C Giavoli
- Endocrinology Unit, Fondazione IRCCS Cà Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - A Grossi
- Endocrine Pathology of Chronic and Post-Tumor Diseases Unit, "Bambino Gesù" Pediatric Hospital, Rome, Italy
| | - M C Meriggiola
- Division of Gynecology and Physiopathology of Reproduction, Department of Medical and Surgical Sciences (DIMEC), IRCCS Azienda Ospedaliero - Universitaria di Bologna, Bologna, Italy
| | - E Profka
- Endocrinology Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - M Salerno
- Pediatric Section, Department of Translational Medical Sciences, University of Naples Federico II, Naples, Italy
| | - S Stagi
- Health Sciences Department, University of Florence, Florence, Italy
- Meyer Children's Hospital IRCCS, Florence, Italy
| | - E Scarano
- Pediatric Unit, IRCCS Azienda Ospedaliero - Universitaria di Bologna, Bologna, Italy
| | - M C Zatelli
- Section of Endocrinology, Geriatrics and Internal Medicine, Department of Medical Sciences, University of Ferrara, Ferrara, Italy
| | - M Wasniewska
- Department of Human Pathology of Adulthood and Childhood, University of Messina, Messina, Italy.
- Pediatric Unit, University Hospital "G. Martino", Via Consolare Valeria N. 1, 98124, Messina, Italy.
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Rosen JN, Finlayson C, Papadakis JL, Grabaowksi J, Laronda MM, Rowell EE, Wadhwani N, Weisman AG, Johnson EK. Turner Syndrome With Y Chromosome and Germ Cells: A Case Report Highlighting the Need to Prioritize Individualized Care. Urology 2024:S0090-4295(24)00412-6. [PMID: 38825087 DOI: 10.1016/j.urology.2024.05.020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2024] [Accepted: 05/20/2024] [Indexed: 06/04/2024]
Abstract
Turner syndrome (TS) is a genetic condition in phenotypic females in which the individual has 1 intact X chromosome and the second sex chromosome is absent or structurally altered Components of Y chromosome (eg, 45,X/46,XY) have been found in 5%-15% of patients with TS; these patients are often referred to as having "Turner syndrome with Y" (TS+Y). The presence of Y chromosome material increases risk for development of gonadal tumors. Historically, prophylactic gonadectomy has been recommended in this population to prevent malignancy, and patients were presumed infertile due to the presence of streak gonads with no germ cells (GCs). More recently, studies have reported on spontaneous puberty and menarche in TS+Y patients suggesting the presence of viable GC and ovarian function. Our institution offers patients with TS+Y the option of experimental gonadal tissue cryopreservation (GTC) at the time of gonadectomy. We present a unique case of a young girl with TS+Y who had GCs present in her gonads and underwent experimental GTC at the time of gonadectomy.
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Affiliation(s)
- Jennifer N Rosen
- Division of Pediatric Urology, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, IL; Department of Urology, Northwestern University Feinberg School of Medicine, Chicago, IL
| | - Courtney Finlayson
- Division of Pediatric Endocrinology, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, IL; Department of Pediatrics, Northwestern University Feinberg School of Medicine, Chicago, IL
| | - Jaclyn L Papadakis
- Pritzker Department of Psychiatry and Behavioral Health, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, IL; Department of Psychiatry and Behavioral Sciences, Northwestern University Feinberg School of Medicine, Chicago, IL
| | - Julia Grabaowksi
- Division of Pediatric Surgery, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, IL; Department of Surgery, Northwestern University Feinberg School of Medicine, Chicago, IL
| | - Monica M Laronda
- Division of Pediatric Endocrinology, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, IL; Division of Pediatric Surgery, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, IL; Department of Pediatrics, Northwestern University Feinberg School of Medicine, Chicago, IL; Department of Obstetrics and Gynecology, Northwestern University Feinberg School of Medicine, Chicago, IL; Stanley Manne Children's Research Institute, Chicago, IL
| | - Erin E Rowell
- Division of Pediatric Surgery, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, IL; Department of Surgery, Northwestern University Feinberg School of Medicine, Chicago, IL
| | - Nitin Wadhwani
- Division of Pathology and Laboratory Medicine, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, IL; Department of Pathology Northwestern University Feinberg School of Medicine, Chicago, IL
| | - Allison Goetsch Weisman
- Division of Pediatric Endocrinology, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, IL; Division of Genetics, Genomics & Metabolism, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, IL; Department of Pediatrics, Northwestern University Feinberg School of Medicine, Chicago, IL
| | - Emilie K Johnson
- Division of Pediatric Urology, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, IL; Department of Urology, Northwestern University Feinberg School of Medicine, Chicago, IL.
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Gomes I, Jesus-Ribeiro J, Abuhaiba SI, Bento C, Teotónio R. Frontal lobe epilepsy in a patient with mosaic Turner syndrome. Epileptic Disord 2023; 25:787-790. [PMID: 37559190 DOI: 10.1002/epd2.20138] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2022] [Revised: 07/08/2023] [Accepted: 07/14/2023] [Indexed: 08/11/2023]
Affiliation(s)
- Inês Gomes
- Neurology, Centro Hospitalar e Universitário de Coimbra, Coimbra, Portugal
| | - Joana Jesus-Ribeiro
- Neurology, Centro Hospitalar de Leiria, Leiria, Portugal
- Center of Investigation on Environment, Genetics, and Oncobiology (CIMAGO), Faculty of Medicine, University of Coimbra, Coimbra, Portugal
| | - Sulaiman I Abuhaiba
- Institute of Nuclear Sciences of Applied Health Sciences, University of Coimbra, Coimbra, Portugal
- CIBIT Coimbra Institute for Biomedical Imaging and Translational Research, Coimbra, Portugal
| | - Conceição Bento
- Neurology, Centro Hospitalar e Universitário de Coimbra, Coimbra, Portugal
- Epilepsy and Sleep Monitoring Unit, Neurology Department, Coimbra University Hospital Center, Coimbra, Portugal
| | - Rute Teotónio
- Neurology, Centro Hospitalar e Universitário de Coimbra, Coimbra, Portugal
- Epilepsy and Sleep Monitoring Unit, Neurology Department, Coimbra University Hospital Center, Coimbra, Portugal
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Ching AS, Zhang X, Furuya KN, Benoy ME, Bartlett HL. Turner syndrome may be associated with hepatic adenoma. Am J Med Genet A 2023; 191:2578-2584. [PMID: 37431210 DOI: 10.1002/ajmg.a.63341] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2022] [Revised: 04/12/2023] [Accepted: 06/09/2023] [Indexed: 07/12/2023]
Abstract
Turner syndrome, caused by complete or partial loss of an X chromosome, is marked by a range of clinical manifestations including short stature, cardiovascular and renal disease. Hepatic involvement is an increasingly recognized concern. Steatosis and elevated transaminases are commonly observed in this population, but case reports have also described hepatic adenoma. Hepatic adenomas are rare, occurring in one per million people in the general population. They are typically benign but malignant transformation or rupture can occur. We sought to investigate whether Turner syndrome is associated with hepatic adenoma. Patients with Turner syndrome encountered at a single, academic institution between 2006 and 2020 were identified using ICD-10 codes and demographic, medication, laboratory, and imaging data were analyzed. Of the 228 patients identified, 46.9% had liver function testing, which were abnormal in 48.6%. Five of 77 patients with hepatic imaging had abnormalities. Three patients (1.3%) had hepatic adenoma, one after presenting in hemorrhagic shock due to rupture. These findings suggest that patients with Turner syndrome may have an increased risk for developing hepatic adenoma. Annual monitoring of liver function tests is already recommended in Turner syndrome. The addition of periodic hepatic imaging may also be beneficial.
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Affiliation(s)
- Alisha S Ching
- Department of Pediatrics, University of Wisconsin - Madison, Madison, Wisconsin, USA
| | - Xiao Zhang
- Department of Pediatrics, University of Wisconsin - Madison, Madison, Wisconsin, USA
| | - Katryn N Furuya
- Department of Pediatrics, University of Wisconsin - Madison, Madison, Wisconsin, USA
| | - Megan E Benoy
- Department of Pediatrics, University of Wisconsin - Madison, Madison, Wisconsin, USA
| | - Heather L Bartlett
- Department of Pediatrics, University of Wisconsin - Madison, Madison, Wisconsin, USA
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Ritchie F, Macgill K, Cairney D, Kiff S, Miles H, Gillett PM. Turner Syndrome Mosaicism after Diagnosis of Coeliac Disease-A High Index of Clinical Suspicion Required? MEDICINA (KAUNAS, LITHUANIA) 2023; 59:1693. [PMID: 37763812 PMCID: PMC10535906 DOI: 10.3390/medicina59091693] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/23/2023] [Revised: 08/30/2023] [Accepted: 09/05/2023] [Indexed: 09/29/2023]
Abstract
The association of coeliac disease (CD) in girls with Turner syndrome (TS) is well described. There is, however, a paucity of current research describing TS in patients with known CD. We report two cases of mosaic Turner syndrome diagnosed in girls with CD who failed to achieve expected catch-up growth despite strict adherence to a gluten-free diet (GFD) and the normalisation of TGA-IgA levels. We highlight the need to consider additional diagnoses in patients with CD and ongoing faltering growth. In such patients, referral to a paediatric endocrinologist and relevant investigations, including genetic investigations, should be considered if growth remains suboptimal after one year with a GFD. First-line investigations should include thyroid function, IGF-1, cortisol, gonadotrophins, oestrogen/testosterone, prolactin, karyotype and a bone age X-ray. Clinical suspicion in this situation is key, as an early diagnosis of TS will allow timely treatment with growth hormone, inform discussion around ovarian function and allow screening for important TS associations.
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Affiliation(s)
- F Ritchie
- Departments of Paediatric Endocrinology, Royal Hospital for Children and Young People, 50 Little France Crescent, Edinburgh EH16 4TJ, UK
| | - K Macgill
- Departments of Gastroenterology, Royal Hospital for Children and Young People, 50 Little France Crescent, Edinburgh EH16 4TJ, UK
| | - D Cairney
- Departments of Gastroenterology, Royal Hospital for Children and Young People, 50 Little France Crescent, Edinburgh EH16 4TJ, UK
| | - S Kiff
- Departments of Paediatric Endocrinology, Royal Hospital for Children and Young People, 50 Little France Crescent, Edinburgh EH16 4TJ, UK
| | - H Miles
- Departments of Paediatric Endocrinology, Royal Hospital for Children and Young People, 50 Little France Crescent, Edinburgh EH16 4TJ, UK
| | - P M Gillett
- Departments of Gastroenterology, Royal Hospital for Children and Young People, 50 Little France Crescent, Edinburgh EH16 4TJ, UK
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Rodriguez-Buritica D, Mones M, Prakash SK, Rivera M, Aldrich M, Rogge M, Richardson K. Dermatological concerns for women and girls with turner syndrome. Front Med (Lausanne) 2023; 10:1235187. [PMID: 37780576 PMCID: PMC10533914 DOI: 10.3389/fmed.2023.1235187] [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] [Received: 06/05/2023] [Accepted: 08/23/2023] [Indexed: 10/03/2023] Open
Abstract
Introduction Turner syndrome (TS) is associated with distinct manifestations in women and girls including short stature, cardiac abnormalities, premature ovarian failure as well as dermatological features, including lymphedema, keloids, onychodystrophy, and acne. Although many dermatological concerns present during the first few decades of life, the overwhelming majority of respondents are not provided with dermatology referrals at diagnosis. Methods This cross-sectional study utilized an author designed survey to assess self-reported dermatological manifestations, dermatology referral experience, common therapies for select dermatological conditions, as well as a validated 10-question Dermatology Life Quality Index (DLQI) to assess quality-of-life impact in women and girls with Turner syndrome. Results In our cohort, 64% (n = 149) had been referred to a dermatologist at some point in their life time. The majority of individuals self-identified their dermatological concern (79.6%) and were referred after a dermatological concern had already occurred (90.2%). The most common dermatological findings reported were xerosis cutis (78.7%), lymphedema (73%), and more than 20 acquired melanocytic nevi (70%). The overall mean DLQI score was 3.52, indicative of a small effect on the patient's life. Onychodystrophy, history of skin biopsy, and lymphedema were statistically significant to have a higher impact on quality of life. Discussion Our data reveal that skin conditions are highly prevalent in the TS population during the early decades of life and affirm utilizing these conditions in the TS diagnostic process, as well as emphasize the need for specialized dermatology referrals to address the detrimental impacts related to skin concerns on quality of life.
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Affiliation(s)
- David Rodriguez-Buritica
- Department of Pediatrics, Division of Medical Genetics, McGovern Medical School at the University of Texas Health Science Center at Houston (UTHealth Houston) and Children’s Memorial Hermann Hospital, Houston, TX, United States
- Cancer Center UTHealth Graduate School of Biomedical Sciences, Houston, TX, United States
| | - Meaghan Mones
- Cancer Center UTHealth Graduate School of Biomedical Sciences, Houston, TX, United States
| | - Siddharth K. Prakash
- Cancer Center UTHealth Graduate School of Biomedical Sciences, Houston, TX, United States
- Department of Internal Medicine, McGovern Medical School at the University of Texas Health Science Center at Houston (UTHealth Houston), Houston, TX, United States
| | - Michelle Rivera
- Cancer Center UTHealth Graduate School of Biomedical Sciences, Houston, TX, United States
- Department of Pediatrics, Division of Pediatric Endocrinology, McGovern Medical School at the University of Texas Health Science Center at Houston (UTHealth Houston) and Children’s Memorial Hermann Hospital, Houston, TX, United States
| | - Melissa Aldrich
- Cancer Center UTHealth Graduate School of Biomedical Sciences, Houston, TX, United States
- Brown Foundation Institute of Molecular Medicine, McGovern Medical School at the University of Texas Health Science Center at Houston (UTHealth Houston) and Children’s Memorial Hermann Hospital, Houston, TX, United States
| | - Megan Rogge
- Department of Dermatology, McGovern Medical School at the University of Texas Health Science Center at Houston (UTHealth Houston) and Children’s Memorial Hermann Hospital, Houston, TX, United States
| | - Kate Richardson
- Department of Pediatrics, Division of Medical Genetics, McGovern Medical School at the University of Texas Health Science Center at Houston (UTHealth Houston) and Children’s Memorial Hermann Hospital, Houston, TX, United States
- Cancer Center UTHealth Graduate School of Biomedical Sciences, Houston, TX, United States
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Granero-Molina J, Román RA, Del Mar Jiménez-Lasserrotte M, Ruiz-Fernández MD, Ventura-Miranda MI, Granero-Heredia G, Fernández-Medina IM. 'I'm still a woman': A qualitative study on sexuality in heterosexual women with Turner Syndrome. J Clin Nurs 2023; 32:6634-6647. [PMID: 37029475 DOI: 10.1111/jocn.16715] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2022] [Revised: 03/21/2023] [Accepted: 03/23/2023] [Indexed: 04/09/2023]
Abstract
AIM AND OBJECTIVES The aim of this study was to describe and understand how heterosexual women with Turner Syndrome experience sexuality. BACKGROUND Turner Syndrome is a genetic condition that is the result of one of the X chromosomes missing or partially missing, and it affects women of all ages. Turner Syndrome may lead to psychological, relational and sex life disorders. DESIGN This is a qualitative study, and the COREQ checklist was employed to report on the current study. METHODS The study was conducted in a region of southern Spain. Convenience and snowball sampling were used to recruit 18 women, aged 22-51 years, who had been diagnosed with Turner Syndrome. Participants' experiences were explored through semi-structured interviews between January and May 2021. Thematic analysis was used for data analysis. RESULTS Three main themes and eight sub-themes emerge from the data analysis: (1) Sexuality linked to corporeality, with the sub-themes: 'Discovering that your body is different', 'Social stigma limits one's sex life' and 'Fear of penetration surpresses sexual desire'. (2) Adapting one's sexuality to Turner Syndrome, with the sub-themes: 'Feeling like a woman' and 'Suffering from and adapting to comorbidities'. (3) When infertility overshadows sexuality, with the sub-themes: 'Prolonging childhood by ignoring sexuality', 'Fertility treatment: always a possibility' and 'Lack of specialised professional knowledge'. CONCLUSION Heterosexual women with Turner Syndrome suffer from sexual problems, delayed diagnosis and treatment, and lack of information. Unawareness and relational problems may also lead to scarce and late sexual relations, jealousy and a fear of being left. The women with Turner Syndrome refer to little self-exploration or masturbation as well as a fear of penetration. RELEVANCE TO CLINICAL PRACTICE Understanding the experiences of sexuality in heterosexual women with Turner Syndrome is a challenge for clinical nurses, who could provide quality care to these women in contextualised services.
