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Tsai LP, Luo DZ, Chan H, Hung WC, Lai WS, Min MY, Wong SB. Implication of locus coeruleus dysfunction in Prader-Willi syndrome: Insights from a mouse model. Exp Neurol 2024; 381:114927. [PMID: 39159912 DOI: 10.1016/j.expneurol.2024.114927] [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: 04/09/2024] [Revised: 08/05/2024] [Accepted: 08/16/2024] [Indexed: 08/21/2024]
Abstract
Prader-Willi syndrome (PWS) is a multisystemic disorder. Notably, many characteristic symptoms of PWS are correlated with locus coeruleus norepinephrine system (LC-NE) dysfunction, including impairment in arousal, learning, pain modulation, and stress-induced negative affective states. Although electrophysiological experiments in necdin-deficient mice, an established PWS animal model, have revealed decreased spontaneous neuronal firing activity in the LC and impaired excitability, the behavioral phenotypes related to LC-NE dysfunction remain unexplored. In this study, heterozygous necdin-deficient mice (B6.Cg-Ndntm1ky) were bred from wild-type (WT) females to generate WT (+m/+p) and heterozygous (+m/-p) animals. Compared to WT mice, Ndn + m/-p mice demonstrated impaired visual-spatial memory in the Y-maze test, reduced social interaction, impaired sexual recognition, and shorter falling latency on the Rotarod. Using the open field test (OFT) and elevated plus maze (EPM), we observed similar locomotion activity of Ndn + m/-p and WT mice, but Ndn + m/-p mice were less anxious. After acute restraint, Ndn + m/-p mice exhibited significant impairment in stress-induced anxiety. Additionally, the plasma norepinephrine surge following exposure to acute restraint stress was also impaired. Pretreatment with atomoxetine, a norepinephrine reuptake inhibitor aimed to enhance LC function, restored Ndn + m/-p mice to exhibit a normal response to acute restraint stress. Furthermore, by employing chemogenetic approaches to facilitate LC neuronal firing, post-stress anxious responses were also partially rescued in Ndn + m/-p mice. These data strongly suggest that LC dysfunction is implicated in the pathogenesis of stress-related neuropsychiatric symptoms in PWS. Manipulation of LC activity may hold therapeutic potential for patients with PWS.
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Affiliation(s)
- Li-Ping Tsai
- Department of Pediatrics, Taipei Tzu Chi Hospital, Tzu Chi Medical Foundation, New Taipei City 23142, Taiwan; School of Medicine, Tzu Chi University, Hualien 97071, Taiwan; Department of Pediatrics, Heping Fuyou Branch, Taipei City Hospital, Taipei 100027, Taiwan
| | - Da-Zhong Luo
- Department of Psychology, National Taiwan University, Taipei 10617, Taiwan
| | - Hao Chan
- Department of Pediatrics, Taipei Tzu Chi Hospital, Tzu Chi Medical Foundation, New Taipei City 23142, Taiwan; Department of Life Science, College of Life Science, National Taiwan University, Taipei 10617, Taiwan
| | - Wei-Chen Hung
- Department of Pediatrics, Taipei Tzu Chi Hospital, Tzu Chi Medical Foundation, New Taipei City 23142, Taiwan; Department of Life Science, College of Life Science, National Taiwan University, Taipei 10617, Taiwan
| | - Wen-Sung Lai
- Department of Psychology, National Taiwan University, Taipei 10617, Taiwan
| | - Ming-Yuan Min
- Department of Life Science, College of Life Science, National Taiwan University, Taipei 10617, Taiwan
| | - Shi-Bing Wong
- Department of Pediatrics, Taipei Tzu Chi Hospital, Tzu Chi Medical Foundation, New Taipei City 23142, Taiwan; School of Medicine, Tzu Chi University, Hualien 97071, Taiwan.
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Shaikh MG, Barrett TG, Bridges N, Chung R, Gevers EF, Goldstone AP, Holland A, Kanumakala S, Krone R, Kyriakou A, Livesey EA, Lucas-Herald AK, Meade C, Passmore S, Roche E, Smith C, Soni S. Prader-Willi syndrome: guidance for children and transition into adulthood. Endocr Connect 2024; 13:e240091. [PMID: 38838713 PMCID: PMC11301552 DOI: 10.1530/ec-24-0091] [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: 03/04/2024] [Accepted: 06/05/2024] [Indexed: 06/07/2024]
Abstract
Prader-Willi syndrome (PWS) is a rare orphan disease and complex genetic neurodevelopmental disorder, with a birth incidence of approximately 1 in 10,000-30,000. Management of people with PWS requires a multi-disciplinary approach, ideally through a multi-disciplinary team (MDT) clinic with community support. Hypotonia, poor feeding and faltering growth are characteristic features in the neonatal period, followed by hyperphagia and risk of rapid weight gain later in childhood. Children and adolescents (CA) with PWS usually display developmental delay and mild learning disability and can develop endocrinopathies, scoliosis, respiratory difficulties (both central and obstructive sleep apnoea), challenging behaviours, skin picking, and mental health issues, especially into adulthood. This consensus statement is intended to be a reference document for clinicians managing children and adolescents (up to 18 years of age) with PWS. It considers the bio-psycho-social domains of diagnosis, clinical assessment, and management in the paediatric setting as well as during and after transition to adult services. The guidance has been developed from information gathered from peer-reviewed scientific reports and from the expertise of a range of experienced clinicians in the United Kingdom and Ireland involved in the care of patients with PWS.
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Affiliation(s)
- M Guftar Shaikh
- Department of Paediatric Endocrinology, Royal Hospital for Children, Glasgow, UK
- Developmental Endocrinology Research Group, University of Glasgow, Glasgow, UK
| | - Timothy G Barrett
- Department of Endocrinology, Birmingham Womens and Children’s Hospital, Birmingham, UK
- Institute of Cancer and Genomic Sciences, University of Birmingham, Birmingham, UK
| | - Nicola Bridges
- Department of Paediatric Endocrinology, Chelsea and Westminster Hospital, London, UK
| | - Robin Chung
- Research Working Group, Prader-Willi Syndrome Association, Northampton, UK
| | - Evelien F Gevers
- Department of Paediatric Endocrinology, Barts Health NHS Trust, Royal London Hospital, London, UK
- Centre for Endocrinology, William Harvey Research Institute, Barts and The London Medical School, Queen Mary University of London, London, UK
| | - Anthony P Goldstone
- PsychoNeuroEndocrinologyResearch Group, Division of Psychiatry, Department of Brain Sciences, Faculty of Medicine, Imperial College London, London, UK
- Department of Endocrinology, Imperial College Healthcare NHS Trust, Hammersmith Hospital, London, UK
| | - Anthony Holland
- Department of Psychiatry, University of Cambridge, Cambridge, UK
| | | | - Ruth Krone
- Department of Endocrinology, Birmingham Womens and Children’s Hospital, Birmingham, UK
| | - Andreas Kyriakou
- Department of Paediatric Endocrinology, Royal Hospital for Children, Glasgow, UK
- Department of Paediatric Endocrinology, Makarios Children's Hospital, Nicosia, Cyprus
| | - E Anne Livesey
- Royal Alexandra Children’s Hospital, Brighton, UK
- Sussex Community NHS Trust, Brighton, UK
| | - Angela K Lucas-Herald
- Department of Paediatric Endocrinology, Royal Hospital for Children, Glasgow, UK
- Developmental Endocrinology Research Group, University of Glasgow, Glasgow, UK
| | - Christina Meade
- CHI at Tallaght University Hospital, Dublin, Republic of Ireland
| | | | - Edna Roche
- CHI at Tallaght University Hospital, Dublin, Republic of Ireland
- The University of Dublin, Trinity College Dublin, Dublin, Republic of Ireland
| | - Chris Smith
- Royal Alexandra Children’s Hospital, Brighton, UK
| | - Sarita Soni
- Learning Disability Psychiatry, NHS Greater Glasgow and Clyde, Glasgow, UK
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Wędrychowicz AM, Doleżal-Ołtarzewska K, Zygmunt-Górska A, Kalicka-Kasperczyk AU, Tyrawa K, Wojcik M, Janus D, Kot A, Lecka-Ambroziak A, Petriczko E, Wielopolska J, Starzyk J. Should we routinely assess hypothalamic-pituitary-adrenal axis in pediatric patients with Prader-Willi syndrome? Front Endocrinol (Lausanne) 2024; 15:1406931. [PMID: 38994010 PMCID: PMC11236674 DOI: 10.3389/fendo.2024.1406931] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/25/2024] [Accepted: 05/31/2024] [Indexed: 07/13/2024] Open
Abstract