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Affiliation(s)
- José Granero-Molina
- Department of Nursing, Physiotherapy and Medicine, University of Almeria, Almeria, Spain
- Faculty of Health Sciences, Universidad Autónoma de Chile, Santiago de Chile, Chile
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10
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Deferring gonadectomy in patients with turner syndrome with a genetic Y component is not a safe practice. J Pediatr Urol 2023:S1477-5131(22)00589-7. [PMID: 36740540 DOI: 10.1016/j.jpurol.2022.12.012] [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: 07/21/2022] [Revised: 11/04/2022] [Accepted: 12/19/2022] [Indexed: 01/12/2023]
Abstract
INTRODUCTION Patients with Turner syndrome who harbor Y chromosome material are known to be at increased risk of developing germ cell neoplasms. The optimal timing to perform gonadectomy to reduce the risk of cancer development in these patients is not well defined. We present outcomes of Turner with a Y component (TSY) patients who underwent gonadectomy at our institution. HYPOTHESIS/OBJECTIVE We hypothesized that tumors could occur in a significant portion of TSY patients at any age and gonadectomy can be safely performed at diagnosis rather than deferred. STUDY DESIGN We performed an IRB-approved retrospective single center study in which we queried our institutions electronic health record to identify all patients with TSY who underwent gonadectomy at our institution from 2012 to 2021. RESULTS In our series of 18 consecutive TSY patients, a tumor was identified in 6 patients (33.3%): 4 (22.2%) with dysgerminoma (DG) [Fig. 1] and 2 (11.1%) with gonadoblastoma (GB). DISCUSSION Our cohort of 18 consecutive TSY who underwent gonadectomy over a 9-year period is the largest published single site cohort to date. Additionally, our patient who was found to have GB at 40 days is to our knowledge the youngest TSY patient to be diagnosed with GB in the literature. This patient's remarkably early incidence of tumor occurrence illustrates the urgency of protective gonadectomy. Given the high incidence of tumor formation in this population and the minimal morbidity associated with gonadectomy, we do not recommend delaying gonadectomy in this population for any reason. Our study is vulnerable to selection bias and confounding innate to any retrospective study. There was variation with respect to the frequency and timing of pre-operative imaging as a strict preoperative imaging protocol with sequential studies was not in place at our institution. Additionally, we do not have a comparison cohort of patients who are being followed without operative intervention as all TSY patients at our institution have undergone gonadectomy. CONCLUSION TSY patients cannot be safely observed for tumor formation based on clinical factors such as imaging or age. Gonadectomy is safe with a low complication rate and without tumor recurrence during three-year follow-up. We continue to recommend bilateral gonadectomy in this patient population at the time of diagnosis.
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11
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Mediå LM, Fauske L, Sigurdardottir S, Feragen KJB, Heggeli C, Wæhre A. ‘It was Supposed to be a Secret’: a study of disclosure and stigma as experienced by adults with differences of sex development. Health Psychol Behav Med 2022; 10:579-595. [PMID: 35898596 PMCID: PMC9310795 DOI: 10.1080/21642850.2022.2102018] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022] Open
Affiliation(s)
- Line Merete Mediå
- Women and Children’s Division, Centre for Rare Disorders, Oslo University Hospital, Oslo, Norway
- Department of Interdisciplinary Health Sciences, Institute of Health and Society, University of Oslo, Oslo, Norway
| | - Lena Fauske
- Department of Interdisciplinary Health Sciences, Institute of Health and Society, University of Oslo, Oslo, Norway
- Department of Oncology, Norwegian Radium Hospital, Oslo University Hospital, Oslo, Norway
| | - Solrun Sigurdardottir
- Women and Children’s Division, Centre for Rare Disorders, Oslo University Hospital, Oslo, Norway
| | | | - Charlotte Heggeli
- Women and Children’s Division, Centre for Rare Disorders, Oslo University Hospital, Oslo, Norway
- Educational Psychology Service, Tonsberg Municipality, Tonsberg, Norway
| | - Anne Wæhre
- Department of Child and Adolescent Psychiatry, Oslo University Hospital and Institute of Clinical Medicine, Oslo, Norway
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12
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Almoshantaf MB, Swed S, Ezzdean W, Kashkash F, Ghaith HS, Sawaf B, Motawea KR. A rare coincidence of Turner syndrome and bronchiectasis: A case report. Clin Case Rep 2022; 10:e6378. [PMID: 36188039 PMCID: PMC9500422 DOI: 10.1002/ccr3.6378] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2022] [Revised: 08/19/2022] [Accepted: 08/29/2022] [Indexed: 11/09/2022] Open
Abstract
Similar to bronchiectasis, Turner syndrome is possible to have more pathological manifestations or etiologies than what has already been documented. Slower recovery process is expected when treating a patient with several comorbidities like Turner syndrome. Turner syndrome patients are vulnerable and should be extensively monitored to lower late presentation rates.
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Affiliation(s)
| | - Sarya Swed
- Faculty of MedicineAleppo UniversityAleppoSyria
| | - Weaam Ezzdean
- Department of UrologyIbn Al‐Nafess HospitalDamascusSyria
| | - Fateh Kashkash
- Department of PulmonologyAleppo University HospitalAleppoSyria
| | | | - Bisher Sawaf
- Department of Internal MedicineHamad Medical CorporationDohaQatar
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13
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Fedor I, Zold E, Barta Z. Liver abnormalities in Turner’s syndrome – the importance of estrogen replacement. J Endocr Soc 2022; 6:bvac124. [PMID: 36111277 PMCID: PMC9469926 DOI: 10.1210/jendso/bvac124] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/23/2022] [Indexed: 12/02/2022] Open
Abstract
Turner syndrome is one of the most frequently reported sex chromosomal abnormalities, affecting approximately 40 in every 100 000 live female births. The underlying chromosomal alteration is the complete or partial loss of X chromosome or mosaicism. Because of primary ovarian insufficiency, the synthesis of estrogen hormones is compromised, and patients require hormone substitution. Apart from the phenotypical presentation (short stature, primary amenorrhea), the effects of ovarian insufficiency can affect diverse organ systems (such as cardiovascular, endocrine, and lymphatic systems). Hepatobiliary pathology can present on a broad spectrum: from mild asymptomatic hypertransaminasemia to marked architectural changes. Estrogen hormone replacement therapy in these patients can improve the perturbations of laboratory values and can attenuate the progression of hepatic structural changes. Moreover, providing sufficient estrogen replacement has numerous benefits for other conditions of the patients as well. Both the all-cause mortality and deaths from cardiovascular complications are greatly increased in Turner syndrome, and hormone replacement might contribute to the decreased incidence of these events. The diagnostics of Turner syndrome are outside the scope of our paper, and we briefly discuss the cardiovascular complications because many the liver involvement partially involves alterations of vascular origin. Though we sought to highlight the importance of proper hormone replacement therapy, we did not attempt to write a comprehensive recommendation for exact treatment protocols. We provided an overview of preferred therapeutic approaches, as the treatment should be tailored according to the individual patient’s needs.
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Affiliation(s)
- Istvan Fedor
- Department of Public Health and Epidemiology, Faculty of Medicine, University of Debrecen , Debrecen, Hungary
- Department of Clinical Immunology, Doctoral School of Clinical Immunology and Allergology, Institute of Internal Medicine, Faculty of Medicine, University of Debrecen , Hungary
| | - Eva Zold
- Department of Clinical Immunology, Doctoral School of Clinical Immunology and Allergology, Institute of Internal Medicine, Faculty of Medicine, University of Debrecen , Hungary
| | - Zsolt Barta
- GI Unit, Department of Infectology, Doctoral School of Clinical Immunology and Allergology, Faculty of Medicine, University of Debrecen , Hungary
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Abstract
Growth hormone (GH) is an injectable medication originally used to replace the deficiency of the hormone, but has expanded to treating conditions that may reduce growth and adult height even when the body maintains endogenous GH production. In the United States, there are 8 Food and Drug Administration (FDA)-approved indications for pediatric GH therapy: GH deficiency, Prader-Willi Syndrome, small for gestational age (SGA) without catch-up growth, idiopathic short stature, Turner syndrome, SHOX gene haploinsufficiency, Noonan Syndrome, and chronic renal insufficiency. We characterize the growth patterns and effects of GH treatment in each of these indications. We also review patterns of growth that warrant referral to a pediatric endocrinologist, as well as safety updates. This review is intended to guide practitioners on the initial evaluation and management of patients with short stature, and the indications for GH therapy.
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Affiliation(s)
- Melinda Danowitz
- CHOP Division of Pediatric Endocrinology, Abramson Building, Office 804F, 3401 Civic Center Boulevard, Philadelphia, PA 19104, USA
| | - Adda Grimberg
- Children's Hospital of Philadelphia, The Hub for Clinical Collaboration, Division of Endocrinology, 7th floor, 3500 Civic Center Boulevard, Philadelphia, PA 19104, USA; Department of Pediatrics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA.
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15
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Abstract
PURPOSE OF REVIEW Turner syndrome is the most common sex chromosome abnormality in female individuals, affecting 1/2000-1/2500 female newborns. Despite the high incidence of this condition, the mechanisms underlying the development of multiorgan dysfunction have not been elucidated. RECENT FINDINGS Clinical features involve multiple organ systems and include short stature, dysmorphic facial features, delayed puberty and gonadal failure, cardiac and renal abnormalities, audiologic abnormalities, and a high prevalence of endocrine and autoimmune disorders. Paucity of available genotype/phenotype correlation limits the ability of clinicians to provide accurate guidance and management. Given the advent of robust genetic testing and analysis platforms, developments in the genetic basis of disease are materializing at a rapid pace. SUMMARY The objective of this review is to highlight the recent advances in knowledge and to provide a framework with which to apply new data to the foundational understanding of the condition.
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16
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Lucien JN, Ortega MT, Calvert ME, Smith C, White X, Rogers H, Mosley B, Agrawal R, Drude A, McGee C, George M, Brown A, Downey K, Wild C, Njunge A, Kuzmiak CM, Zava D, Zava T, Pollard J, Francis J, Beery BL, Harlin M, Gonzalez GR, Shaw ND. The Launch of A Girl's First Period Study: Demystifying Reproductive Hormone Profiles in Adolescent Girls. J Pediatr Adolesc Gynecol 2022; 35:420-425. [PMID: 35031446 PMCID: PMC9271526 DOI: 10.1016/j.jpag.2021.12.018] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/02/2021] [Revised: 12/17/2021] [Accepted: 12/31/2021] [Indexed: 01/01/2023]
Abstract
Limited data exist on the reproductive hormone dynamics that govern the transition from menarche to the establishment of the mature ovulatory cycles of a fertile young woman. It is also unclear how environmental and lifestyle factors could modulate this transition in contemporary girls. Here, we introduce A Girl's First Period Study, an ambitious longitudinal study aimed at charting the early post-menarchal course of a cohort of healthy girls in the Triangle region of North Carolina.
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Affiliation(s)
- Janet N Lucien
- Clinical Research Branch, National Institute of Environmental Health Sciences, National Institutes of Health, Research Triangle Park, North Carolina; Division of Pediatric Endocrinology, University of North Carolina School of Medicine, Chapel Hill, North Carolina.
| | - Madison T Ortega
- Clinical Research Branch, National Institute of Environmental Health Sciences, National Institutes of Health, Research Triangle Park, North Carolina
| | - Madison E Calvert
- Clinical Research Branch, National Institute of Environmental Health Sciences, National Institutes of Health, Research Triangle Park, North Carolina
| | - Cynthia Smith
- Clinical Research Branch, National Institute of Environmental Health Sciences, National Institutes of Health, Research Triangle Park, North Carolina
| | - Xiomara White
- Clinical Research Branch, National Institute of Environmental Health Sciences, National Institutes of Health, Research Triangle Park, North Carolina
| | - Heidi Rogers
- Clinical Research Branch, National Institute of Environmental Health Sciences, National Institutes of Health, Research Triangle Park, North Carolina
| | - Brittany Mosley
- Clinical Research Branch, National Institute of Environmental Health Sciences, National Institutes of Health, Research Triangle Park, North Carolina
| | - Ruhani Agrawal
- Clinical Research Branch, National Institute of Environmental Health Sciences, National Institutes of Health, Research Triangle Park, North Carolina
| | - Anna Drude
- Clinical Research Branch, National Institute of Environmental Health Sciences, National Institutes of Health, Research Triangle Park, North Carolina
| | - Christopher McGee
- Clinical Research Branch, National Institute of Environmental Health Sciences, National Institutes of Health, Research Triangle Park, North Carolina
| | - Margaret George
- Clinical Research Branch, National Institute of Environmental Health Sciences, National Institutes of Health, Research Triangle Park, North Carolina
| | - Audrey Brown
- Clinical Research Branch, National Institute of Environmental Health Sciences, National Institutes of Health, Research Triangle Park, North Carolina
| | - Kimberly Downey
- Clinical Research Branch, National Institute of Environmental Health Sciences, National Institutes of Health, Research Triangle Park, North Carolina
| | - Catherine Wild
- Clinical Research Branch, National Institute of Environmental Health Sciences, National Institutes of Health, Research Triangle Park, North Carolina
| | - Alexander Njunge
- Clinical Research Branch, National Institute of Environmental Health Sciences, National Institutes of Health, Research Triangle Park, North Carolina
| | - Cherie M Kuzmiak
- Department of Radiology, University of North Carolina School of Medicine, Chapel Hill, North Carolina
| | | | | | - Jenny Pollard
- Clinical Research Branch, National Institute of Environmental Health Sciences, National Institutes of Health, Research Triangle Park, North Carolina
| | - Julie Francis
- Clinical Research Branch, National Institute of Environmental Health Sciences, National Institutes of Health, Research Triangle Park, North Carolina
| | - Breana L Beery
- Clinical Research Branch, National Institute of Environmental Health Sciences, National Institutes of Health, Research Triangle Park, North Carolina
| | - Margaret Harlin
- Clinical Research Branch, National Institute of Environmental Health Sciences, National Institutes of Health, Research Triangle Park, North Carolina
| | - Gladys Ruby Gonzalez
- Clinical Research Branch, National Institute of Environmental Health Sciences, National Institutes of Health, Research Triangle Park, North Carolina
| | - Natalie D Shaw
- Clinical Research Branch, National Institute of Environmental Health Sciences, National Institutes of Health, Research Triangle Park, North Carolina.
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17
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Gutierrez J, Davis BA, Nevonen KA, Ward S, Carbone L, Maslen CL. DNA Methylation Analysis of Turner Syndrome BAV. Front Genet 2022; 13:872750. [PMID: 35711915 PMCID: PMC9194862 DOI: 10.3389/fgene.2022.872750] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2022] [Accepted: 04/13/2022] [Indexed: 11/30/2022] Open
Abstract
Turner Syndrome (TS) is a rare cytogenetic disorder caused by the complete loss or structural variation of the second sex chromosome. The most common cause of early mortality in TS results from a high incidence of left-sided congenital heart defects, including bicuspid aortic valve (BAV), which occurs in about 30% of individuals with TS. BAV is also the most common congenital heart defect in the general population with a prevalence of 0.5-2%, with males being three-times more likely to have a BAV than females. TS is associated with genome-wide hypomethylation when compared to karyotypically normal males and females. Alterations in DNA methylation in primary aortic tissue are associated with BAV in euploid individuals. Here we show significant differences in DNA methylation patterns associated with BAV in TS found in peripheral blood by comparing TS BAV (n = 12), TS TAV (n = 13), and non-syndromic BAV (n = 6). When comparing TS with BAV to TS with no heart defects we identified a differentially methylated region encompassing the BAV-associated gene MYRF, and enrichment for binding sites of two known transcription factor contributors to BAV. When comparing TS with BAV to euploid women with BAV, we found significant overlapping enrichment for ChIP-seq transcription factor targets including genes in the NOTCH1 pathway, known for involvement in the etiology of non-syndromic BAV, and other genes that are essential regulators of heart valve development. Overall, these findings suggest that altered DNA methylation affecting key aortic valve development genes contributes to the greatly increased risk for BAV in TS.
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Affiliation(s)
- Jacob Gutierrez
- Department of Medical Informatics and Clinical Epidemiology, Oregon Health and Science University, Portland, OR, United States
| | - Brett A. Davis
- Department of Medical Informatics and Clinical Epidemiology, Oregon Health and Science University, Portland, OR, United States
| | - Kimberly A. Nevonen
- Department of Medical Informatics and Clinical Epidemiology, Oregon Health and Science University, Portland, OR, United States
| | - Samantha Ward
- Department of Medical Informatics and Clinical Epidemiology, Oregon Health and Science University, Portland, OR, United States
| | - Lucia Carbone
- Department of Medical Informatics and Clinical Epidemiology, Oregon Health and Science University, Portland, OR, United States
- Department of Medicine, Oregon Health and Science University, Portland, OR, United States
- Department of Molecular and Medical Genetics, Oregon Health and Science University, Portland, OR, United States
- Division of Genetics, Oregon National Primate Research Center, Beaverton, OR, United States
| | - Cheryl L. Maslen
- Knight Cardiovascular Institute, Oregon Health and Science University, Portland, OR, United States
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18
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Dong D, Wang H, Chen L, Wang W, Liu T. Hormone Therapy: A Potential Risk Factor Affecting Survival and Functional Restoration of Transplanted Lymph Nodes. Front Pharmacol 2022; 13:853859. [PMID: 35431925 PMCID: PMC9008310 DOI: 10.3389/fphar.2022.853859] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2022] [Accepted: 03/09/2022] [Indexed: 11/16/2022] Open
Abstract
Background: Transplantation of lymph nodes (LNs) is an increasingly popular option for treating lymphedema. Increasing evidence indicates an intrinsic correlation between estrogen signaling and the lymphatic system. We explored the effects of 17β estradiol and antiestrogen treatment (tamoxifen) on the survival and functional restoration of transplanted popliteal lymph nodes (PLNs). Methods: A total of forty-eight ovariectomized mice were divided into three groups of 16: OVX + E2 (treated with 17β-estradiol), OVX + TMX (treated with tamoxifen), and OVX (control; treated with olive oil as a solvent). After 2 weeks, PLNs were transplanted. Then, reconnections of lymphatic vessels were observed, and the morphology and survival of transplanted PLNs were evaluated 4 weeks after transplantation. T cells, B cells, lymphatic vessels, and high endothelial venules (HEVs) were subjected to immunofluorescence staining or immunohistochemical staining and quantified. Results: The percentage of lymphatic reconnections was 93.75% in the OVX + E2 group, 68.75% in the OVX + TMX group, and 75% in the OVX group. Surviving PLNs were observed in 16 of 16 in the OVX + E2 group, seven of 16 in the OVX + TMX group, and 13 of 16 in the OVX group. The mean size of PLNs in the largest cross section of the OVX + TMX group was significantly lower than that in the other groups. The distributions of B cells and T cells in surviving PLNs were similar to those in normal LNs. The ratio of dilated HEVs/total HEVs and density of lymphatic vessels in the OVX + E2 group were the highest among the three groups, whereas the lowest ratio and density were observed in the OVX + TMX group. Conclusion: Tamoxifen treatment might lead to cellular loss of transplanted LNs and interfere with the structural reconstruction and functional restoration, thereby inhibiting the survival of transplanted PLNs. Estrogen treatment facilitated the maintenance and regeneration of functional HEVs as well as lymphangiogenesis.
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Affiliation(s)
- Dong Dong
- Department of Plastic and Aesthetic Surgery, Huadong Hospital Affiliated to Fudan University, Shanghai, China
- Shanghai Medical College of Fudan University, Shanghai, China
| | - Heng Wang
- Department of Plastic and Aesthetic Surgery, Huadong Hospital Affiliated to Fudan University, Shanghai, China
- Shanghai Medical College of Fudan University, Shanghai, China
| | - Liang Chen
- Department of Plastic and Aesthetic Surgery, Huadong Hospital Affiliated to Fudan University, Shanghai, China
| | - Wei Wang
- Department of Plastic and Aesthetic Surgery, Huadong Hospital Affiliated to Fudan University, Shanghai, China
- Shanghai Medical College of Fudan University, Shanghai, China
| | - Tianyi Liu
- Department of Plastic and Aesthetic Surgery, Huadong Hospital Affiliated to Fudan University, Shanghai, China
- *Correspondence: Tianyi Liu,
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19
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Grant CN, Rhee D, Tracy ET, Aldrink JH, Baertschiger RM, Lautz TB, Glick RD, Rodeberg DA, Ehrlich PF, Christison-Lagay E. Pediatric solid tumors and associated cancer predisposition syndromes: Workup, management, and surveillance. A summary from the APSA Cancer Committee. J Pediatr Surg 2022; 57:430-442. [PMID: 34503817 DOI: 10.1016/j.jpedsurg.2021.08.008] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/15/2021] [Revised: 08/11/2021] [Accepted: 08/19/2021] [Indexed: 02/06/2023]
Abstract
BACKGROUND/PURPOSE Cancer predisposition syndromes (CPS) are a heterogeneous group of inherited disorders that greatly increase the risk of developing malignancies. CPS are particularly relevant to pediatric surgeons since nearly 10% of cancer diagnoses are due to inherited genetic traits, and CPS often contribute to cancer development during childhood. MATERIALS/METHODS The English language literature was searched for manuscripts, practice guidelines, and society statements on "cancer predisposition syndromes in children". Following review of these manuscripts and cross-referencing of their bibliographies, tables were created to summarize findings of the most common CPS associated with surgically treated pediatric solid malignancies. RESULTS Pediatric surgeons should be aware of CPS as the identification of one of these syndromes can completely change the management of certain tumors, such as WT. The most common CPS associated with pediatric solid malignancies are outlined, with an emphasis on those most often encountered by pediatric surgeons: neuroblastoma, Wilms' tumor, hepatoblastoma, and medullary thyroid cancer. Frequently associated non-tumor manifestations of these CPS are also included as a guide to increase surgeon awareness. Screening and management guidelines are outlined, and published genetic testing and counseling guidelines are included where available. CONCLUSION Pediatric surgeons play an important role as surgical oncologists and are often the first point of contact for children with solid tumors. In their role of delivering a diagnosis and developing a follow-up and treatment plan as part of a multidisciplinary team, familiarity with common CPS will ensure evidence-based practices are followed, including important principles such as organ preservation and intensified surveillance plans. This review defines and summarizes the CPS associated with common childhood solid tumors encountered by the pediatric surgeon, as well as common non-cancerous disease stigmata that may help guide diagnosis. TYPE OF STUDY Summary paper. LEVEL OF EVIDENCE 5.
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Affiliation(s)
- Christa N Grant
- Division of Pediatric Surgery, Penn State Children's Hospital, Milton S. Hershey Medical Center, Hershey, PA, United States.
| | - Daniel Rhee
- Division of Pediatric Surgery, Department of Surgery, Johns Hopkins School of Medicine, Baltimore, MD, United States
| | - Elisabeth T Tracy
- Division of Pediatric Surgery, Department of Surgery, Duke University Medical Center, Durham, NC, United States
| | - Jennifer H Aldrink
- Division of Pediatric Surgery, Department of Surgery, Nationwide Children's Hospital, The Ohio State University College of Medicine, Columbus, OH, United States
| | - Reto M Baertschiger
- Division of General and Thoracic Surgery, The Hospital for Sick Children, University of Toronto, Toronto, ON, Canada
| | - Timothy B Lautz
- Division of Pediatric Surgery, Ann & Robert H Lurie Children's Hospital of Chicago, Northwestern University, Chicago, IL, United States
| | - Richard D Glick
- Division of Pediatric Surgery, Department of Surgery, Zucker School of Medicine at Hofstra/Northwell, Cohen Children's Medical Center, New Hyde Park, NY, United States
| | - David A Rodeberg
- Division of Pediatric Surgery, East Carolina Medical Center, Greenville, NC, United States
| | - Peter F Ehrlich
- Division of Pediatric Surgery, C.S. Mott Children's Hospital, University of Michigan, United States
| | - Emily Christison-Lagay
- Division of Pediatric Surgery, Yale-New Haven Children's Hospital, Yale School of Medicine, New Haven, CT, United States
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20
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Streur CS, Floody EA, Lapham ZK, Sandberg DE. The transition to independence and adult care for women with Turner syndrome: Current status and priorities of 1338 women and parents. Am J Med Genet A 2022; 188:400-413. [PMID: 34773722 PMCID: PMC8758527 DOI: 10.1002/ajmg.a.62564] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2021] [Revised: 08/31/2021] [Accepted: 10/15/2021] [Indexed: 02/03/2023]
Abstract
Transitioning to adult health care and functioning is crucial for youth and young adults with special health care needs, such as those with Turner syndrome (TS). The International Turner Syndrome Consensus Group developed clinical practice guidelines to improve this transition. This study sought to evaluate how effectively they have been implemented and whether they align with the priorities of women with TS and families of girls and women with TS. A web-based survey was offered to those affiliated with major TS support organizations, with 1338 successfully responding (n = 543 women [≥18 years]; n = 232 parents of a woman [≥18 years]; and n = 563 parents of a girl with TS [<18 years]). Findings demonstrated that while most women transitioned to adult primary care providers, follow-up with key specialists was lacking. Women and families prioritized flexibility in appointments and designating one provider to oversee all their TS-related care. They identified health care coverage as a barrier to receiving care. The transition process to adult care and independence commonly occurred after girls become legal adults. Together, these findings serve to inform strategies to improve the delivery of transitional care for girls and women with TS.
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Affiliation(s)
- Courtney S. Streur
- Division of Pediatric Urology, Department of Urology, University of Michigan,Susan B. Meister Child Health Evaluation and Research Center, Department of Pediatrics, University of Michigan
| | | | - Zoe K. Lapham
- Susan B. Meister Child Health Evaluation and Research Center, Department of Pediatrics, University of Michigan
| | - David E. Sandberg
- Susan B. Meister Child Health Evaluation and Research Center, Department of Pediatrics, University of Michigan,Division of Pediatric Psychology, Department of Pediatrics, University of Michigan
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21
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Butler MG, Miller BS, Romano A, Ross J, Abuzzahab MJ, Backeljauw P, Bamba V, Bhangoo A, Mauras N, Geffner M. Genetic conditions of short stature: A review of three classic examples. Front Endocrinol (Lausanne) 2022; 13:1011960. [PMID: 36339399 PMCID: PMC9634554 DOI: 10.3389/fendo.2022.1011960] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/04/2022] [Accepted: 09/20/2022] [Indexed: 11/30/2022] Open
Abstract
Noonan, Turner, and Prader-Willi syndromes are classical genetic disorders that are marked by short stature. Each disorder has been recognized for several decades and is backed by extensive published literature describing its features, genetic origins, and optimal treatment strategies. These disorders are accompanied by a multitude of comorbidities, including cardiovascular issues, endocrinopathies, and infertility. Diagnostic delays, syndrome-associated comorbidities, and inefficient communication among the members of a patient's health care team can affect a patient's well-being from birth through adulthood. Insufficient information is available to help patients and their multidisciplinary team of providers transition from pediatric to adult health care systems. The aim of this review is to summarize the clinical features and genetics associated with each syndrome, describe best practices for diagnosis and treatment, and emphasize the importance of multidisciplinary teams and appropriate care plans for the pediatric to adult health care transition.