Background It has been reported that central adrenal insufficiency (CAI) in pediatric patients (pts) with Prader-Willi syndrome (PWS) may be a potential cause of their sudden death. In addition, the risk of CAI may increase during treatment with recombinant human growth hormone (rhGH). Objective To prevent both over- and undertreatment with hydrocortisone, we evaluated the prevalence of CAI in a large multicenter cohort of pediatric pts with PWS analyzing adrenal response in the low-dose ACTH test (LDAT) and/or the glucagon stimulation test (GST) and reviewing the literature. Methods A total of 46 pts with PWS were enrolled to the study, including 34 treated with rhGH with a median dose of 0.21 mg/kg/week. LDAT was performed in 46 pts, and GST was carried out in 13 pts. Both tests were conducted in 11 pts. The tests began at 8:00 a.m. Hormones were measured by radioimmunoassays. Serum cortisol response >181.2 ng/mL (500 nmol/L) in LDAT and >199.3 ng/mL (550 nmol/L) in GST was considered a normal response. Additionally, cortisol response delta (the difference between baseline and baseline) >90 ng/mL and doubling/tripling of baseline cortisol were considered indicators of normal adrenal reserve. Results Three GSTs were not diagnostic (no hypoglycemia obtained). LDAT results suggested CAI in four pts, but in two out of four pts, and CAI was excluded in GST. GST results suggested CAI in only one patient, but it was excluded in LDAT. Therefore, CAI was diagnosed in 2/46 pts (4.3%), 1 treated and 1 untreated with rhGH, with the highest cortisol values of 162 and 175 ng/dL, but only in one test. However, in one of them, the cortisol delta response was >90 ng/mL and peak cortisol was more than tripled from baseline. Finally, CAI was diagnosed in one patient treated with rhGH (2.2%). Conclusion We present low prevalence of CAI in pediatric pts with PWS according to the latest literature. Therefore, we do not recommend to routinely screen the function of the hypothalamic-pituitary-adrenal axis (HPAA) in all pts with PWS, both treated and untreated with rhGH. According to a review of the literature, signs and symptoms or low morning ACTH levels suggestive of CAI require urgent and appropriate diagnosis of HPAA by stimulation test. Our data indicate that the diagnosis of CAI should be confirmed by at least two tests to prevent overtreatment with hydrocortisone.
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Affiliation(s)
- Anna Maria Wędrychowicz
- Department of Pediatric and Adolescent Endocrinology, Jagiellonian University Medical College, Kraków, Lesser Poland, Poland
- Department of Pediatric and Adolescent Endocrinology, University Children's Hospital of Cracow, Cracow, Poland
| | | | - Agata Zygmunt-Górska
- Department of Pediatric and Adolescent Endocrinology, University Children's Hospital of Cracow, Cracow, Poland
| | - Anna Urszula Kalicka-Kasperczyk
- Department of Pediatric and Adolescent Endocrinology, Jagiellonian University Medical College, Kraków, Lesser Poland, Poland
- Department of Pediatric and Adolescent Endocrinology, University Children's Hospital of Cracow, Cracow, Poland
| | - Katarzyna Tyrawa
- Department of Pediatric and Adolescent Endocrinology, University Children's Hospital of Cracow, Cracow, Poland
| | - Malgorzata Wojcik
- Department of Pediatric and Adolescent Endocrinology, Jagiellonian University Medical College, Kraków, Lesser Poland, Poland
- Department of Pediatric and Adolescent Endocrinology, University Children's Hospital of Cracow, Cracow, Poland
| | - Dominika Janus
- Department of Pediatric and Adolescent Endocrinology, Jagiellonian University Medical College, Kraków, Lesser Poland, Poland
- Department of Pediatric and Adolescent Endocrinology, University Children's Hospital of Cracow, Cracow, Poland
| | - Adrianna Kot
- Department of Pediatric and Adolescent Endocrinology, University Children's Hospital of Cracow, Cracow, Poland
| | - Agnieszka Lecka-Ambroziak
- Department of Endocrinology and Diabetology, The Children's Memorial Health Institute, Warsaw, Masovian, Poland
- Endocrinology Outpatient Clinic, Institute of Mother and Child, Warsaw, Masovian, Poland
| | - Elzbieta Petriczko
- Department of Pediatrics, Endocrinology, Diabetes, Metabolic Disorders and Cardiology of Developmental Age, Pomeranian Medical University, Szczecin, West Pomeranian, Poland
| | - Joanna Wielopolska
- Department of Pediatrics, Endocrinology, Diabetes, Metabolic Disorders and Cardiology of Developmental Age, Pomeranian Medical University, Szczecin, West Pomeranian, Poland
| | - Jerzy Starzyk
- Department of Pediatric and Adolescent Endocrinology, Jagiellonian University Medical College, Kraków, Lesser Poland, Poland
- Department of Pediatric and Adolescent Endocrinology, University Children's Hospital of Cracow, Cracow, Poland
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Torun D, Akin O. Genotype-phenotype characteristics of 57 patients with Prader-Willi syndrome: a single-center experience from Turkey. Clin Dysmorphol 2024:00019605-990000000-00075. [PMID: 38934057 DOI: 10.1097/mcd.0000000000000506] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/28/2024]
Abstract
OBJECTIVES Prader-Willi syndrome (PWS) is a rare and complex genetic disorder caused by the loss of expression of the paternal copy of the imprinted genes on chromosome 15q11-q13. A variety of findings have been reported on the phenotypic differences between the genetic subtypes of PWS. This article compares the clinical findings of 57 PWS patients by genetic subtype and explores possible associations in this context. METHODS Methylation‑specific multiplex ligation-dependent probe amplification and single nucleotide polymorphism microarrays were used to diagnose deletion and uniparental disomy (UPD). For phenotype-genotype correlation, clinical data were collected and genetic subgroups were compared statistically, and P < 0.05 was considered to indicate statistical significance. RESULTS These 57 patients consisted of 15 type I deletions, 20 type II deletions, six atypic deletions, 11 heterodisomy UPD, four isodisomy UPD, and one translocation-type PWS. All patients had hypotonia, poor neonatal sucking, and feeding difficulties during infancy. Other PWS-related clinical findings, such as speech articulation problems (85.9%), sleep apnea (77.2%), normal birth length (71.9%), small hands/feet (71.9%), childhood polyphagia (57.9%), clinodactyly (56.1%), thick viscous saliva (54.4%), and behavioral problems (50.9%) were observed at varying rates with no statistical difference between genetic subtypes in general. CONCLUSION This study highlights the phenotype-genotype associations on PWS from a cohort of Turkish pediatric patients as a single-center experience.
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Affiliation(s)
| | - Onur Akin
- Pediatric Endocrinology, Gülhane Faculty of Medicine, University of Health Sciences, Ankara, Turkey
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Madeo SF, Zagaroli L, Vandelli S, Calcaterra V, Crinò A, De Sanctis L, Faienza MF, Fintini D, Guazzarotti L, Licenziati MR, Mozzillo E, Pajno R, Scarano E, Street ME, Wasniewska M, Bocchini S, Bucolo C, Buganza R, Chiarito M, Corica D, Di Candia F, Francavilla R, Fratangeli N, Improda N, Morabito LA, Mozzato C, Rossi V, Schiavariello C, Farello G, Iughetti L, Salpietro V, Salvatoni A, Giordano M, Grugni G, Delvecchio M. Endocrine features of Prader-Willi syndrome: a narrative review focusing on genotype-phenotype correlation. Front Endocrinol (Lausanne) 2024; 15:1382583. [PMID: 38737552 PMCID: PMC11082343 DOI: 10.3389/fendo.2024.1382583] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/05/2024] [Accepted: 04/12/2024] [Indexed: 05/14/2024] Open
Abstract
Prader-Willi syndrome (PWS) is a complex genetic disorder caused by three different types of molecular genetic abnormalities. The most common defect is a deletion on the paternal 15q11-q13 chromosome, which is seen in about 60% of individuals. The next most common abnormality is maternal disomy 15, found in around 35% of cases, and a defect in the imprinting center that controls the activity of certain genes on chromosome 15, seen in 1-3% of cases. Individuals with PWS typically experience issues with the hypothalamic-pituitary axis, leading to excessive hunger (hyperphagia), severe obesity, various endocrine disorders, and intellectual disability. Differences in physical and behavioral characteristics between patients with PWS due to deletion versus those with maternal disomy are discussed in literature. Patients with maternal disomy tend to have more frequent neurodevelopmental problems, such as autistic traits and behavioral issues, and generally have higher IQ levels compared to those with deletion of the critical PWS region. This has led us to review the pertinent literature to investigate the possibility of establishing connections between the genetic abnormalities and the endocrine disorders experienced by PWS patients, in order to develop more targeted diagnostic and treatment protocols. In this review, we will review the current state of clinical studies focusing on endocrine disorders in individuals with PWS patients, with a specific focus on the various genetic causes. We will look at topics such as neonatal anthropometry, thyroid issues, adrenal problems, hypogonadism, bone metabolism abnormalities, metabolic syndrome resulting from severe obesity caused by hyperphagia, deficiencies in the GH/IGF-1 axis, and the corresponding responses to treatment.