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Affiliation(s)
- Merlin G. Butler
- Department of Psychiatry & Behavioral Sciences, University of Kansas Medical Center, Kansas City, KS, United States
- Department of Pediatrics, University of Kansas Medical Center, Kansas City, KS, United States
- *Correspondence: Merlin G. Butler,
| | - Bradley S. Miller
- Pediatric Endocrinology, University of Minnesota Masonic Children’s Hospital, Minneapolis, MN, United States
| | - Alicia Romano
- Department of Pediatrics, New York Medical College, Valhalla, NY, United States
| | - Judith Ross
- Department of Pediatrics, Nemours Children’s Health, Wilmington, DE, United States
- Department of Pediatrics, Thomas Jefferson University, Philadelphia, PA, United States
| | | | - Philippe Backeljauw
- Cincinnati Children’s Hospital Medical Center, University of Cincinnati College of Medicine, Cincinnati, OH, United States
| | - Vaneeta Bamba
- Division of Endocrinology, Children’s Hospital of Philadelphia; Department of Pediatrics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, United States
| | - Amrit Bhangoo
- Pediatric Endocrinology, Children's Health of Orange County (CHOC) Children’s Hospital, Orange, CA, United States
| | - Nelly Mauras
- Division of Endocrinology, Nemours Children’s Health, Jacksonville, FL, United States
| | - Mitchell Geffner
- The Saban Research Institute, Children’s Hospital Los Angeles, Los Angeles, CA, United States
- Keck School of Medicine, University of Southern California, Los Angeles, CA, United States
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22
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Kim J, Kim MS, Suh BK, Ko CW, Lee KH, Yoo HW, Shin CH, Hwang JS, Kim HS, Chung WY, Kim CJ, Han HS, Jin DK. Recombinant growth hormone therapy in children with Turner Syndrome in Korea: a phase III Randomized Trial. BMC Endocr Disord 2021; 21:243. [PMID: 34893062 PMCID: PMC8662840 DOI: 10.1186/s12902-021-00904-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/31/2021] [Accepted: 11/12/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Short stature is the most consistent characteristic feature of Turner syndrome (TS). To improve final heights of children with TS effectively, it is important to provide them with early and appropriate treatment using growth hormone (GH). The objective of this study was to assess the efficacy and safety of a new recombinant human GH, Growtropin®-II (DA-3002, Dong-A ST Co., Ltd) versus a comparator (Genotropin®, Pfizer Inc.) for Korean children with TS. METHODS This open-label, active-controlled, parallel-group, randomized controlled phase III trial was conducted at 11 hospitals in Korea. Eligible patients (n = 58) were randomized to two groups: 1) DA-3002 group (administrated with DA-3002 at 0.14 IU [0.0450-0.050 mg] /kg/day); and 2) comparator group (administrated with the comparator at 0.14 IU [0.0450-0.050 mg] /kg/day). RESULTS The change from baseline in annualized height velocity (HV) after a 52-week treatment period was 4.15 ± 0.30 cm/year in the DA-3002 group and 4.34 ± 0.29 cm/year in the comparator group. The lower bound of 95% two-sided confidence interval for group difference in the change of annualized HV (- 1.02) satisfied the non-inferiority margin (- 1.5). The change in height standard deviation score (HtSDS) at 52-week was 0.70 ± 0.23 for the DA-3002 group and 0.66 ± 0.39 for the comparator group, showing no significant (p = 0.685) difference between the two groups. The change of skeletal maturity defined as change in bone age/change in chronological age between the two groups was not significantly different (1.25 ± 0.58 for the DA-3002 group and 1.47 ± 0.45 for the comparator group, p = 0.134). Changes from baseline in serum insulin-like growth factor-1 (IGF-1) and insulin-like growth factor binding protein-3 (IGFBP-3) after 52 weeks of treatment did not differ significantly between the two groups (p = 0.565 and p = 0.388, respectively) either. The occurrence of adverse events was not statistically different between groups. CONCLUSIONS This study demonstrates that the efficacy and safety of GH treatment with DA-3002 in children with TS are comparable with those of the comparator. It is expected to analysis the long-term effect of DA-3002 on the increase of final adult height in children with TS and possible late-onset complications in the future. TRIAL REGISTRATION The study was registered at ClinicalTrials.gov. ClinicalTrials.gov identifier: NCT01813630 (19/03/2013).
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Affiliation(s)
- Jinsup Kim
- Department of Pediatrics, Hanyang University Medical Center, Hanyang University College of Medicine, Seoul, South Korea
| | - Min-Sun Kim
- Department of Pediatrics, Samsung Medical Center, Sungkyunkwan University School of Medicine, 81 Irwon-Ro Gangnam-gu, Seoul, 06351, South Korea
| | - Byung-Kyu Suh
- Department of Pediatrics, Seoul St. Mary's Hospital, The Catholic University of Korea, Seoul, South Korea
| | - Cheol Woo Ko
- Department of Pediatrics, Kyungpook National University Hospital, Daegu, Republic of Korea
| | - Kee-Hyoung Lee
- Department of Pediatrics, Korea University Anam Hospital, Seoul, South Korea
| | - Han-Wook Yoo
- Department of Pediatrics, Medical Genetics Clinic and Laboratory, Asan Medical Center Children's Hospital, University of Ulsan College of Medicine, Seoul, South Korea
| | - Choong Ho Shin
- Department of Pediatrics, Seoul National University Children's Hospital, Seoul, South Korea
| | - Jin Soon Hwang
- Department of Pediatrics, Ajou University Hospital, Suwon, South Korea
| | - Ho-Seong Kim
- Department of Pediatrics, Severance Hospital, Yonsei University College of Medicine, Seoul, South Korea
| | - Woo Yeong Chung
- Department of Pediatrics, Inje University Busan Paik Hospital, Busan, South Korea
| | - Chan Jong Kim
- Department of Pediatrics, Chonnam National University Hospital, Gwangju, South Korea
| | - Heon-Seok Han
- Department of Pediatrics, Chungbuk National University Hospital, Cheongju, South Korea
| | - Dong-Kyu Jin
- Department of Pediatrics, Samsung Medical Center, Sungkyunkwan University School of Medicine, 81 Irwon-Ro Gangnam-gu, Seoul, 06351, South Korea.
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de Souza AF, Bressan FF, Pieri NCG, Botigelli RC, Revay T, Haddad SK, Covas DT, Ramos ES, King WA, Meirelles FV. Generation of Primordial Germ Cell-like Cells from iPSCs Derived from Turner Syndrome Patients. Cells 2021; 10:cells10113099. [PMID: 34831322 PMCID: PMC8624672 DOI: 10.3390/cells10113099] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2021] [Revised: 11/02/2021] [Accepted: 11/04/2021] [Indexed: 12/31/2022] Open
Abstract
Turner syndrome (TS) is a genetic disorder in females with X Chromosome monosomy associated with highly variable clinical features, including premature primary gonadal failure leading to ovarian dysfunction and infertility. The mechanism of development of primordial germ cells (PGCs) and their connection with ovarian failure in TS is poorly understood. An in vitro model of PGCs from TS would be beneficial for investigating genetic and epigenetic factors that influence germ cell specification. Here we investigated the potential of reprogramming peripheral mononuclear blood cells from TS women (PBMCs-TS) into iPSCs following in vitro differentiation in hPGCLCs. All hiPSCs-TS lines demonstrated pluripotency state and were capable of differentiation into three embryonic layers (ectoderm, endoderm, and mesoderm). The PGCLCs-TS recapitulated the initial germline development period regarding transcripts and protein marks, including the epigenetic profile. Overall, our results highlighted the feasibility of producing in vitro models to help the understanding of the mechanisms associated with germ cell formation in TS.
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Affiliation(s)
- Aline Fernanda de Souza
- Department of Veterinary Medicine, Faculty of Animal Science and Food Engineering, University of São Paulo (USP), Pirassununga 13635-000, Brazil; (F.F.B.); (N.C.G.P.); (R.C.B.)
- Department of Biomedical Sciences, Ontario Veterinary College (OVC), University of Guelph, Guelph, ON N1G 2W1, Canada;
- Correspondence: (A.F.d.S.); (F.V.M.)
| | - Fabiana Fernandes Bressan
- Department of Veterinary Medicine, Faculty of Animal Science and Food Engineering, University of São Paulo (USP), Pirassununga 13635-000, Brazil; (F.F.B.); (N.C.G.P.); (R.C.B.)
| | - Naira Caroline Godoy Pieri
- Department of Veterinary Medicine, Faculty of Animal Science and Food Engineering, University of São Paulo (USP), Pirassununga 13635-000, Brazil; (F.F.B.); (N.C.G.P.); (R.C.B.)
| | - Ramon Cesar Botigelli
- Department of Veterinary Medicine, Faculty of Animal Science and Food Engineering, University of São Paulo (USP), Pirassununga 13635-000, Brazil; (F.F.B.); (N.C.G.P.); (R.C.B.)
- Department of Pharmacology, Institute of Biosciences (IBB), São Paulo State University (UNESP), Botucatu 18618-689, Brazil
| | - Tamas Revay
- Department Alberta Children’s Hospital Research Institute (ACHRI), University of Calgary, Calgary, AB T2N 4N1, Canada;
| | - Simone Kashima Haddad
- Center for Cell-Based Therapy, Regional Blood Center of Ribeirão Preto, Ribeirão Preto Medical School, University of São Paulo, Ribeirão Preto 14051-060, Brazil; (S.K.H.); (D.T.C.)
| | - Dimas Tadeu Covas
- Center for Cell-Based Therapy, Regional Blood Center of Ribeirão Preto, Ribeirão Preto Medical School, University of São Paulo, Ribeirão Preto 14051-060, Brazil; (S.K.H.); (D.T.C.)
| | - Ester Silveira Ramos
- Department of Genetics, Ribeirão Preto Medical School, University of São Paulo, Ribeirão Preto 14049-900, Brazil;
| | - Willian Allan King
- Department of Biomedical Sciences, Ontario Veterinary College (OVC), University of Guelph, Guelph, ON N1G 2W1, Canada;
| | - Flavio Vieira Meirelles
- Department of Veterinary Medicine, Faculty of Animal Science and Food Engineering, University of São Paulo (USP), Pirassununga 13635-000, Brazil; (F.F.B.); (N.C.G.P.); (R.C.B.)
- Correspondence: (A.F.d.S.); (F.V.M.)
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Akalın A, Ertuğrul İ, Şimşek-Kiper PÖ, Utine GE, Boduroğlu K. Main Physical Features, Echocardiographic and Renal Ultrasonographic Findings of Turner Syndrome in 107 Pediatric Patients. Mol Syndromol 2021; 12:335-341. [PMID: 34899142 PMCID: PMC8613554 DOI: 10.1159/000516816] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2021] [Accepted: 04/23/2021] [Indexed: 11/19/2022] Open
Abstract
Turner syndrome (TS) is one of the most common malformation syndromes in females. A total number of 107 TS patients, diagnosed between 2000 and 2018, were evaluated for their phenotypic features, and cardiac and renal findings. The mean age of patients at admission was 10.08 ± 4.9 years (range, newborn to 18 years). Four different karyotype groups were encountered, and the most common findings in all groups were short stature, followed by cubitus valgus. Echocardiographic findings of 85 patients were available among which 63 (n = 63/85, 74.1%) were found to be normal. The most common cardiac anomaly was left ventricular outflow tract/aortic arch pathology detected in 9 patients (n = 9/22, 40.9%). Renal malformations were detected in 15 patients (n = 15/84, 17.9%) by renal ultrasonography, and horseshoe kidney was the most common renal malformation, followed by left multicystic dysplastic kidney. There was no significant difference in the frequency of renal malformation and cardiac anomalies among the 4different karyotype groups (χ2 exact test, p > 0.05). Compared with the literature, the frequency of renal anomalies was detected at a lower rate. Karyotype analysis should be carried out in all female patients with short stature, even if there are no associated phenotypic findings suggestive of TS. Since cardiac anomalies are frequently seen in TS patients and they represent a common cause of mortality, echocardiography should be carried out as soon as the definite diagnosis is established. Renal anomalies may be less frequent than cardiac anomalies; however, evaluation of TS patients with renal ultrasonography should be done at the time of diagnosis. Although renal ultrasonography can be used as the initial renal screening in TS patients, it may underestimate the frequency of renal malformation; hence, further management may be required.
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Affiliation(s)
- Akçahan Akalın
- Department of Pediatric Genetics, Department of Pediatrics, Hacettepe University Faculty of Medicine, Ankara, Turkey
| | - İlker Ertuğrul
- Department of Pediatric Cardiology, Department of Pediatrics, Hacettepe University Faculty of Medicine, Ankara, Turkey
| | - Pelin Özlem Şimşek-Kiper
- Department of Pediatric Genetics, Department of Pediatrics, Hacettepe University Faculty of Medicine, Ankara, Turkey
| | - Gülen Eda Utine
- Department of Pediatric Genetics, Department of Pediatrics, Hacettepe University Faculty of Medicine, Ankara, Turkey
| | - Koray Boduroğlu
- Department of Pediatric Genetics, Department of Pediatrics, Hacettepe University Faculty of Medicine, Ankara, Turkey
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Luo SD, Chiu TJ, Chen WC, Wang CS. Sex Differences in Otolaryngology: Focus on the Emerging Role of Estrogens in Inflammatory and Pro-Resolving Responses. Int J Mol Sci 2021; 22:ijms22168768. [PMID: 34445474 PMCID: PMC8395901 DOI: 10.3390/ijms22168768] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2021] [Revised: 08/09/2021] [Accepted: 08/13/2021] [Indexed: 12/02/2022] Open
Abstract
Otolaryngology (also known as ear, nose, and throat (ENT)) diseases can be significantly affected by the level of sex hormones, which indicates that sex differences affect the manifestation, pathophysiology, and outcomes of these diseases. Recently, increasing evidence has suggested that proinflammatory responses in ENT diseases are linked to the level of sex hormones. The sex hormone receptors are present on a wide variety of immune cells; therefore, it is evident that they play crucial roles in regulating the immune system and hence affect the disease progression of ENT diseases. In this review, we focus on how sex hormones, particularly estrogens, regulate ENT diseases, such as chronic rhinosinusitis, vocal fold polyps, thyroid cancer, Sjögren’s syndrome, and head and neck cancers, from the perspectives of inflammatory responses and specialized proresolving mediator-driven resolution. This paper aims to clarify why considering sex differences in the field of basic and medical research on otolaryngology is a key component to successful therapy for both males and females in the future.
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Affiliation(s)
- Sheng-Dean Luo
- Department of Otolaryngology, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung 833, Taiwan; (S.-D.L.); (W.-C.C.)
- Graduate Institute of Clinical Medical Sciences, College of Medicine, Chang Gung University, Taoyuan 333, Taiwan;
| | - Tai-Jan Chiu
- Graduate Institute of Clinical Medical Sciences, College of Medicine, Chang Gung University, Taoyuan 333, Taiwan;
- Department of Hematology-Oncology, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung 833, Taiwan
| | - Wei-Chih Chen
- Department of Otolaryngology, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung 833, Taiwan; (S.-D.L.); (W.-C.C.)
| | - Ching-Shuen Wang
- School of Dentistry, College of Oral Medicine, Taipei Medical University, Taipei 110, Taiwan
- Correspondence: ; Tel.: +886-227-361-661 (ext. 5166)
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26
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Backeljauw P, Kanumakala S, Loche S, Schwab KO, Pfäffle RW, Höybye C, Lundberg E, Battelino T, Kriström B, Giemza T, Zouater H. Safety and Effectiveness of Recombinant Human Growth Hormone in Children with Turner Syndrome: Data from the PATRO Children Study. Horm Res Paediatr 2021; 94:133-143. [PMID: 34350858 PMCID: PMC8491505 DOI: 10.1159/000515875] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/10/2020] [Accepted: 03/15/2021] [Indexed: 11/19/2022] Open
Abstract
INTRODUCTION PATRO Children is an international, observational, postmarketing surveillance study for a biosimilar recombinant human growth hormone (rhGH; somatropin, Omnitrope®; Sandoz), approved by the European Medicines Agency in 2006. We report safety and effectiveness data for patients with Turner syndrome (TS). METHODS The study population included infants, children, and adolescents with TS who received Omnitrope® treatment according to standard clinical practice. Adverse events (AEs) were monitored for safety evaluation, and height velocity (HV), height standard deviation score (HSDS), and HVSDS were calculated to evaluate treatment effectiveness. RESULTS As of August 2019, 348 TS patients were enrolled from 130 centers. At baseline, 314 patients (90.2%) were prepubertal and 284 patients (81.6%) were rhGH treatment naïve. The mean (range) age at baseline was 9.0 (0.7-18.5) years, and mean (SD) treatment duration in the study was 38.5 (26.8) months. Overall, 170 patients (48.9%) reported AEs, which were considered treatment related in 25 patients (7.2%). One treatment-related serious AE was reported (intracranial hypertension). Mean ΔHSDS after 3 years of therapy was +1.17 in treatment-naïve prepubertal patients and +0.1 in pretreated prepubertal patients. In total, 51 patients (31.1%) reached adult height (AH), 35 of whom were rhGH treatment naïve; in these patients, mean (SD) HSDS was -2.97 (1.03) at the start of Omnitrope® treatment, and they achieved a mean (SD) AHSDS of -2.02 (0.9). CONCLUSION These data suggest that biosimilar rhGH is well tolerated and effective in TS patients managed in real-life clinical practice. Optimization of rhGH dose may contribute to a higher AH.
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Affiliation(s)
| | | | - Sandro Loche
- Hospital for Children Microcitemico “A. Cao”, Cagliari, Italy
| | | | | | - Charlotte Höybye
- Department of Endocrinology, Karolinska University Hospital, Solna, Sweden,Department of Molecular Medicine and Surgery, Karolinska Institute, Stockholm, Sweden
| | - Elena Lundberg
- Institute of Clinical Science/Pediatrics, Umeå University, Umeå, Sweden
| | - Tadej Battelino
- Department of Paediatric Endocrinology, Diabetes and Metabolic Diseases, University Medical Centre-University Children's Hospital, and University of Ljubljana, Ljubljana, Slovenia
| | - Berit Kriström
- Institute of Clinical Science/Pediatrics, Umeå University, Umeå, Sweden
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Chen J, Guo M, Luo M, Deng S, Tian Q. Clinical characteristics and management of Turner patients with a small supernumerary marker chromosome. Gynecol Endocrinol 2021; 37:730-734. [PMID: 33870841 DOI: 10.1080/09513590.2021.1911992] [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] [Indexed: 10/21/2022] Open
Abstract
OBJECTIVE To summarize the clinical characteristics of Turner syndrome (TS) with a small supernumerary marker chromosome (sSMC) and discuss the clinical significance and management of TS patients with sSMC. METHODS A retrospective analysis was conducted on the clinical data of 244 patients with disorders of sexual development admitted to Peking Union Medical College Hospital from February 1984 to July 2020. RESULTS Among the 244 patients with a disorder of sexual development, 69 cases of TS were identified in which 13 patients had sSMC. Their ages ranged from 3 to 28 years old with an average of 14.31 ± 6.40 years. All 13 sSMC-positive patients had typical clinical manifestations of TS except ambiguous genitalia in four cases. SRY gene testing was performed in 11sSMC-positive patients and 10 patients were positive for SRY and one was negative. Among the 10 SRY-positive patients, two cases had hirsutism and clitoral enlargement and two cases had clitoral enlargement only. Nine sSMC and SRY-positive patients underwent gonadectomy and one had left gonadal gonadoblastoma with seminoma in situ and right gonadal seminoma in situ. CONCLUSIONS Although the sSMC positive detection rate in DSD patients is uncommon (5.33% in our sample), the positive SRY detection rate in sSMC-positive TS patients was extremely high in our TS patients. And TS patients with sSMC and SRY positive had a significantly increased risk of gonadal germ cell tumors. Routine SRY screening should be performed in TS patients with sSMC, and a gonadectomy should be performed in TS patients with sSMC and SRY positive to prevent the occurrence of tumors.
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Affiliation(s)
| | | | | | | | - Qinjie Tian
- Department of Obstetrics and Gynecology, Peking Union Medical College Hospital, Peking Union Medical College and Chinese Academy of Medical Sciences, Beijing, China
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Hosseinirad H, Yadegari P, Mohanazadeh Falahieh F, Nouraei S, Paktinat S, Afsharzadeh N, Sadeghi Y. Disorders of sex development and female reproductive capacity: A literature review. Syst Biol Reprod Med 2021; 67:323-336. [PMID: 34196232 DOI: 10.1080/19396368.2021.1937376] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
Disorders of sex development (DSD) are a wide-ranging group of complex conditions that influence chromosomal, gonadal, and phenotypic sex. The prevalence of DSD is very low, but affected patients deserve individualized management to improve psychological, sexual, and reproductive outcomes. This review aims to clarify the fertility potential of DSD patients who can be reared as females and their chance of becoming pregnant, especially using assisted reproductive techniques (ART). Due to the effects of DSD on internal and external genital organs, these conditions result in varying degrees of fertility potential. Fertility rate depends on the phenotype and is inversely related to the severity of the disorder. Reproductive endocrinologists and infertility specialists must be considered active partners of the interdisciplinary treatment team. With current advances in ART, pregnancy is more achievable in patients who were considered infertile at first glance. Due to the complexity of the medical management in DSD patients, more studies should be conducted to conclusively suggest the best choice for improving their fertility potential.Abbreviations: AIS: Androgen Insensitivity Syndrome; AMH: Anti-Müllerian Hormone; ART: Assisted Reproductive Technology; ASRM: American Society for Reproductive Medicine; CAH: Congenital Adrenal Hyperplasia; CAIS: Complete Androgen Insensitivity Syndrome; DHT: Dihydrotestosterone; DSD: Disorders of Sexual Development; FSH: Follicle Stimulating Hormone; GD: Gonadal Dysgenesis; ICSI: Intracytoplasmic Sperm Injection; IUGR: Intrauterine Growth Restriction; IVF: In Vitro Fertilization; IVF-ET: IVF and Embryo Transfer; LH: Luteinizing Hormone; MGD: Mixed Gonadal Dysgenesis; MRI: Magnetic Resonance Imaging; MRKH: Mayer-Rokitansky-Kuster-Hauser; US: Ultrasonography; HSG: Hysterosalpingography; PAIS: Partial Androgen Insensitivity Syndrome; PGD: Preimplantation Genetic Diagnosis; POR: P450 Oxidoreductase; PROM: Premature Rupture of Membranes; TS: Turner Syndrome; 17β-HSD III: 17β-Hydroxysteroid Dehydrogenase III; 21-OHD: 21-hydroxylase deficiency; 5α-RD-2: 5α-reductase-2.
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Affiliation(s)
- Hossein Hosseinirad
- Student Research Committee, School of Medicine, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Pouya Yadegari
- Student Research Committee, School of Medicine, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | | | - Soheila Nouraei
- Department of Midwifery, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Shahrokh Paktinat
- Student Research Committee, School of Medicine, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | | | - Yousef Sadeghi
- Department of Anatomy and Physiology, Faculty of Medicine, Dentistry and Health Sciences, The University of Melbourne, Victoria, Australia
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Al-Bluwi GSM, AlNababteh AH, Östlundh L, Al-Shamsi S, Al-Rifai RH. Prevalence of Celiac Disease in Patients With Turner Syndrome: Systematic Review and Meta-Analysis. Front Med (Lausanne) 2021; 8:674896. [PMID: 34222285 PMCID: PMC8247446 DOI: 10.3389/fmed.2021.674896] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2021] [Accepted: 05/26/2021] [Indexed: 01/15/2023] Open
Abstract
Introduction: Celiac disease (CD) is a multifactorial autoimmune disorder, and studies have reported that patients with Turner syndrome (TS) are at risk for CD. This systematic review and meta-analysis aimed to quantify the weighted prevalence of CD among patients with TS and determine the weighted strength of association between TS and CD. Methods: Studies published between January 1991 and December 2019 were retrieved from four electronic databases: PubMed, Scopus, Web of Science, and Embase. Eligible studies were identified and relevant data were extracted by two independent reviewers following specific eligibility criteria and a data extraction plan. Using the random-effects model, the pooled, overall and subgroup CD prevalence rates were determined, and sources of heterogeneity were investigated using meta-regression. Results: Among a total of 1,116 screened citations, 36 eligible studies were included in the quantitative synthesis. Nearly two-thirds of the studies (61.1%) were from European countries. Of the 6,291 patients with TS who were tested for CD, 241 were diagnosed with CD, with a crude CD prevalence of 3.8%. The highest and lowest CD prevalence rates of 20.0 and 0.0% were reported in Sweden and Germany, respectively. The estimated overall weighted CD prevalence was 4.5% (95% confidence interval [CI], 3.3–5.9, I2, 67.4%). The weighted serology-based CD prevalence in patients with TS (3.4%, 95% CI, 1.0–6.6) was similar to the weighted biopsy-based CD prevalence (4.8%; 95% CI, 3.4–6.5). The strength of association between TS and CD was estimated in only four studies (odds ratio 18.1, 95% CI, 1.82–180; odds ratio 4.34, 95% CI, 1.48–12.75; rate ratio 14, 95% CI, 1.48–12.75; rate ratio 42.5, 95% CI, 12.4–144.8). Given the lack of uniformity in the type of reported measures of association and study design, producing a weighted effect measure to evaluate the strength of association between TS and CD was unfeasible. Conclusion: Nearly 1 in every 22 patients with TS had CD. Regular screening for CD in patients with TS might facilitate early diagnosis and therapeutic management to prevent adverse effects of CD such as being underweight and osteoporosis.
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Affiliation(s)
- Ghada S M Al-Bluwi
- Department of Internal Medicine, College of Medicine and Health Sciences, United Arab Emirates University, Al-Ain, United Arab Emirates
| | - Asma H AlNababteh
- Institute of Public Health, College of Medicine and Health Sciences, United Arab Emirates University, Al-Ain, United Arab Emirates
| | - Linda Östlundh
- National Medical Library, College of Medicine and Health Sciences, United Arab Emirates University, Al-Ain, United Arab Emirates
| | - Saif Al-Shamsi
- Department of Internal Medicine, College of Medicine and Health Sciences, United Arab Emirates University, Al-Ain, United Arab Emirates
| | - Rami H Al-Rifai
- Institute of Public Health, College of Medicine and Health Sciences, United Arab Emirates University, Al-Ain, United Arab Emirates
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Grimstad FW, Knoll MM, Jacobson JD. Oxandrolone Use in Trans-Masculine Youth Appears to Increase Adult Height: Preliminary Evidence. LGBT Health 2021; 8:300-306. [PMID: 33819432 DOI: 10.1089/lgbt.2020.0355] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
Abstract
Purpose: Early use of oxandrolone and gonadotropin-releasing hormone analogs has been shown to increase adult height in patients at risk for short stature, but use in trans-masculine (TM) youth to augment height has not been explored. The purpose of this study was to identify the impact of oxandrolone on adult height in TM youth. Methods: This was a single-center, retrospective chart review of TM patients seen between 2013 and 2018. Hormone regimens, heights, mid-parental height, and bone ages were recorded. We examined correlations between adult height and age at the initiation of treatment or with the age of referral (in untreated patients). Results: Of TM patients, 154 had achieved adult height, including 34 who received oxandrolone, 42 who reached adult height before starting gender-affirming hormone therapy (GAHT), and 14 who received no treatment. Adult height correlated inversely with age at hormone initiation in oxandrolone-treated patients only (p = 0.001). Each earlier year of treatment yielded a 2.3 cm increase in adult height. Those who started oxandrolone younger than the median age achieved an adult height of 169.6 ± 6.4 cm compared to 162.1 ± 6.0 cm in those starting later than the median age (p < 0.001), 164.6 ± 4.8 cm in those receiving no treatment (p = 0.02), and 163.9 ± 6.5 cm in those receiving all other regimens (p < 0.001). Conclusions: Early use of oxandrolone may augment adult height in TM youth. Height discussions should be part of comprehensive GAHT counseling.
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Affiliation(s)
- Frances W Grimstad
- Division of Gynecology, Department of Surgery, Boston Children's Hospital, Boston, Massachusetts, USA.,Department of Obstetrics, Gynecology, and Reproductive Biology, Harvard Medical School, Boston, Massachusetts, USA
| | - Michelle M Knoll
- Division of Endocrinology, Department of Pediatrics, Children's Mercy Hospital, Kansas City, Missouri, USA
| | - Jill D Jacobson
- Division of Endocrinology, Department of Pediatrics, Children's Mercy Hospital, Kansas City, Missouri, USA
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Sex Hormones in Lymphedema. Cancers (Basel) 2021; 13:cancers13030530. [PMID: 33573286 PMCID: PMC7866787 DOI: 10.3390/cancers13030530] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2020] [Revised: 01/21/2021] [Accepted: 01/27/2021] [Indexed: 01/15/2023] Open
Abstract
Simple Summary Lymphedema is a life-long disease that affects a large number of patients treated for breast-, gynecological-, and urologic cancers in Western countries. Given that hormone levels are strongly modified in these conditions, and that patients widely undergo through hormone therapy, it is tempting to speculate that hormones might be key regulators in the maintenance of lymphedema. Despite an obvious prevalence for women, the role of sex hormones and gender has been poorly investigated in this pathology. This review aims to decipher how sex hormones interact with lymphatic vessels and whether hormone therapy could participate in lymphedema development. Abstract Lymphedema is a disorder of the lymphatic vascular system characterized by impaired lymphatic return resulting in swelling of the extremities and accumulation of undrained interstitial fluid/lymph that results in fibrosis and adipose tissue deposition in the limb. Whereas it is clearly established that primary lymphedema is sex-linked with an average ratio of one male for three females, the role of female hormones, in particular estrogens, has been poorly explored. In addition, secondary lymphedema in Western countries affects mainly women who developed the pathology after breast cancer and undergo through hormone therapy up to five years after cancer surgery. Although lymphadenectomy is identified as a trigger factor, the effect of co-morbidities associated to lymphedema remains elusive, in particular, estrogen receptor antagonists or aromatase inhibitors. In addition, the role of sex hormones and gender has been poorly investigated in the etiology of the pathology. Therefore, this review aims to recapitulate the effect of sex hormones on the physiology of the lymphatic system and to investigate whetherhormone therapy could promote a lymphatic dysfunction leading to lymphedema.