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Affiliation(s)
- Simona F. Madeo
- Department of Medical and Surgical Sciences for Mother, Children and Adults, Pediatric Unit, University of Modena and Reggio Emilia, Modena, Italy
| | - Luca Zagaroli
- Department of Pediatrics, University of L’Aquila, L’Aquila, Italy
| | - Sara Vandelli
- Department of Medical and Surgical Sciences for Mother, Children and Adults, Post-Graduate School of Pediatrics, University of Modena and Reggio Emilia, Modena, Italy
| | - Valeria Calcaterra
- Department of Internal Medicine and Therapeutics, University of Pavia, Pavia, Italy
- Pediatric Department, Buzzi Children’s Hospital, Milano, Italy
| | - Antonino Crinò
- Center for Rare Diseases and Congenital Defects, Fondazione Policlinico Universitario A. Gemelli, IRCCS, Rome, Italy
| | - Luisa De Sanctis
- Pediatric Endocrinology, Regina Margherita Children Hospital – Department of Public Health and Pediatric Sciences, University of Torino, Torino, Italy
| | - Maria Felicia Faienza
- Pediatric Unit, Department of Precision and Regenerative Medicine and Ionian Area, University of Bari “Aldo Moro”, Bari, Italy
| | - Danilo Fintini
- Prader Willi Reference Center, Endocrinology and Diabetology Unit, Pediatric University Department, IRCCS Bambino Gesù Children Hospital, Rome, Italy
| | - Laura Guazzarotti
- Pediatric Endocrinology Unit, University Hospital of Padova, Padova, Italy
| | - Maria Rosaria Licenziati
- Neuro-endocrine Diseases and Obesity Unit, Department of Neurosciences, Santobono-Pausilipon Children’s Hospital, Naples, Italy
| | - Enza Mozzillo
- Department of Translational and Medical Science, Section of Pediatrics, University of Naples Federico II, Naples, Italy
| | - Roberta Pajno
- Pediatric Unit, IRCCS San Raffaele Institute, Milan, Italy
| | - Emanuela Scarano
- Pediatric Unit, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy
| | - Maria E. Street
- Department of Medicine and Surgery, University of Parma, Parma, Italy
- Department of Medicine and Surgery, University Hospital of Parma, Parma, Italy
| | - Malgorzata Wasniewska
- Department of Human Pathology of Adulthood and Childhood, University of Messina, Messina, Italy
- Pediatric Unit, Gaetano Martino University Hospital of Messina, Messina, Italy
| | - Sarah Bocchini
- Prader Willi Reference Center, Endocrinology and Diabetology Unit, Pediatric University Department, IRCCS Bambino Gesù Children Hospital, Rome, Italy
| | - Carmen Bucolo
- Pediatric Unit, IRCCS San Raffaele Institute, Milan, Italy
| | - Raffaele Buganza
- Pediatric Endocrinology, Regina Margherita Children Hospital – Department of Public Health and Pediatric Sciences, University of Torino, Torino, Italy
| | - Mariangela Chiarito
- Pediatric Unit, Department of Precision and Regenerative Medicine and Ionian Area, University of Bari “Aldo Moro”, Bari, Italy
| | - Domenico Corica
- Department of Human Pathology of Adulthood and Childhood, University of Messina, Messina, Italy
- Pediatric Unit, Gaetano Martino University Hospital of Messina, Messina, Italy
| | - Francesca Di Candia
- Department of Translational and Medical Science, Section of Pediatrics, University of Naples Federico II, Naples, Italy
| | | | - Nadia Fratangeli
- Division of Auxology, Istituto Auxologico Italiano, Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS), Verbania, Italy
| | - Nicola Improda
- Neuro-endocrine Diseases and Obesity Unit, Department of Neurosciences, Santobono-Pausilipon Children’s Hospital, Naples, Italy
| | | | - Chiara Mozzato
- Child and Women Health Department, University of Padova, Padova, Italy
| | - Virginia Rossi
- Pediatric Department, Buzzi Children’s Hospital, Milano, Italy
| | | | - Giovanni Farello
- Department of Clinical Medicine, Public Health, Life and Environmental Sciences, University of L’Aquila, L’Aquila, Italy
| | - Lorenzo Iughetti
- Department of Medical and Surgical Sciences for Mother, Children and Adults, Pediatric Unit, University of Modena and Reggio Emilia, Modena, Italy
| | - Vincenzo Salpietro
- Department of Biotechnological and Applied Clinical Sciences, University of L’Aquila, L’Aquila, Italy
| | | | - Mara Giordano
- Laboratory of Genetics, Struttura Complessa a Direzione Universitaria (SCDU) Biochimica Clinica, Ospedale Maggiore della Carità, Novara, Italy
- Department of Health Sciences, University of Piemonte Orientale, Novara, Italy
| | - Graziano Grugni
- Division of Auxology, Istituto Auxologico Italiano, Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS), Verbania, Italy
| | - Maurizio Delvecchio
- Department of Biotechnological and Applied Clinical Sciences, University of L’Aquila, L’Aquila, Italy
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Grootjen LN, Kerkhof GF, Juriaans AF, Trueba-Timmermans DJ, Hokken-Koelega ACS. Acute stress response of the HPA-axis in children with Prader-Willi syndrome: new insights and consequences for clinical practice. Front Endocrinol (Lausanne) 2023; 14:1146680. [PMID: 37288298 PMCID: PMC10242050 DOI: 10.3389/fendo.2023.1146680] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/17/2023] [Accepted: 05/10/2023] [Indexed: 06/09/2023] Open
Abstract
Background Prader-Willi syndrome (PWS) is associated with hypothalamic dysfunction. It has been reported that the HPA axis might show a delayed response during acute stress, and it is unknown whether the response of the HPA-axis during acute stress changes with age in children with PWS. Aim To investigate the HPA-axis response during an overnight single-dose metyrapone (MTP) test in children with PWS and to assess if the response changes with age, whether it is delayed and if it changes with repeated testing over time. In addition, we evaluated different cut-off points of ACTH and 11-DOC levels to assess stress-related central adrenal insufficiency (CAI). Methods An overnight single-dose MTP test was performed in 93 children with PWS. Over time, 30 children had a second test and 11 children a third one. Children were divided into age groups (0-2 years, 2-4 years, 4-8 years and > 8 years). Results Most children did not have their lowest cortisol level at 7.30h, but at 04.00h. Their ACTH and 11-DOC peaks appeared several hours later, suggesting a delayed response. When evaluated according to a subnormal ACTH peak (13-33 pmol/L) more children had an subnormal response compared to evaluation based on a subnormal 11-doc peak (< 200 nmol/L). The percentage of children with a subnormal ACTH response ranged from 22.2 to 70.0% between the age groups, while the percentage of a subnormal 11-DOC response ranged from 7.7 to 20.6%. When using the ACTH peak for diagnosing acute-stress-related CAI, differences between age groups and with repeated testing over time were found, whereas there was no age difference when using the 11-DOC peak. Conclusion Early morning ACTH or 11-DOC levels are not appropriate to determine acute stress-related CAI in children with PWS, thus multiple measurements throughout the night are needed for an accurate interpretation. Our data suggest a delayed response of the HPA-axis during acute stress. Using the 11-DOC peak for the test interpretation is less age-dependent than the ACTH peak. Repeated testing of the HPA-axis over time is not required, unless clinically indicated.
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Affiliation(s)
- Lionne N. Grootjen
- Dutch Reference Center for Prader-Willi Syndrome, Rotterdam, Netherlands
- Department of Pediatrics, Subdivision of Endocrinology, Erasmus University Medical Center-Sophia Children’s Hospital, Rotterdam, Netherlands
- Dutch Growth Research Foundation, Rotterdam, Netherlands
| | - Gerthe F. Kerkhof
- Dutch Reference Center for Prader-Willi Syndrome, Rotterdam, Netherlands
- Department of Pediatrics, Subdivision of Endocrinology, Erasmus University Medical Center-Sophia Children’s Hospital, Rotterdam, Netherlands
| | - Alicia F. Juriaans
- Dutch Reference Center for Prader-Willi Syndrome, Rotterdam, Netherlands
- Department of Pediatrics, Subdivision of Endocrinology, Erasmus University Medical Center-Sophia Children’s Hospital, Rotterdam, Netherlands
- Dutch Growth Research Foundation, Rotterdam, Netherlands
| | - Demi J. Trueba-Timmermans
- Dutch Reference Center for Prader-Willi Syndrome, Rotterdam, Netherlands
- Department of Pediatrics, Subdivision of Endocrinology, Erasmus University Medical Center-Sophia Children’s Hospital, Rotterdam, Netherlands
- Dutch Growth Research Foundation, Rotterdam, Netherlands
| | - Anita C. S. Hokken-Koelega
- Dutch Reference Center for Prader-Willi Syndrome, Rotterdam, Netherlands
- Department of Pediatrics, Subdivision of Endocrinology, Erasmus University Medical Center-Sophia Children’s Hospital, Rotterdam, Netherlands
- Dutch Growth Research Foundation, Rotterdam, Netherlands
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Gaston LS, Stafford DE. Premature adrenarche in Prader-Willi syndrome is associated with accelerated pre-pubertal growth and advanced bone age. J Pediatr Endocrinol Metab 2023; 36:185-194. [PMID: 36458449 PMCID: PMC10103844 DOI: 10.1515/jpem-2022-0468] [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: 09/13/2022] [Accepted: 11/11/2022] [Indexed: 12/03/2022]
Abstract
OBJECTIVES Prader-Willi syndrome (PWS) is characterized by obesity, growth hormone deficiency, hypogonadism, and a high prevalence of premature adrenarche despite reported hypothalamic-pituitary-adrenal axis dysfunction. While idiopathic premature adrenarche is associated with accelerated pre-pubertal growth and advanced bone age, the consequences of elevated adrenal androgens on growth and bone maturation in PWS remain unknown. This study therefore sought to describe age-related changes in dehydroepiandrosterone sulfate (DHEAS) and their effects on growth and bone maturation in PWS. METHODS This retrospective observational study included 62 children with PWS. Simple and multiple regression models were constructed to relate age and BMI-SDS with DHEAS levels. Height velocity was compared to age and sex-based norms with t-tests and two-way ANOVA. Patterns in bone age Z-score were examined with two-way ANOVA, and the contributions of age, BMI-SDS, and DHEAS to bone age Z-score were analyzed with multiple regression. RESULTS DHEAS levels rose earlier and were less strongly correlated with age in males and females with PWS (R2=0.12 and 0.30) compared to healthy controls (R2=0.89 and 0.88) in a pattern unrelated to BMI-SDS (adjusted R2=0.076, p=0.10 for age, and 0.29 for BMI-SDS). Mid-childhood height velocity was increased in males and preserved in females with PWS before declining at the age of expected puberty (p<0.0001). Peri-adrenarchal bone age was advanced in a manner associated with DHEAS but not BMI-SDS (p<0.0001; adjusted R2=0.48, p=0.0014 for DHEAS, and 0.78 for BMI-SDS). CONCLUSIONS An obesity-independent increase in adrenal androgens is associated with accelerated mid-childhood growth and bone maturation in PWS.
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Affiliation(s)
- Lindsey S Gaston
- Department of Pediatrics, Division of Endocrinology, Boston Children's Hospital, Harvard Medical School, Boston, MA, USA
| | - Diane E Stafford
- Department of Pediatrics, Division of Endocrinology and Diabetes, Stanford University School of Medicine, Palo Alto, CA, USA
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Salvatore M, Torreri P, Grugni G, Rocchetti A, Maghnie M, Patti G, Crinò A, Elia M, Greco D, Romano C, Franzese A, Mozzillo E, Colao A, Pugliese G, Pagotto U, Lo Preiato V, Scarano E, Schiavariello C, Tornese G, Fintini D, Bocchini S, Osimani S, De Sanctis L, Sacco M, Rutigliano I, Delvecchio M, Faienza MF, Wasniewska M, Corica D, Stagi S, Guazzarotti L, Maffei P, Dassie F, Taruscio D. The Italian registry for patients with Prader-Willi syndrome. Orphanet J Rare Dis 2023; 18:28. [PMID: 36793093 PMCID: PMC9930253 DOI: 10.1186/s13023-023-02633-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2022] [Accepted: 02/06/2023] [Indexed: 02/17/2023] Open
Abstract
BACKGROUND Prader-Willi syndrome (PWS) is a rare and complex genetic disease, with numerous implications on metabolic, endocrine, neuropsychomotor systems, and with behavioural and intellectual disorders. Rare disease patient registries are important scientific tools (1) to collect clinical and epidemiologic data, (2) to assess the clinical management including the diagnostic delay, (3) to improve patients' care and (4) to foster research to identify new therapeutic solutions. The European Union has recommended the implementation and use of registries and databases. The main aims of this paper are to describe the process of setting up the Italian PWS register, and to illustrate our preliminary results. MATERIALS AND METHODS The Italian PWS registry was established in 2019 with the aims (1) to describe the natural history of the disease, (2) to determine clinical effectiveness of health care services, (3) to measure and monitor quality of care of patients. Information from six different variables are included and collected into this registry: demographics, diagnosis and genetics, patient status, therapy, quality of life and mortality. RESULTS A total of 165 patients (50.3% female vs 49.7% male) were included into Italian PWS registry in 2019-2020 period. Average age at genetic diagnosis was 4.6 years; 45.4% of patients was less than 17 years old aged, while the 54.6% was in adult age (> 18 years old). Sixty-one percent of subjects had interstitial deletion of the proximal long arm of paternal chromosome 15, while 36.4% had uniparental maternal disomy for chromosome 15. Three patients presented an imprinting centre defect and one had a de novo translocation involving chromosome 15. A positive methylation test was demonstrated in the remaining 11 individuals but the underlying genetic defect was not identified. Compulsive food-seeking and hyperphagia was present in 63.6% of patients (prevalently in adults); 54.5% of patients developed morbid obesity. Altered glucose metabolism was present in 33.3% of patients. Central hypothyroidism was reported in 20% of patients; 94.7% of children and adolescents and 13.3% of adult patients is undergoing GH treatment. CONCLUSIONS The analyses of these six variables allowed to highlight important clinical aspects and natural history of PWS useful to inform future actions to be taken by national health care services and health professionals.