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Capkova P, Capkova Z, Rohon P, Adamová K, Zapletalova J. Short stature and SHOX (Short stature homeobox) variants-efficacy of screening using various strategies. PeerJ 2020; 8:e10236. [PMID: 33240610 PMCID: PMC7678493 DOI: 10.7717/peerj.10236] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2020] [Accepted: 10/04/2020] [Indexed: 11/20/2022] Open
Abstract
Background SHOX mutations have previously been described as causes of Léri-Weill dyschondrosteosis (LWD), Langer mesomelic dysplasia (LMD), and idiopathic short stature. The loss of X chromosome—Turner syndrome or mosaic 45,X/46,XX or 46,XY—also leads to the heterozygous loss of SHOX in patients with short stature only or with features similar to LWD. The aim of this study was to assess the efficacy of the targeted screening for SHOX variants, which involved different methods in the laboratory analysis of short stature. We determined the significance and positive predictive value of short stature for the detection of SHOX variants. Methods Targeted screening for variants in SHOX involving MLPA, sequencing, karyotyping and FISH was performed in the short stature cohort (N = 174) and control cohort (N = 91). The significance of short stature and particular characteristics for the detection of SHOX variants was determined by Fisher’s exact test, and the probability of SHOX mutation occurrence was calculated using a forward/stepwise logistic regression model. Results In total, 27 and 15 variants influencing SHOX were detected in the short stature and control cohorts, respectively (p > 0.01). Sex chromosome aberrations and pathogenic CNV resulting in diagnosis were detected in eight (4.6%) and five (2.9%) patients of the short stature group and three (3.3%) and one (1.1%) individuals of the control group. VUS variants were discovered in 14 (8.0%) and 11 (12.1%) individuals of the short stature and control groups, respectively. MLPA demonstrated the detection rate of 13.22%, and it can be used as a frontline method for detection of aberrations involving SHOX. However, only mosaicism of monosomy X with a higher frequency of monosomic cells could be reliably discovered by this method. Karyotyping and FISH can compensate for this limitation; their detection rates in short stature group were 3.55% and 13.46% (N = 52), respectively. FISH proved to be more effective than karyotyping in the study as it could reveal cryptic mosaics in some cases where karyotyping initially failed to detect such a clone. We suggest adding FISH on different tissue than peripheral blood to verify sex-chromosome constitution, especially in cases with karyotypes: 45,X; mosaic 45,X/46,XX or 46,XY; 46,Xidic(Y) detected from blood; in children, where mosaic 45,X was detected prenatally but was not confirmed from peripheral blood. The correlation of short stature with the occurrence of SHOX mutations was insignificant and short stature demonstrates a low positive predictive value-15.5% as unique indicator for SHOX mutations. The typical skeletal signs of LWD, including Madelung deformity and disproportionate growth, positively correlate with the findings of pathogenic SHOX variants (p < 0.01) by Fisher’s exact test but not with the findings of VUS variants in SHOX which are more prevalent in the individuals with idiopathic short stature or in the individuals with normal height.
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Affiliation(s)
- Pavlina Capkova
- Department of Medical Genetics, University Hospital Olomouc, Olomouc, Czech Republic.,Department of Medical Genetics, Faculty of Medicine and Dentistry, Palacky University Olomouc, Olomouc, Czech Republic
| | - Zuzana Capkova
- Department of Medical Genetics, University Hospital Olomouc, Olomouc, Czech Republic.,Department of Medical Genetics, Faculty of Medicine and Dentistry, Palacky University Olomouc, Olomouc, Czech Republic
| | - Peter Rohon
- Department of Medical Genetics, Faculty of Medicine and Dentistry, Palacky University Olomouc, Olomouc, Czech Republic
| | - Katerina Adamová
- Department of Medical Genetics, University Hospital Olomouc, Olomouc, Czech Republic
| | - Jirina Zapletalova
- Department of Pediatrics, Faculty of Medicine and Dentistry, Palacky University Olomouc, Olomouc, Czech Republic
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Bihunyak T, Bondarenko YI, Кulyanda OO, Charnosh SM, Sverstiuk AS, Bihuniak KO. CHROMOSOMAL DISEASES IN THE HUMAN PATHOLOGY. INTERNATIONAL JOURNAL OF MEDICINE AND MEDICAL RESEARCH 2020. [DOI: 10.11603/ijmmr.2413-6077.2020.1.11501] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Background. Chromosomal diseases are the cause of 45-50 % of multiple birth defects. Basic research on mutations is performed using genomic technologies to identify a correlation between genotype and phenotype in aneuploidies and to understand its pathogenesis.
Objective. The aim of the research is to study the etiology, pathogenesis of symptoms and diagnostics for patients with Down, Klinefelter, Turner syndromes and double aneuploidies by 21 and sex chromosomes.
Methods. A literature review by the keywords “Down syndrome”, “Klinefelter syndrome”, “Turner syndrome”, “double aneuploidy” for the period of 2000-2020 was carried out.
Results. Down, Klinefelter and Turner syndromes are the most common aneuploidy among viable newborns. Frequency of meiotic non-disjunction events causing these aneuploidies increases with the age of a woman. Identified genes are responsible for pathogenesis of symptoms in trisomy 21, Turner and Klinefelter syndromes. Diagnostics of chromosomal diseases includes prenatal screening programs and postnatal testing.
Conclusions. Cytogenetic variants of Down syndrome are simple complete trisomy 21, translocation form and mosaicism. Trisomy 21 is associated with advanced maternal age. Phenotypic manifestations of Down syndrome are associated with the locus 21q22. The maternal and parental nondisjunction of X-chromosomes in meiosis causes Klinefelter and Turner syndromes. These chromosomal diseases are variants of intersexualism with intermediate chromosomal sex. Down-Klinefelter and Down-Turner syndromes are double aneuploidies. Patients have a Down syndrome phenotype at birth, and signs of Klinefelter and Turner syndromes occur during puberty. Diagnosis of aneuploidy is based on the cytogenetic investigation (karyotyping), DNA analysis, ultrasonography and biochemical markers of chromosomal pathology.
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Akasaka M, Kamei A, Ito J, Oyama K. Turner Syndrome Associated With Refractory Seizures and Intellectual Disability: A Case Study. Cureus 2020; 12:e11364. [PMID: 33304697 PMCID: PMC7721081 DOI: 10.7759/cureus.11364] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
Turner syndrome (TS) is the most frequent sex abnormality in women. The physical features include short stature, webbing of the neck, and gonadal dysgenesis. Typically, patients with Turner syndrome exhibit no intellectual disability, and a few cases of TS have been associated with epilepsy. Herein, we present a case of TS with intractable epilepsy. The patient presented with global developmental delay at the age of two and karyotyping revealed mosaicism [45, X/46, X del (X) (q21.1)]. At the age of seven, she had generalized tonic epilepsy as well as several focal-onset seizures. She developed daily seizures, which were refractory to several antiepileptic drugs. Interictal electroencephalography (EEG) revealed multifocal spikes, and ictal EEG revealed shifting foci. She visited our hospital at the age of 13. Her peripheral white blood cells G-band and fluorescence in situ hybridization (FISH) method chromosome with cheek swab examinations revealed 45, X. Her peripheral white blood cell mosaic pattern may have disappeared over time or become indetectable. We treated her with clobazam, and then lamotrigine and valproic acid combination therapy, which resulted in a reduction in the frequency of seizures by approximately 50%. Epilepsy and intellectual disability in this case may be due to the mosaic deletion at Xq21.1. Further analysis of similar cases may provide valuable information for effective therapeutic strategies.
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Affiliation(s)
| | | | - Jun Ito
- Pediatrics, Iwate Medical University, Morioka, JPN
| | - Kotaro Oyama
- Pediatrics, Iwate Medical University, Morioka, JPN
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Chiarito M, Brunetti G, D'Amato G, Faienza MF. Monitoring and maintaining bone health in patients with Turner syndrome. Expert Rev Endocrinol Metab 2020; 15:431-438. [PMID: 33074770 DOI: 10.1080/17446651.2020.1834846] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/27/2020] [Accepted: 10/07/2020] [Indexed: 12/19/2022]
Abstract
INTRODUCTION Subjects affected with Turner Syndrome (TS) suffer low bone mineral density and high risk of fracture from a young age. Estrogen deficiency is considered the main risk factor but other factors, such as intrinsic bone abnormalities, enhanced osteoclastogenesis, vitamin D deficiency and other comorbidities may contribute to the exalted bone fragility. AREAS COVERED The authors performed a literature search in PubMed and EMBASE, using selected key words. They focused their search on pathogenetic mechanisms of osteoporosis in TS and updated the diagnosis, prevention and therapeutic interventions. EXPERT OPINION Bone health is a concern in subjects with TS, and strategies to prevent osteoporosis and fractures should be considered from childhood. Advice on how to live a healthy lifestyle, including physical activity and correct nutrition, should be given during childhood in order to prevent bone impairment later in life. The screening for vitamin D deficiency should be performed between the ages of 9 and 11, and every 2-3 years thereafter. Early initiation of estrogen replacement therapy (ERT) between 11-12 years of age, prompt titration to the adult dose after 2 years, and long-term follow-up to guarantee compliance with ERT, are the key points of osteoporosis prevention in women with TS.
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Affiliation(s)
- Mariangela Chiarito
- Department of Biomedical Sciences and Human Oncology, University "A.Moro" , Bari, Italy
| | - Giacomina Brunetti
- Department of Basic Medical Sciences, Neuroscience and Sense Organs, Section of Human Anatomy and Histology, University "A. Moro" , Bari, Italy
| | - Gabriele D'Amato
- Department of Women's and Children's Health, ASL Bari, Neonatal Intensive Care Unit, Di Venere Hospital , Bari, Italy
| | - Maria Felicia Faienza
- Department of Biomedical Sciences and Human Oncology, University "A.Moro" , Bari, Italy
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Davies K. Biological basis of child health 7: growth, development and the reproductive system. Nurs Child Young People 2020; 33:e1308. [PMID: 33016664 DOI: 10.7748/ncyp.2020.e1308] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/26/2020] [Indexed: 11/09/2022]
Abstract
This article is the seventh in a series on the biological basis of child health. It describes early developmental milestones, stages of growth, puberty and the development of the reproductive system. It also outlines the methods used to assess growth and development, and describes conditions that affect growth and development in infants, children and young people. Understanding childhood growth and development is crucial for children's nurses, who need to be able to identify potential deviations from the norm, since these often reveal underlying conditions that require treatment.
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Affiliation(s)
- Kate Davies
- London South Bank University and honorary research fellow in paediatric endocrinology, Barts and The London School of Medicine and Dentistry, Queen Mary University of London, London, England
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Lukowski SL, Padrutt ER, Sarafoglou K, Ross JL, Law JR, Olson RE, Mazzocco MMM. Variation in early number skills and mathematics achievement: Implications from cognitive profiles of children with or without Turner syndrome. PLoS One 2020; 15:e0239224. [PMID: 33006984 PMCID: PMC7531844 DOI: 10.1371/journal.pone.0239224] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2020] [Accepted: 09/01/2020] [Indexed: 01/15/2023] Open
Abstract
Individuals with Mathematics Learning Disabilities have persistent mathematics underperformance but vary with respect to their cognitive profiles. The present study examined mathematics ability and achievement, and associated mathematics-specific numerical skills and domain-general cognitive abilities, in young children with Turner syndrome compared to their matched peers. We utilized two independent peer groups so that group comparisons would account for verbal skills, a hypothesized strength of girls with Turner syndrome, and nonsymbolic magnitude comparison skills, a hypothesized difference of girls with Turner syndrome. This individual matching approach afforded characterization of mathematics profiles of girls with Turner syndrome and girls without Turner syndrome that share potential key features of the Turner syndrome phenotype. Results indicated differences in mathematics ability and nonsymbolic magnitude comparison tasks between girls with Turner syndrome and peers with similar levels of verbal skill. Mathematics ability and mathematics achievement scores of girls with Turner syndrome did not differ significantly from their peers with similar levels of accuracy on a nonsymbolic magnitude comparison task. Cognitive correlates of mathematics outcomes showed disparate patterns across groups. These quantitative and qualitative differences across profiles enhance our understanding of variation in mathematics ability in early childhood and inform how mathematics skills develop in young children with or without Turner syndrome.
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Affiliation(s)
- Sarah L. Lukowski
- Institute of Child Development, University of Minnesota, Minneapolis, Minnesota, United States of America
| | - Emily R. Padrutt
- Institute of Child Development, University of Minnesota, Minneapolis, Minnesota, United States of America
| | - Kyriakie Sarafoglou
- Department of Pediatrics, University of Minnesota Medical School, Minneapolis, Minnesota, United States of America
- Department of Experimental and Clinical Pharmacology, University of Minnesota College of Pharmacy, Minneapolis, Minnesota, United States of America
| | - Judith L. Ross
- Department of Pediatrics, Nemours DuPont Hospital for Children, Thomas Jefferson University, Philadelphia, Pennsylvania, United States of America
| | - Jennifer R. Law
- Division of Pediatric Endocrinology, Department of Pediatrics, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, United States of America
| | - Rachel E. Olson
- Institute of Child Development, University of Minnesota, Minneapolis, Minnesota, United States of America
| | - Michèle M. M. Mazzocco
- Institute of Child Development, University of Minnesota, Minneapolis, Minnesota, United States of America
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Abstract
Evaluation of the child with abnormal pubertal development can be challenging for the primary care provider. Understanding the factors associated with timing of pubertal onset and the normal sequence of pubertal changes is useful in evaluation of children with puberty disorders. A thorough workup includes assessment of growth rate, Tanner staging, and rate of pubertal progression, in addition to an extensive history and physical examination to identify signs and symptoms of disorders associated with abnormal pubertal timing. Initial diagnostic studies will most often include a bone age, levels of gonadotropins, and levels of estradiol (for girls) or testosterone (for boys).