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Affiliation(s)
- Marco Salvatore
- National Centre for Rare Diseases, Undiagnosed Rare Diseases Interdepartmental Unit, Istituto Superiore di Sanità, Viale Regina Elena 299, 00161, Rome, Italy.
| | - Paola Torreri
- grid.416651.10000 0000 9120 6856National Centre for Rare Diseases, Undiagnosed Rare Diseases Interdepartmental Unit, Istituto Superiore di Sanità, Viale Regina Elena 299, 00161 Rome, Italy
| | - Graziano Grugni
- grid.418224.90000 0004 1757 9530Division of Auxology, Istituto Auxologico Italiano IRCCS, Piancavallo di Oggebbio, VB Italy
| | - Adele Rocchetti
- grid.416651.10000 0000 9120 6856National Centre for Rare Diseases, Undiagnosed Rare Diseases Interdepartmental Unit, Istituto Superiore di Sanità, Viale Regina Elena 299, 00161 Rome, Italy
| | - Mohamad Maghnie
- grid.419504.d0000 0004 1760 0109Department of Pediatrics, IRCCS Istituto Giannina Gaslini, Genoa, Italy ,grid.5606.50000 0001 2151 3065Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health, University of Genova, Genoa, Italy
| | - Giuseppa Patti
- grid.419504.d0000 0004 1760 0109Department of Pediatrics, IRCCS Istituto Giannina Gaslini, Genoa, Italy ,grid.5606.50000 0001 2151 3065Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health, University of Genova, Genoa, Italy
| | - Antonino Crinò
- grid.411075.60000 0004 1760 4193Center for Rare Diseases and Congenital Defects, Fondazione Policlinico Universitario “Agostino Gemelli” IRCCS, Rome, Italy
| | - Maurizio Elia
- grid.419843.30000 0001 1250 7659Oasi Research Institute – IRCCS, Troina, EN Italy
| | - Donatella Greco
- grid.419843.30000 0001 1250 7659Oasi Research Institute – IRCCS, Troina, EN Italy
| | - Corrado Romano
- grid.419843.30000 0001 1250 7659Oasi Research Institute – IRCCS, Troina, EN Italy ,grid.8158.40000 0004 1757 1969Department of Biomedical and Biotechnological Sciences, University of Catania, Catania, Italy
| | | | - Enza Mozzillo
- grid.4691.a0000 0001 0790 385XAOU Federico II, Naples, Italy
| | - Annamaria Colao
- grid.4691.a0000 0001 0790 385XAOU Federico II, Naples, Italy
| | | | - Uberto Pagotto
- grid.6292.f0000 0004 1757 1758Unità di Endocrinologia e Prevenzione e Cura del Diabete, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Dipartimento di Scienze Mediche e Chirurgiche (DIMEC), Alma Mater Studiorum Università di Bologna, Bologna, Italy
| | - Valentina Lo Preiato
- grid.6292.f0000 0004 1757 1758Unità di Endocrinologia e Prevenzione e Cura del Diabete, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Dipartimento di Scienze Mediche e Chirurgiche (DIMEC), Alma Mater Studiorum Università di Bologna, Bologna, Italy
| | - Emanuela Scarano
- Rare Diseases Unit, Department of Pediatrics, IRCCS AOU Sant’Orsola, Bologna, Italy
| | | | - Gianluca Tornese
- grid.418712.90000 0004 1760 7415IRCCS Materno Infantile Burlo Garofolo, Trieste, Italy
| | - Danilo Fintini
- grid.414603.4IRCCS Bambino Gesù Paediatric Hospital, Rome, Italy
| | - Sarah Bocchini
- grid.414603.4IRCCS Bambino Gesù Paediatric Hospital, Rome, Italy
| | - Sara Osimani
- grid.18887.3e0000000417581884IRCCS Ospedale San Raffaele, Milan, Italy
| | - Luisa De Sanctis
- grid.7605.40000 0001 2336 6580AOU Città della Salute e della Scienza/Ospedale Infantile Regina Margherita and Dipartimento di Scienze di Sanità Pubblica e Pediatriche, Università di Torino, Turin, Italy
| | - Michele Sacco
- grid.413503.00000 0004 1757 9135IRCCS Casa Sollievo della Sofferenza - San Giovanni Rotondo, Foggia, Italy
| | - Irene Rutigliano
- grid.413503.00000 0004 1757 9135IRCCS Casa Sollievo della Sofferenza - San Giovanni Rotondo, Foggia, Italy
| | | | | | | | | | - Stefano Stagi
- grid.413181.e0000 0004 1757 8562Azienda Ospedaliera Universitaria Meyer, Florence, Italy
| | - Laura Guazzarotti
- grid.411474.30000 0004 1760 2630Azienda Ospedale Università Padova (LG), Padua, Italy ,grid.5608.b0000 0004 1757 3470Dipartimento di Medicina (DIMED), University of Padua (PM, FD), Padua, Italy
| | - Pietro Maffei
- grid.411474.30000 0004 1760 2630Azienda Ospedale Università Padova (LG), Padua, Italy ,grid.5608.b0000 0004 1757 3470Dipartimento di Medicina (DIMED), University of Padua (PM, FD), Padua, Italy
| | - Francesca Dassie
- grid.411474.30000 0004 1760 2630Azienda Ospedale Università Padova (LG), Padua, Italy ,grid.5608.b0000 0004 1757 3470Dipartimento di Medicina (DIMED), University of Padua (PM, FD), Padua, Italy
| | - Domenica Taruscio
- grid.416651.10000 0000 9120 6856National Centre for Rare Diseases, Undiagnosed Rare Diseases Interdepartmental Unit, Istituto Superiore di Sanità, Viale Regina Elena 299, 00161 Rome, Italy
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9
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Poitou C, Holland A, Höybye C, de Graaff LCG, Bottius S, Otterlei B, Tauber M. The transition from pediatric to adult care in individuals with Prader-Willi syndrome. Endocr Connect 2023; 12:e220373. [PMID: 36347048 PMCID: PMC9782397 DOI: 10.1530/ec-22-0373] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/03/2022] [Accepted: 11/08/2022] [Indexed: 11/09/2022]
Abstract
Prader-Willi syndrome (PWS), the most common form of syndromic obesity, is a complex neurodevelopmental genetic disorder including obesity with hyperphagia, endocrine and metabolic disorders and also psychiatric disorders. The most frequent endocrine disturbances include hypogonadism and growth hormone (GH) deficiency. Hypothyroidism and central adrenal insufficiency can also be observed but are less frequent. The transition of individuals with PWS from adolescence to adult life is challenging because of multiple comorbidities and complex disabilities. Individuals and caregivers face psychological, medical and social issues. This period of profound changes is thus prone to disruptions, and the main risks being the worsening of the medical situation and loss to follow-up of the individuals. Medical care may be poorly adapted to the needs of individuals because of a lack of knowledge concerning the syndrome and also lack of the necessary specific skills. A multidisciplinary panel composed of several experts in PWS met in November 2021 during an European Reference Network on Rare Endocrine Conditions (Endo-ERN) webinar. They presented complementary aspects of PWS from the perspective of the transition including psychiatric, pediatric and adult endocrinological and parent's and patient's points of view and shed light on the best way to approach this pivotal period.
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Affiliation(s)
- Christine Poitou
- Assistance Publique-Hôpitaux de Paris, Centre de référence Maladies Rares (PRADORT, Syndrome de Prader-Willi et autres formes rares d’obésité avec troubles du comportement alimentaire), Service de Nutrition, Hôpital Pitié-Salpêtrière, Paris, France
| | | | - Charlotte Höybye
- Department of Endocrinology and Department of Molecular Medicine and Surgery, Karolinska University Hospital and Karolinska Institute, Stockholm, Sweden
| | - Laura C G de Graaff
- Center for Adults with Rare Genetic Syndromes, Department of Internal Medicine, Division of Endocrinology, Erasmus Medical Center, University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - Sandrine Bottius
- Assistance Publique-Hôpitaux de Paris, Centre de référence Maladies Rares (PRADORT, Syndrome de Prader-Willi et autres formes rares d’obésité avec troubles du comportement alimentaire), Service de Nutrition, Hôpital Pitié-Salpêtrière, Paris, France
| | - Berit Otterlei
- Landsforeningen for Prader-Willis Syndrom Hiltonåsen, Slependen, Norway
| | - Maithé Tauber
- Centre de référence Maladies Rares (PRADORT, Syndrome de Prader-Willi et autres formes rares d’obésité avec troubles du comportement alimentaire), Service d’Endocrinologie, Obésités, Maladies Osseuses, Génétique et Gynécologie Médicale, Hôpital des Enfants, Toulouse, France
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10
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van Abswoude DH, Pellikaan K, Rosenberg AGW, Davidse K, Coupaye M, Høybye C, Markovic TP, Grugni G, Crinò A, Caixàs A, Poitou C, Mosbah H, Weir T, van Vlimmeren LA, Rutges JPHJ, De Klerk LWL, Zillikens MC, van der Lely AJ, de Graaff LCG. Bone Health in Adults With Prader-Willi Syndrome: Clinical Recommendations Based on a Multicenter Cohort Study. J Clin Endocrinol Metab 2022; 108:59-84. [PMID: 36149817 PMCID: PMC9759176 DOI: 10.1210/clinem/dgac556] [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: 07/12/2022] [Revised: 09/13/2022] [Indexed: 02/03/2023]
Abstract
CONTEXT Prader-Willi syndrome (PWS) is a rare complex genetic syndrome, characterized by delayed psychomotor development, hypotonia, and hyperphagia. Hormone deficiencies such as hypogonadism, hypothyroidism, and growth hormone deficiency are common. The combination of hypotonia, low physical activity, and hypogonadism might lead to a decrease in bone mass and increase in fracture risk. Moreover, one would expect an increased risk of scoliosis due to hypotonia and low physical activity. OBJECTIVE To study the prevalence and risk factors for skeletal problems (reduced bone mineral density, fractures, and scoliosis) in adults with PWS. METHODS We retrospectively collected patient characteristics, medical history, medication, biochemical measurements, dual-energy X-ray absorptiometry scans, and spinal X-rays and reviewed the current literature. RESULTS We included 354 adults with PWS (median age 31 years; 43% males), of whom 51 (14%) had osteoporosis (T-score below -2.5) and 143 (54%) had osteopenia (T-score -1 to -2.5). The most prevalent modifiable risk factors for osteoporosis were hypogonadism, insufficient dairy intake, sedentary lifestyle, and corticosteroid use. Male sex was associated with osteoporosis (P = .005). Growth hormone treatment was not associated with osteoporosis. A history of vertebral fractures was present in 10 (3%) and nonvertebral fractures in 59 (17%). Scoliosis was present in 263 (80%), but no modifiable risk factors were identified. CONCLUSION Besides scoliosis, osteoporosis is common in adults with PWS. Based on the literature and the risk factors for osteoporosis found in our cohort, we provide practical clinical recommendations to avoid skeletal complications in these vulnerable patients.
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Affiliation(s)
| | | | - Anna G W Rosenberg
- Department of Internal Medicine, Division of Endocrinology, Erasmus Medical
Center, University Medical Center Rotterdam, 3015 GD
Rotterdam, The Netherlands
- Center for Adults with Rare Genetic Syndromes, Department of Internal
Medicine, Division of Endocrinology, Erasmus Medical Center, University Medical Center
Rotterdam, 3015 GD Rotterdam, The Netherlands
- Dutch Center of Reference for Prader-Willi Syndrome,
3015 GD Rotterdam, The
Netherlands
- Academic Center for Growth Disorders, Erasmus Medical Center, University
Medical Center Rotterdam, 3015 GD Rotterdam,
The Netherlands
| | - Kirsten Davidse
- Department of Internal Medicine, Division of Endocrinology, Erasmus Medical
Center, University Medical Center Rotterdam, 3015 GD
Rotterdam, The Netherlands
- Center for Adults with Rare Genetic Syndromes, Department of Internal
Medicine, Division of Endocrinology, Erasmus Medical Center, University Medical Center
Rotterdam, 3015 GD Rotterdam, The Netherlands
- Dutch Center of Reference for Prader-Willi Syndrome,
3015 GD Rotterdam, The
Netherlands
- Academic Center for Growth Disorders, Erasmus Medical Center, University
Medical Center Rotterdam, 3015 GD Rotterdam,
The Netherlands
| | - Muriel Coupaye
- Assistance Publique-Hôpitaux de Paris, Rare Diseases Center of reference
‘Prader-Willi Syndrome and obesity with eating disorders’ (PRADORT), Nutrition
Department, Institute of Cardiometabolism and Nutrition, ICAN, Pitié-Salpêtrière
Hospital, Sorbonne Université, INSERM, Nutriomics, F75013
Paris, France
- International Network for Research, Management & Education on adults
with Prader-Willi Syndrome (INfoRMEd-PWS)
| | - Charlotte Høybye
- International Network for Research, Management & Education on adults
with Prader-Willi Syndrome (INfoRMEd-PWS)
- ENDO-ERN (European Reference Network)
- Department of Molecular Medicine and Surgery, Karolinska Institute and
Karolinska University Hospital, Stockholm,
Sweden
- Department of Endocrinology, Karolinska Institute and Karolinska University
Hospital, Stockholm, Sweden
| | - Tania P Markovic
- International Network for Research, Management & Education on adults
with Prader-Willi Syndrome (INfoRMEd-PWS)
- Metabolism & Obesity Services, Royal Prince Alfred
Hospital, Camperdown, Australia
- Boden Initiative, Charles Perkins Centre, University of
Sydney, SydneyAustralia
| | - Graziano Grugni
- International Network for Research, Management & Education on adults
with Prader-Willi Syndrome (INfoRMEd-PWS)
- ENDO-ERN (European Reference Network)
- Divison of Auxology, Istituto Auxologico Italiano, IRCCS,
Piancavallo (VB), Italy
| | - Antonino Crinò
- International Network for Research, Management & Education on adults
with Prader-Willi Syndrome (INfoRMEd-PWS)
- Reference Center for Prader-Willi syndrome, Bambino Gesù Hospital, Research
Institute, Palidoro (Rome), Italy
| | - Assumpta Caixàs
- International Network for Research, Management & Education on adults
with Prader-Willi Syndrome (INfoRMEd-PWS)
- Department of Endocrinology and Nutrition, Hospital Universitari Parc
Taulí, Institut d’Investigació i Innovació Parc Taulí (I3PT), Universitat Autònoma de
Barcelona, Sabadell, Spain
- Department of Medicine, Universitat Autònoma de Barcelona,
Sabadell, Spain
| | - Christine Poitou
- Assistance Publique-Hôpitaux de Paris, Rare Diseases Center of reference
‘Prader-Willi Syndrome and obesity with eating disorders’ (PRADORT), Nutrition
Department, Institute of Cardiometabolism and Nutrition, ICAN, Pitié-Salpêtrière
Hospital, Sorbonne Université, INSERM, Nutriomics, F75013
Paris, France
- International Network for Research, Management & Education on adults
with Prader-Willi Syndrome (INfoRMEd-PWS)
- ENDO-ERN (European Reference Network)
| | - Helena Mosbah
- Assistance Publique-Hôpitaux de Paris, Rare Diseases Center of reference
‘Prader-Willi Syndrome and obesity with eating disorders’ (PRADORT), Nutrition
Department, Institute of Cardiometabolism and Nutrition, ICAN, Pitié-Salpêtrière
Hospital, Sorbonne Université, INSERM, Nutriomics, F75013
Paris, France
| | - Tessa Weir
- Department of Endocrinology, Nepean-Blue Mountains Hospital,
Sydney, NSW, Australia
- Northern Clinical School, Faculty of Medicine and Health, University of
Sydney, Sydney, NSW, Australia
| | - Leo A van Vlimmeren
- Department of Rehabilitation and Pediatric Physical Therapy, Radboud
University Medical Centrum, 6525 GA Nijmegen,
The Netherlands
| | - Joost P H J Rutges
- Department of Orthopedic surgery, Erasmus Medical Center, University
Medical Center Rotterdam, 3015 GD Rotterdam,
The Netherlands
| | - Luuk W L De Klerk
- Department of Orthopedic surgery, Sint Maartensclinic,
6500 GM Nijmegen, The
Netherlands
| | - M Carola Zillikens
- Department of Internal Medicine, Division of Endocrinology, Erasmus Medical
Center, University Medical Center Rotterdam, 3015 GD
Rotterdam, The Netherlands
- ENDO-ERN (European Reference Network)
- Academic Center for Rare Bone Disorders, Erasmus Medical Center, University
Medical Center Rotterdam, 3015 GD Rotterdam,
The Netherlands
- European Reference Network for rare bone diseases (ERN BOND)
| | - Aart J van der Lely
- Department of Internal Medicine, Division of Endocrinology, Erasmus Medical
Center, University Medical Center Rotterdam, 3015 GD
Rotterdam, The Netherlands
| | - Laura C G de Graaff
- Correspondence: Laura de Graaff, MD, PhD, Dept. of Internal Medicine, Erasmus
MC, University Medical Center, Dr. Molewaterplein 40, 3015 GD Rotterdam, The Netherlands.