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Affiliation(s)
- Swati V Elchuri
- Pediatric Diagnostic Center, 300 Hillmont Avenue, Building 340, Suite 302, Ventura, CA 93003, USA
| | - Jennifer J Momen
- Division of Physician Assistant Studies, Department of Human Performance and Applied Exercise Science, West Virginia University School of Medicine, 1 Medical Center Drive, PO Box 9226, Morgantown, WV 26506-9226, USA.
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The Impact of Estrogen Receptor in Arterial and Lymphatic Vascular Diseases. Int J Mol Sci 2020; 21:ijms21093244. [PMID: 32375307 PMCID: PMC7247322 DOI: 10.3390/ijms21093244] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2020] [Revised: 04/17/2020] [Accepted: 04/29/2020] [Indexed: 12/12/2022] Open
Abstract
The lower incidence of cardiovascular diseases in pre-menopausal women compared to men is well-known documented. This protection has been largely attributed to the protective effect of estrogens, which exert many beneficial effects against arterial diseases, including vasodilatation, acceleration of healing in response to arterial injury, arterial collateral growth and atheroprotection. More recently, with the visualization of the lymphatic vessels, the impact of estrogens on lymphedema and lymphatic diseases started to be elucidated. These estrogenic effects are mediated not only by the classic nuclear/genomic actions via the specific estrogen receptor (ER) α and β, but also by rapid extra-nuclear membrane-initiated steroid signaling (MISS). The ERs are expressed by endothelial, lymphatic and smooth muscle cells in the different vessels. In this review, we will summarize the complex vascular effects of estrogens and selective estrogen receptor modulators (SERMs) that have been described using different transgenic mouse models with selective loss of ERα function and numerous animal models of vascular and lymphatic diseases.
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Genetische Diagnostik vor assistierter Reproduktion – Empfehlungen der neuen S2k-Leitlinie 2019. GYNAKOLOGISCHE ENDOKRINOLOGIE 2020. [DOI: 10.1007/s10304-020-00317-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
ZusammenfassungGenetische Ursachen sind für etwa 10–20 % der männlichen und 5–10 % der weiblichen In- oder Subfertilität verantwortlich. Bei Männern ist die andrologische Untersuchung Voraussetzung dafür, genetische Ursachen von Spermatogenesestörungen einordnen zu können. Außer Störungen der Geschlechtschromosomen können auch balancierte Chromosomenumbauten zu einer Fertilitätsminderung führen. Eine Azoospermiefaktoranalyse in Bezug auf Y‑chromosomale Mikrodeletionen ist bei Männern mit Azoospermie indiziert, da sie über den Erfolg einer assistierten Reproduktion entscheiden kann. Bei Verdacht auf obstruktive Azoospermie soll eine Analyse des CFTR-Gens zur Diagnostik einer zystischen Fibrose erfolgen. Bei endokrinen Auffälligkeiten sind genetische Ursachen des häufigeren hypergonadotropen Hypogonadismus von denen eines seltenen kongenitalen hypogonadotropen Hypogonadismus zu unterscheiden. Algorithmen zur genetischen Diagnostik sind in der aktuellen Leitlinie im internationalen Vergleich ausgeführt.
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Kyritsi EM, Kanaka-Gantenbein C. Autoimmune Thyroid Disease in Specific Genetic Syndromes in Childhood and Adolescence. Front Endocrinol (Lausanne) 2020; 11:543. [PMID: 32973676 PMCID: PMC7466763 DOI: 10.3389/fendo.2020.00543] [Citation(s) in RCA: 36] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/05/2020] [Accepted: 07/06/2020] [Indexed: 12/14/2022] Open
Abstract
Autoimmune thyroid disease (ATD) is the most frequent cause of acquired thyroid dysfunction, most commonly presenting either as Hashimoto's thyroiditis or Graves' Disease. Hashimoto's thyroiditis is characterized by the presence of thyroid-specific autoantibodies, more commonly anti-thyroperoxidase antibodies in the serum and the typical inhomogeneous echostructure of the thyroid on a thyroid ultrasound examination. Hashimoto's thyroiditis can for a long time be accompanied by normal thyroid function and hypothyroidism can only progressively be established. Graves' disease is much less frequent in childhood and adolescence and presents with overt hyperthyroidism. After the onset of puberty, ATD affects females with a higher incidence than males, while during the prepubertal period there is not such a clear preponderance of affected females. ATD can occur either isolated or in the context of other autoimmune disorders, such as type 1 Diabetes mellitus (T1D), celiac disease, alopecia areata, vitiligo, etc. Especially at the pediatric age, a higher incidence of ATD is also observed in the context of specific genetic syndromes, such as trisomy 21 (Down syndrome), Klinefelter syndrome, Turner syndrome, or 22q11.2 deletion syndrome. Nevertheless, although thyroid dysfunction may also be observed in other genetic syndromes, such as Prader-Willi or Williams syndrome, the thyroid dysfunction in these syndromes is not the result of thyroid autoimmunity. Interestingly, there is emerging evidence supporting a possible link between autoimmunity and RASopathies. In this review article the incidence, as well as the clinical manifestation and accompanied pathologies of ATD in specific genetic syndromes will be presented and regular follow-up for the early identification of the disorder will be proposed.
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Paz-Y-Miño C, Yumiceba V, Moreta G, Paredes R, Ruiz M, Ocampo L, Llamos Paneque A, Ochoa Pérez C, Ruiz-Cabezas JC, Álvarez Vidal J, Jiménez Torres I, Vargas-Vera R, Cruz F, Guapi N VH, Montalván M, Meneses Álvarez S, Garzón Castro M, Lamar Segura E, Recalde Báez MA, Naranjo ME, Tambaco Jijón N, Sinche M, Licuy P, Burgos R, Porras-Borja F, Echeverría-Garcés G, Pérez-Villa A, Armendáriz-Castillo I, García-Cárdenas JM, Guerrero S, Guevara-Ramírez P, López-Cortés A, Zambrano AK, Leone PE. Multi-institutional experience of genetic diagnosis in Ecuador: National registry of chromosome alterations and polymorphisms. Mol Genet Genomic Med 2019; 8:e1087. [PMID: 31830383 PMCID: PMC7005643 DOI: 10.1002/mgg3.1087] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2019] [Revised: 11/06/2019] [Accepted: 11/14/2019] [Indexed: 01/28/2023] Open
Abstract
BACKGROUND Detection of chromosomal abnormalities is crucial in various medical areas; to diagnose birth defects, genetic disorders, and infertility, among other complex phenotypes, in individuals across a wide range of ages. Hence, the present study wants to contribute to the knowledge of type and frequency of chromosomal alterations and polymorphisms in Ecuador. METHODS Cytogenetic registers from different Ecuadorian provinces have been merged and analyzed to construct an open-access national registry of chromosome alterations and polymorphisms. RESULTS Of 28,806 karyotypes analyzed, 6,008 (20.9%) exhibited alterations. Down syndrome was the most frequent autosome alteration (88.28%), followed by Turner syndrome (60.50%), a gonosome aneuploidy. A recurrent high percentage of Down syndrome mosaicism (7.45%) reported here, as well as by previous Ecuadorian preliminary registries, could be associated with geographic location and admixed ancestral composition. Translocations (2.46%) and polymorphisms (7.84%) were not as numerous as autosomopathies (64.33%) and gonosomopathies (25.37%). Complementary to conventional cytogenetics tests, molecular tools have allowed identification of submicroscopic alterations regions or candidate genes which can be possibly implicated in patients' symptoms and phenotypes. CONCLUSION The Ecuadorian National Registry of Chromosome Alterations and Polymorphisms provides a baseline to better understand chromosomal abnormalities in Ecuador and therefore their clinical management and awareness. This data will guide public policy makers to promote and financially support cytogenetic and genetic testing.
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Affiliation(s)
- César Paz-Y-Miño
- Centro de Investigación Genética y Genómica, Facultad de Ciencias de la Salud Eugenio Espejo, Universidad UTE, Quito, Ecuador
| | - Verónica Yumiceba
- Centro de Investigación Genética y Genómica, Facultad de Ciencias de la Salud Eugenio Espejo, Universidad UTE, Quito, Ecuador
| | - Germania Moreta
- Servicio de Genética Médica, Hospital de Especialidades, Quito, Ecuador
| | - Rosario Paredes
- Servicio de Genética Médica, Hospital de Especialidades, Quito, Ecuador
| | | | - Ligia Ocampo
- Laboratorio de Genética, Génica Laboratorios, Quito, Ecuador
| | | | | | - Juan Carlos Ruiz-Cabezas
- Hospital "Dr. Juan Tanca Marengo", SOLCA Matriz, Guayaquil, Ecuador.,Facultad de Medicina, Universidad Espíritu Santo, Guayaquil, Ecuador
| | - Jenny Álvarez Vidal
- Centro de Diagnóstico y Estudios Biomédicos, Facultad de Ciencia Médicas, Universidad de Cuenca, Cuenca, Ecuador
| | | | - Ramón Vargas-Vera
- Facultad de Ciencias Médicas, Universidad de Guayaquil, Guayaquil, Ecuador
| | - Fernando Cruz
- Centro de Genética Médica, CEGEMED, Ministerio de Salud Pública, Quito, Ecuador
| | - Víctor Hugo Guapi N
- Hospital General Provincial "Luis G. Dávila", Ministerio de Salud Pública, Tulcán, Ecuador
| | - Martha Montalván
- Centro de Investigaciones, Universidad Espíritu Santo, Guayaquil, Ecuador
| | | | | | | | | | | | | | - María Sinche
- Hospital "Dr. Juan Tanca Marengo", SOLCA Matriz, Guayaquil, Ecuador
| | - Pedro Licuy
- Hospital "Dr. Juan Tanca Marengo", SOLCA Matriz, Guayaquil, Ecuador
| | - Ramiro Burgos
- Hospital "Dr. Juan Tanca Marengo", SOLCA Matriz, Guayaquil, Ecuador
| | - Fabián Porras-Borja
- Centro de Genética Médica, CEGEMED, Ministerio de Salud Pública, Quito, Ecuador
| | | | - Andy Pérez-Villa
- Centro de Investigación Genética y Genómica, Facultad de Ciencias de la Salud Eugenio Espejo, Universidad UTE, Quito, Ecuador
| | - Isaac Armendáriz-Castillo
- Centro de Investigación Genética y Genómica, Facultad de Ciencias de la Salud Eugenio Espejo, Universidad UTE, Quito, Ecuador
| | - Jennyfer M García-Cárdenas
- Centro de Investigación Genética y Genómica, Facultad de Ciencias de la Salud Eugenio Espejo, Universidad UTE, Quito, Ecuador
| | - Santiago Guerrero
- Centro de Investigación Genética y Genómica, Facultad de Ciencias de la Salud Eugenio Espejo, Universidad UTE, Quito, Ecuador
| | - Patricia Guevara-Ramírez
- Centro de Investigación Genética y Genómica, Facultad de Ciencias de la Salud Eugenio Espejo, Universidad UTE, Quito, Ecuador
| | - Andrés López-Cortés
- Centro de Investigación Genética y Genómica, Facultad de Ciencias de la Salud Eugenio Espejo, Universidad UTE, Quito, Ecuador
| | - Ana Karina Zambrano
- Centro de Investigación Genética y Genómica, Facultad de Ciencias de la Salud Eugenio Espejo, Universidad UTE, Quito, Ecuador
| | - Paola E Leone
- Centro de Investigación Genética y Genómica, Facultad de Ciencias de la Salud Eugenio Espejo, Universidad UTE, Quito, Ecuador
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Harky A, Fan KS, Fan KH. The genetics and biomechanics of thoracic aortic diseases. VASCULAR BIOLOGY 2019; 1:R13-R25. [PMID: 32923967 PMCID: PMC7439919 DOI: 10.1530/vb-19-0027] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/19/2019] [Accepted: 10/15/2019] [Indexed: 12/20/2022]
Abstract
Thoracic aortic aneurysms and aortic dissections (TAAD) are highly fatal emergencies within cardiothoracic surgery. With increasing age, thoracic aneurysms become more prevalent and pose an even greater threat when they develop into aortic dissections. Both diseases are multifactorial and are influenced by a multitude of physiological and biomechanical processes. Structural stability of aorta can be disrupted by genes, such as those for extracellular matrix and contractile protein, as well as telomere dysfunction, which leads to senescence of smooth muscle and endothelial cells. Biomechanical changes such as increased luminal pressure imposed by hypertension are also very prevalent and lead to structural instability. Furthermore, ageing is associated with a pro-inflammatory state that exacerbates degeneration of vessel wall, facilitating the development of both aortic aneurysms and aortic dissection. This literature review provides an overview of the aetiology and pathophysiology of both thoracic aneurysms and aortic dissections. With an improved understanding, new therapeutic targets may eventually be identified to facilitate treatment and prevention of these diseases.
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Affiliation(s)
- Amer Harky
- Department of Cardiothoracic Surgery, Liverpool Heart and Chest, Liverpool, UK
| | - Ka Siu Fan
- St. George's Medical School, University of London, London, UK
| | - Ka Hay Fan
- Faculty of Medicine, Imperial College London, London, UK
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Plachy L, Strakova V, Elblova L, Obermannova B, Kolouskova S, Snajderova M, Zemkova D, Dusatkova P, Sumnik Z, Lebl J, Pruhova S. High Prevalence of Growth Plate Gene Variants in Children With Familial Short Stature Treated With GH. J Clin Endocrinol Metab 2019; 104:4273-4281. [PMID: 30753492 DOI: 10.1210/jc.2018-02288] [Citation(s) in RCA: 38] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/23/2018] [Accepted: 02/04/2019] [Indexed: 12/28/2022]
Abstract
CONTEXT Familial short stature (FSS) is a term describing a growth disorder that is vertically transmitted. Milder forms may result from the combined effect of multiple genes; more severe short stature is suggestive of a monogenic condition. The etiology of most FSS cases has not been thoroughly elucidated to date. OBJECTIVES To identify the genetic etiology of severe FSS in children treated with GH because of the diagnosis of small for gestational age or GH deficiency (SGA/GHD). DESIGN, SETTINGS, AND PATIENTS Of 736 children treated with GH because of GHD/SGA, 33 with severe FSS (life-minimum height -2.5 SD or less in both the patient and shorter parent) were included in the study. The genetic etiology was known in 5 of 33 children prior to the study [ACAN (in 2], NF1, PTPN11, and SOS1). In the remaining 28 of 33, whole-exome sequencing was performed. The results were evaluated using American College of Medical Genetics and Genomics standards and guidelines. RESULTS In 30 of 33 children (90%), we found at least one variant with potential clinical significance in genes known to affect growth. A genetic cause was elucidated in 17 of 33 (52%). Of these children, variants in growth plate-related genes were found in 9 of 17 [COL2A1, COL11A1, and ACAN (all in 2), FLNB, FGFR3, and IGF1R], and IGF-associated proteins were affected in 2 of 17 (IGFALS and HMGA2). In the remaining 6 of 17, the discovered genetic mechanisms were miscellaneous (TRHR, MBTPS2, GHSR, NF1, PTPN11, and SOS1). CONCLUSIONS Single-gene variants are frequent among families with severe FSS, with variants affecting the growth plate being the most prevalent.
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Affiliation(s)
- Lukas Plachy
- Department of Pediatrics, 2nd Faculty of Medicine, Charles University in Prague, Prague, Czech Republic
- University Hospital Motol, Prague 5, Czech Republic
| | - Veronika Strakova
- Department of Pediatrics, 2nd Faculty of Medicine, Charles University in Prague, Prague, Czech Republic
- University Hospital Motol, Prague 5, Czech Republic
| | - Lenka Elblova
- Department of Pediatrics, 2nd Faculty of Medicine, Charles University in Prague, Prague, Czech Republic
- University Hospital Motol, Prague 5, Czech Republic
| | - Barbora Obermannova
- Department of Pediatrics, 2nd Faculty of Medicine, Charles University in Prague, Prague, Czech Republic
- University Hospital Motol, Prague 5, Czech Republic
| | - Stanislava Kolouskova
- Department of Pediatrics, 2nd Faculty of Medicine, Charles University in Prague, Prague, Czech Republic
- University Hospital Motol, Prague 5, Czech Republic
| | - Marta Snajderova
- Department of Pediatrics, 2nd Faculty of Medicine, Charles University in Prague, Prague, Czech Republic
- University Hospital Motol, Prague 5, Czech Republic
| | - Dana Zemkova
- Department of Pediatrics, 2nd Faculty of Medicine, Charles University in Prague, Prague, Czech Republic
- University Hospital Motol, Prague 5, Czech Republic
| | - Petra Dusatkova
- Department of Pediatrics, 2nd Faculty of Medicine, Charles University in Prague, Prague, Czech Republic
- University Hospital Motol, Prague 5, Czech Republic
| | - Zdenek Sumnik
- Department of Pediatrics, 2nd Faculty of Medicine, Charles University in Prague, Prague, Czech Republic
- University Hospital Motol, Prague 5, Czech Republic
| | - Jan Lebl
- Department of Pediatrics, 2nd Faculty of Medicine, Charles University in Prague, Prague, Czech Republic
- University Hospital Motol, Prague 5, Czech Republic
| | - Stepanka Pruhova
- Department of Pediatrics, 2nd Faculty of Medicine, Charles University in Prague, Prague, Czech Republic
- University Hospital Motol, Prague 5, Czech Republic
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Abstract
Turner syndrome is one of the most common sex chromosomal anomalies, characterized by the complete or partial loss of one X chromosome. Females with Turner syndrome are characterized by skeletal abnormalities, short stature and primary ovarian insufficiency. The aim of this narrative review was to identify the underlying mechanisms of osteoporosis in Turner syndrome, summarize its clinical manifestations and provide suggestions regarding the management of osteoporosis. Girls and women with Turner syndrome have lower bone mineral density and a higher fracture rate than healthy individuals. The most important risk factors for osteoporosis are inadequately treated primary ovarian insufficiency, followed by intrinsic bone abnormalities. Comorbidities that further increase the risk of osteoporosis include vitamin D deficiency, celiac disease and inflammatory bowel disease. In addition, hearing problems can predispose to falls. Early initiation of hormone replacement therapy (HRT) at the age of 11-13 years, prompt titration to the adult dose after 2 years and long-term follow-up to ensure compliance with HRT are the cornerstones of osteoporosis prevention in women with Turner syndrome.
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Nagai T, Hasegawa K, Motegi E, Machida H, Sasaki H, Kato H, Kosaka N, Fukasawa I, Kuroda H. Usefulness of imprint cytology of gonadoblastoma with dysgerminoma in a patient with Turner syndrome and a Y chromosome: A case report and literature review. Diagn Cytopathol 2019; 47:1203-1207. [PMID: 31336030 DOI: 10.1002/dc.24282] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2019] [Revised: 07/08/2019] [Accepted: 07/10/2019] [Indexed: 11/06/2022]
Abstract
Ovarian gonadoblastoma coexisting with a dysgerminoma is extremely rare in patients with Turner syndrome (TS) and a Y chromosome. The cytological findings, including imprint cytology, of these unusual ovarian tumors have rarely been reported. We report a rare patient with a gonadoblastoma with dysgerminoma, 3.0 × 2.0 cm in size; she was a 19-year-old woman with TS and a Y chromosome. She underwent laparoscopic bilateral gonadectomy, and the tumor was classified as stage IA (pT1aNxM0) according to the International Federation of Gynecology and Obstetrics classification system. Intraoperative imprint cytology revealed two types of neoplastic cells: small tumor cells surrounding light green-stained or eosinophilic hyaline globules with marked calcification, suspicious for gonadoblastoma; and large, round, atypical cells with abundant cytoplasm, macronucleoli, and marked lymphocytic infiltration (two-cell pattern), suspicious for dysgerminoma. The cytology results in our patient may represent the second reported results of imprint cytology describing a gonadoblastoma with dysgerminoma. They are the first reported results in a patient with TS and a Y chromosome.
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Affiliation(s)
- Tamiko Nagai
- Department of Pathology, Dokkyo Medical University
| | - Kiyoshi Hasegawa
- Department of Obstetrics and Gynecology, Dokkyo Medical University.,Department of Obstetrics and Gynecology, Inuyama Chuo General Hospital
| | - Emi Motegi
- Department of Obstetrics and Gynecology, Dokkyo Medical University
| | | | - Hideo Sasaki
- Department of Pathology, Dokkyo Medical University
| | - Hikaru Kato
- Department of Pathology, Dokkyo Medical University
| | - Nobuaki Kosaka
- Department of Obstetrics and Gynecology, Dokkyo Medical University
| | - Ichio Fukasawa
- Department of Obstetrics and Gynecology, Dokkyo Medical University
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van Santen HM, van den Heuvel-Eibrink MM, van de Wetering MD, Wallace WH. Hypogonadism in Children with a Previous History of Cancer: Endocrine Management and Follow-Up. Horm Res Paediatr 2019; 91:93-103. [PMID: 30703774 PMCID: PMC6615280 DOI: 10.1159/000495943] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/31/2018] [Accepted: 11/29/2018] [Indexed: 01/15/2023] Open
Abstract
Hypogonadism after treatment for childhood cancer is a recognized complication and its cause may be subdivided into primary gonadal failure and central hypogonadism. Here, we provide an overview of the risk factors for the development of hypogonadism, assessment and potential interventions and give a summary of the current recommendations for management and follow-up of hypogonadism in childhood cancer survivors.
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Affiliation(s)
- Hanneke M van Santen
- Department of Pediatric Endocrinology, Wilhelmina Children's Hospital, UMCU, Utrecht, The Netherlands,
- Princess Máxima Center for Pediatric Oncology, Utrecht, The Netherlands,
| | | | | | - W Hamish Wallace
- Department of Paediatric Haematology and Oncology, Royal Hospital for Sick Children, Edinburgh, United Kingdom
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Wegiel M, Antosz A, Gieburowska J, Szeliga K, Hankus M, Grzybowska-Chlebowczyk U, Wiecek S, Malecka-Tendera E, Gawlik A. Autoimmunity Predisposition in Girls With Turner Syndrome. Front Endocrinol (Lausanne) 2019; 10:511. [PMID: 31417494 PMCID: PMC6682631 DOI: 10.3389/fendo.2019.00511] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/05/2019] [Accepted: 07/12/2019] [Indexed: 12/11/2022] Open
Abstract
Background: Turner Syndrome is associated with an increased risk of autoimmune diseases, such as autoimmune thyroiditis, coeliac disease, type 1 diabetes mellitus, inflammatory bowel disease, alopecia areata, or vitiligo. The presence of isochromosome iXq and exposure to estradiol may contribute to the development of the autoimmune process. The aim of this study was to determine the prevalence of autoimmune diseases in a group of TS patients and to assess the impact of karyotype and puberty on the development of autoimmune diseases. Patients and Methods: The analysis encompassed clinical and biochemical data of 134 patients treated between 2001 and 2018. All the patients were examined for autoimmune disease symptoms and tested for the presence of antithyroperoxidase (anti-TPO) and antithyreoglobulin (anti-TG) antibodies. In 73 of the patients, anti-transglutaminase (anti-tTG) antibodies were measured. Thyroid function was assessed by measuring TSH and fT4 levels. Results: The mean follow-up was 5.7 ± 3 years. An autoimmune disease was diagnosed in 46 (34.3%) patients: 39 (29.1%) had only one disorder, whilst 7 (5.2%) presented two disorders. The most common disorder, observed in 40 (29.9%) patients, was thyroid autoimmunity. Hashimoto disease was diagnosed in 20 (14.9%) patients. Of the 73 patients tested for coeliac disease, 4 (5.5%) had anti-tTG and 2 (2.7%) presented overt coeliac disease. Vitiligo was diagnosed in 3 (2.2%) patients, type 1 diabetes mellitus or psoriasis were diagnosed in 2 (1.5%) patients, whilst alopecia areata or lichen sclerosus were diagnosed in 1 (0.7%) patient. The impact of karyotype or estradiol exposure on developing autoimmune diseases were not statistically significant. Conclusions: Our study showed a higher incidence of autoimmune diseases in TS, which is in line with the literature; however, the impact of iXq, or spontaneous/inducted puberty was not confirmed.
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Affiliation(s)
- Malgorzata Wegiel
- Department of Pediatrics and Pediatric Endocrinology, School of Medicine in Katowice, Medical University of Silesia, Katowice, Poland
| | - Aleksandra Antosz
- Department of Pediatrics and Pediatric Endocrinology, School of Medicine in Katowice, Medical University of Silesia, Katowice, Poland
| | - Joanna Gieburowska
- Department of Pediatrics and Pediatric Endocrinology, School of Medicine in Katowice, Medical University of Silesia, Katowice, Poland
| | - Kamila Szeliga
- Department of Pediatrics and Pediatric Endocrinology, School of Medicine in Katowice, Medical University of Silesia, Katowice, Poland
| | - Magdalena Hankus
- Department of Pediatrics and Pediatric Endocrinology, School of Medicine in Katowice, Medical University of Silesia, Katowice, Poland
| | | | - Sabina Wiecek
- Department of Pediatrics, School of Medicine in Katowice, Medical University of Silesia, Katowice, Poland
| | - Ewa Malecka-Tendera
- Department of Pediatrics and Pediatric Endocrinology, School of Medicine in Katowice, Medical University of Silesia, Katowice, Poland
| | - Aneta Gawlik
- Department of Pediatrics and Pediatric Endocrinology, School of Medicine in Katowice, Medical University of Silesia, Katowice, Poland
- *Correspondence: Aneta Gawlik
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Cioppi F, Casamonti E, Krausz C. Age-Dependent De Novo Mutations During Spermatogenesis and Their Consequences. ADVANCES IN EXPERIMENTAL MEDICINE AND BIOLOGY 2019; 1166:29-46. [DOI: 10.1007/978-3-030-21664-1_2] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
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50
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Gibson CE, Boodhansingh KE, Li C, Conlin L, Chen P, Becker SA, Bhatti T, Bamba V, Adzick NS, De Leon DD, Ganguly A, Stanley CA. Congenital Hyperinsulinism in Infants with Turner Syndrome: Possible Association with Monosomy X and KDM6A Haploinsufficiency. Horm Res Paediatr 2018; 89:413-422. [PMID: 29902804 PMCID: PMC6067979 DOI: 10.1159/000488347] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/30/2017] [Accepted: 03/07/2018] [Indexed: 01/04/2023] Open
Abstract
BACKGROUND Previous case reports have suggested a possible association of congenital hyperinsulinism with Turner syndrome. OBJECTIVE We examined the clinical and molecular features in girls with both congenital hyperinsulinism and Turner syndrome seen at The Children's Hospital of Philadelphia (CHOP) between 1974 and 2017. METHODS Records of girls with hyperinsulinism and Turner syndrome were reviewed. Insulin secretion was studied in pancreatic islets and in mouse islets treated with an inhibitor of KDM6A, an X chromosome gene associated with hyperinsulinism in Kabuki syndrome. RESULTS Hyperinsulinism was diagnosed in 12 girls with Turner syndrome. Six were diazoxide-unresponsive; 3 had pancreatectomies. The incidence of Turner syndrome among CHOP patients with hyperinsulinism (10 of 1,050 from 1997 to 2017) was 48 times more frequent than expected. The only consistent chromosomal anomaly in these girls was the presence of a 45,X cell line. Studies of isolated islets from 1 case showed abnormal elevated cytosolic calcium and heightened sensitivity to amino acid-stimulated insulin release; similar alterations were demonstrated in mouse islets treated with a KDM6A inhibitor. CONCLUSION These results demonstrate a higher than expected frequency of Turner syndrome among children with hyperinsulinism. Our data suggest that haploinsufficiency for KDM6A due to mosaic X chromosome monosomy may be responsible for hyperinsulinism in Turner syndrome.
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Affiliation(s)
- Christopher E. Gibson
- Division of Endocrinology and Diabetes, The Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA,Department of Pediatrics, The Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Kara E. Boodhansingh
- Division of Endocrinology and Diabetes, The Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
| | - Changhong Li
- Division of Endocrinology and Diabetes, The Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
| | - Laura Conlin
- Department of Pathology and Laboratory Medicine, The Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA,Department of Pathology, The Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Pan Chen
- Division of Endocrinology and Diabetes, The Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
| | - Susan A. Becker
- Division of Endocrinology and Diabetes, The Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
| | - Tricia Bhatti
- Department of Pediatrics, The Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania, USA,Department of Pathology and Laboratory Medicine, The Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
| | - Vaneeta Bamba
- Division of Endocrinology and Diabetes, The Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA,Department of Pediatrics, The Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - N. Scott Adzick
- Department of Surgery, The Children's Hospital of Philadelphia, The Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Diva D. De Leon
- Division of Endocrinology and Diabetes, The Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA,Department of Pediatrics, The Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Arupa Ganguly
- Department of Genetics, The Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Charles A. Stanley
- Division of Endocrinology and Diabetes, The Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA,Department of Pediatrics, The Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania, USA,*Charles A Stanley, MD, Division of Endocrinology, The Children's Hospital of Philadelphia, 3401 Civic Center Boulevard, Philadelphia, PA 19104 (USA), E-Mail
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