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11
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Rosenberg AGW, Wellink CM, Tellez Garcia JM, Pellikaan K, Van Abswoude DH, Davidse K, Van Zutven LJCM, Brüggenwirth HT, Resnick JL, Van der Lely AJ, De Graaff LCG. Health Problems in Adults with Prader-Willi Syndrome of Different Genetic Subtypes: Cohort Study, Meta-Analysis and Review of the Literature. J Clin Med 2022; 11:jcm11144033. [PMID: 35887798 PMCID: PMC9323859 DOI: 10.3390/jcm11144033] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2022] [Revised: 06/27/2022] [Accepted: 07/05/2022] [Indexed: 12/04/2022] Open
Abstract
Prader−Willi syndrome (PWS) is a complex, rare genetic disorder caused by a loss of expression of paternally expressed genes on chromosome 15q11.2-q13. The most common underlying genotypes are paternal deletion (DEL) and maternal uniparental disomy (mUPD). DELs can be subdivided into type 1 (DEL-1) and (smaller) type 2 deletions (DEL-2). Most research has focused on behavioral, cognitive and psychological differences between the different genotypes. However, little is known about physical health problems in relation to genetic subtypes. In this cross-sectional study, we compare physical health problems and other clinical features among adults with PWS caused by DEL (N = 65, 12 DEL-1, 27 DEL-2) and mUPD (N = 65). A meta-analysis, including our own data, showed that BMI was 2.79 kg/m2 higher in adults with a DEL (p = 0.001). There were no significant differences between DEL-1 and DEL-2. Scoliosis was more prevalent among adults with a DEL (80% vs. 58%; p = 0.04). Psychotic episodes were more prevalent among adults with an mUPD (44% vs. 9%; p < 0.001). In conclusion, there were no significant differences in physical health outcomes between the genetic subtypes, apart from scoliosis and BMI. The differences in health problems, therefore, mainly apply to the psychological domain.
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Affiliation(s)
- Anna G. W. Rosenberg
- Department of Internal Medicine, Division of Endocrinology, Erasmus MC, University Medical Center Rotterdam, 3015 GD Rotterdam, The Netherlands; (A.G.W.R.); (C.M.W.); (J.M.T.G.); (K.P.); (D.H.V.A.); (K.D.); (A.J.V.d.L.)
- Dutch Center of Reference for Prader–Willi Syndrome, 3015 GD Rotterdam, The Netherlands
- Center for Adults with Rare Genetic Syndromes, Department of Internal Medicine, Division of Endocrinology, Erasmus MC, University Medical Center Rotterdam, 3015 GD Rotterdam, The Netherlands
- Academic Center for Growth Disorders, Erasmus MC, University Medical Center Rotterdam, 3015 GD Rotterdam, The Netherlands
| | - Charlotte M. Wellink
- Department of Internal Medicine, Division of Endocrinology, Erasmus MC, University Medical Center Rotterdam, 3015 GD Rotterdam, The Netherlands; (A.G.W.R.); (C.M.W.); (J.M.T.G.); (K.P.); (D.H.V.A.); (K.D.); (A.J.V.d.L.)
| | - Juan M. Tellez Garcia
- Department of Internal Medicine, Division of Endocrinology, Erasmus MC, University Medical Center Rotterdam, 3015 GD Rotterdam, The Netherlands; (A.G.W.R.); (C.M.W.); (J.M.T.G.); (K.P.); (D.H.V.A.); (K.D.); (A.J.V.d.L.)
| | - Karlijn Pellikaan
- Department of Internal Medicine, Division of Endocrinology, Erasmus MC, University Medical Center Rotterdam, 3015 GD Rotterdam, The Netherlands; (A.G.W.R.); (C.M.W.); (J.M.T.G.); (K.P.); (D.H.V.A.); (K.D.); (A.J.V.d.L.)
- Dutch Center of Reference for Prader–Willi Syndrome, 3015 GD Rotterdam, The Netherlands
- Center for Adults with Rare Genetic Syndromes, Department of Internal Medicine, Division of Endocrinology, Erasmus MC, University Medical Center Rotterdam, 3015 GD Rotterdam, The Netherlands
- Academic Center for Growth Disorders, Erasmus MC, University Medical Center Rotterdam, 3015 GD Rotterdam, The Netherlands
| | - Denise H. Van Abswoude
- Department of Internal Medicine, Division of Endocrinology, Erasmus MC, University Medical Center Rotterdam, 3015 GD Rotterdam, The Netherlands; (A.G.W.R.); (C.M.W.); (J.M.T.G.); (K.P.); (D.H.V.A.); (K.D.); (A.J.V.d.L.)
- Dutch Center of Reference for Prader–Willi Syndrome, 3015 GD Rotterdam, The Netherlands
- Center for Adults with Rare Genetic Syndromes, Department of Internal Medicine, Division of Endocrinology, Erasmus MC, University Medical Center Rotterdam, 3015 GD Rotterdam, The Netherlands
- Academic Center for Growth Disorders, Erasmus MC, University Medical Center Rotterdam, 3015 GD Rotterdam, The Netherlands
| | - Kirsten Davidse
- Department of Internal Medicine, Division of Endocrinology, Erasmus MC, University Medical Center Rotterdam, 3015 GD Rotterdam, The Netherlands; (A.G.W.R.); (C.M.W.); (J.M.T.G.); (K.P.); (D.H.V.A.); (K.D.); (A.J.V.d.L.)
- Dutch Center of Reference for Prader–Willi Syndrome, 3015 GD Rotterdam, The Netherlands
- Center for Adults with Rare Genetic Syndromes, Department of Internal Medicine, Division of Endocrinology, Erasmus MC, University Medical Center Rotterdam, 3015 GD Rotterdam, The Netherlands
- Academic Center for Growth Disorders, Erasmus MC, University Medical Center Rotterdam, 3015 GD Rotterdam, The Netherlands
| | - Laura J. C. M. Van Zutven
- Department of Clinical Genetics, Erasmus MC, University Medical Center Rotterdam, 3015 GD Rotterdam, The Netherlands; (L.J.C.M.V.Z.); (H.T.B.)
| | - Hennie T. Brüggenwirth
- Department of Clinical Genetics, Erasmus MC, University Medical Center Rotterdam, 3015 GD Rotterdam, The Netherlands; (L.J.C.M.V.Z.); (H.T.B.)
| | - James L. Resnick
- Department of Molecular Genetics and Microbiology, College of Medicine, University of Florida, Gainesville, FL 32611, USA;
| | - Aart J. Van der Lely
- Department of Internal Medicine, Division of Endocrinology, Erasmus MC, University Medical Center Rotterdam, 3015 GD Rotterdam, The Netherlands; (A.G.W.R.); (C.M.W.); (J.M.T.G.); (K.P.); (D.H.V.A.); (K.D.); (A.J.V.d.L.)
- ENDO-ERN, European Reference Network on Rare Endocrine Conditions
| | - Laura C. G. De Graaff
- Department of Internal Medicine, Division of Endocrinology, Erasmus MC, University Medical Center Rotterdam, 3015 GD Rotterdam, The Netherlands; (A.G.W.R.); (C.M.W.); (J.M.T.G.); (K.P.); (D.H.V.A.); (K.D.); (A.J.V.d.L.)
- Dutch Center of Reference for Prader–Willi Syndrome, 3015 GD Rotterdam, The Netherlands
- Center for Adults with Rare Genetic Syndromes, Department of Internal Medicine, Division of Endocrinology, Erasmus MC, University Medical Center Rotterdam, 3015 GD Rotterdam, The Netherlands
- Academic Center for Growth Disorders, Erasmus MC, University Medical Center Rotterdam, 3015 GD Rotterdam, The Netherlands
- ENDO-ERN, European Reference Network on Rare Endocrine Conditions
- Correspondence: ; Tel.: +31-618-843-010
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12
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Angulo MA, Butler MG, Hossain WA, Castro-Magana M, Corletto J. Central adrenal insufficiency screening with morning plasma cortisol and ACTH levels in Prader-Willi syndrome. J Pediatr Endocrinol Metab 2022; 35:733-740. [PMID: 35437976 DOI: 10.1515/jpem-2022-0074] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/09/2022] [Accepted: 03/21/2022] [Indexed: 12/11/2022]
Abstract
OBJECTIVES Prader-Willi syndrome (PWS) is a complex genetic disorder with severe hypotonia, failure to thrive, childhood obesity, hypogonadism/hypogenitalism and learning/behavioral problems with endocrine-related growth and other hormone deficiencies. The prevalence of central adrenal insufficiency (CAI) using dynamic testing ranges from rare to 60%. We compared routine morning plasma cortisol (MPC) and ACTH levels in large cohorts of PWS and control children to address CAI. METHODS Retrospective analysis of MPC and ACTH levels was undertaken in 128 PWS growth hormone (GH)-treated children under medical care before considering dynamic testing for CAI and 128 non-syndromic control children with short stature evaluated for GH deficiency. RESULTS The average MPC level in PWS was 9.7 ± 3.7 μg/dL with no difference in age, gender or PWS genetic subtype and 13.4 ± 5.7 μg/dL in the control group. MPC levels were significantly lower (p < 0.05) in PWS but in the normal range. The morning plasma ACTH level in the PWS group was 22.1 ± 8.0 pg/mL with one individual having an initial low plasma ACTH level (8 pg/mL), but normal upon repeat. CONCLUSIONS MPC levels in PWS are normal and comparable with control children, without evidence or increased risk of CAI. Lower but normal MPC levels were seen in PWS and suggestive of reduced local regeneration of cortisol from cortisone in adipose tissue by the GH-IGF-I system. Hence, MPC measures alone or in combination with ACTH should be considered for initial screening for CAI in PWS but prior to dynamic testing.
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Affiliation(s)
- Moris A Angulo
- Department of Pediatrics, NYU Langone Hospital-Long Island, Mineola, NY, USA
| | - Merlin G Butler
- Departments of Psychiatry & Behavioral Sciences, University of Kansas Medical Center, Kansas City, KS, USA
| | - Waheeda A Hossain
- Departments of Psychiatry & Behavioral Sciences, University of Kansas Medical Center, Kansas City, KS, USA
| | | | - Jorge Corletto
- Department of Pediatrics, NYU Langone Hospital-Long Island, Mineola, NY, USA
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Noh ES, Kim MS, Kim C, Jeon K, Kim S, Cho SY, Jin DK. Endocrine and Metabolic Illnesses in Young Adults with Prader-Willi Syndrome. J Pers Med 2022; 12:jpm12060858. [PMID: 35743643 PMCID: PMC9225470 DOI: 10.3390/jpm12060858] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2022] [Revised: 05/22/2022] [Accepted: 05/23/2022] [Indexed: 12/10/2022] Open
Abstract
Prader−Willi syndrome (PWS) is a rare genetic disorder characterized by an insatiable appetite that leads to morbid obesity. Previous studies reported health problems in adults with PWS. However, studies on younger adults are lacking, and there are no specific studies of endocrine and metabolic illness in this age group. We performed a retrospective cohort study of 68 individuals with PWS aged 19 to 34 years at Samsung Medical Center. The prevalence of endocrine and metabolic illnesses were compared with those in an age-, sex-, and BMI-matched healthy control group. Young adults with PWS had a higher prevalence of metabolic syndrome (35.3% vs. 4.4%), type 2 diabetes mellitus (50.0% vs. 5.4%), hypertension (30.8% vs. 16.1%), dyslipidemia (38.2% vs. 14.7%), decreased bone density (26.4% vs. 0.9%), and sleep apnea (32.3% vs. 4.4%) than controls (all p < 0.05). The PWS group that maintained recombinant human growth (rhGH) treatment in adulthood had a lower probability of having a BMI ≥ 30 at the last follow-up (odds ratio = 0.106 (0.012−0.948), p = 0.045). Endocrine and metabolic illnesses in individuals with PWS may have already started in the early teens; therefore, appropriate screening and early intervention are important. Better understanding of the natural history of PWS and age-related complications will lead to better-quality medical care for individuals with PWS.
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Affiliation(s)
- Eu-Seon Noh
- Department of Pediatrics, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul 06351, Korea; (E.-S.N.); (M.-S.K.); (C.K.); (D.-K.J.)
| | - Min-Sun Kim
- Department of Pediatrics, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul 06351, Korea; (E.-S.N.); (M.-S.K.); (C.K.); (D.-K.J.)
| | - Chiwoo Kim
- Department of Pediatrics, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul 06351, Korea; (E.-S.N.); (M.-S.K.); (C.K.); (D.-K.J.)
| | - Kyeongman Jeon
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul 06351, Korea;
| | - Seonwoo Kim
- Academic Research Service Headquarter, LSK Global PS, Seoul 04535, Korea;
| | - Sung Yoon Cho
- Department of Pediatrics, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul 06351, Korea; (E.-S.N.); (M.-S.K.); (C.K.); (D.-K.J.)
- Correspondence:
| | - Dong-Kyu Jin
- Department of Pediatrics, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul 06351, Korea; (E.-S.N.); (M.-S.K.); (C.K.); (D.-K.J.)
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14
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Abstract
Prader-Willi syndrome (PWS) is a rare, multisystemic, genetic disorder involving the hypothalamus. It is caused by loss of expression of paternally inherited genes in chromosome 15 q11-13 region. The estimated incidence is around 1 in 20.000 births. PWS is characterized by a complex lifelong trajectory involving neurodevelopmental, nutritional, endocrine, metabolic, and behavioral changes. The major symptoms are hypotonia, short stature, hypogonadism, and eating disorders ranging from anorexia in infancy to hyperphagia, a deficit of satiety, and a high risk of severe obesity. The patients display intellectual disability comprising cognitive deficit, delayed motor and language development, learning deficits, impaired social skills, and emotional regulation. Behavioral features including temper outbursts, anxiety, obsessive-compulsive symptoms and rigidity are common and become more apparent with increasing age. Almost all have hypogonadism and growth hormone deficiency. Central adrenal insufficiency is rare whereas central hypothyroidism occurs in up to 30% of children with PWS. The prevalence of obesity increases with age from almost none in early childhood to more than 90% in adulthood. Up to 25% of adults with obesity have type 2 diabetes. Obesity and its complications are the major causes of comorbidity and mortality in PWS. As there is no specific treatment, care consists of comprehensive management of feeding disorders, a restricted, controlled diet, regular exercise, hormone substitution, and screening and treatment of comorbidities. Here we present the course of PWS from birth to adulthood in 2 patients and discuss their symptoms in relation to the literature.
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Affiliation(s)
- Charlotte Höybye
- Correspondence: Charlotte Höybye, MD, PhD, Department of Endocrinology, Karolinska Vägen 37A, 171 76 Stockholm, Sweden.
| | - Maithé Tauber
- The Clinical and Scientific Advisory Board of the International Organization for Prader-Willi Syndrome, IPWSO
- Centre de Référence Maladies Rares PRADORT (syndrome de PRADer-Willi et autres Obésités Rares avec Troubles du comportement alimentaire), Hôpital des Enfants, CHU Toulouse, Université Toulouse III, Toulouse, France
- Institut Toulousain des Maladies Infectieuses et Inflammatoires (Infinity) INSERM UMR1291—CNRS UMR5051—Université Toulouse III, Toulouse, France
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15
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Impact of Deprivation on Obesity in Children with PWS. J Clin Med 2022; 11:jcm11082255. [PMID: 35456348 PMCID: PMC9031951 DOI: 10.3390/jcm11082255] [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: 02/15/2022] [Revised: 04/04/2022] [Accepted: 04/13/2022] [Indexed: 02/04/2023] Open
Abstract
Our study aimed to evaluate the social deprivation score in families with a child with Prader-Willi syndrome (PWS) and analyze its impact on the occurrence of obesity in the affected child. We included 147 children with PWS followed in our reference center with Evaluation of the Deprivation and Inequalities of Health in Healthcare Centres by the EPICES score. Deprivation (EPICES ≥ 30) was found in 25.9% of the population. Compared with the non-obese children, children with obesity had more deprived families, 50.0 vs. 18.0% (p = 0.0001); were older, with a median of 10.1 vs. 6.0 years (p = 0.0006); were less frequently treated with growth hormone (GH), 80.6 vs. 91.9% (p = 0.07). The mothers of obese children were more frequently obese, 46.9 vs. 13.3% (p < 0.0001), and achieved high study levels less frequently (≥Bac+2), 40.9 vs. 70.1% (p = 0.012). The multivariate logistic regression indicated that age, living in a deprived family, and having a mother with overweight/obesity were significantly associated with an increased risk of obesity (respectively, OR = 3.31 (1.26−8.73) and OR = 6.76 (2.36−19.37)). The same risk factors of obesity observed in the general population were found in children with PWS. Families at risk, including social deprivation, will require early identification and a reinforced approach to prevent obesity.
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16
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Kusz MJ, Gawlik AM. Adrenal insufficiency in patients with Prader-Willi syndrome. Front Endocrinol (Lausanne) 2022; 13:1021704. [PMID: 36465638 PMCID: PMC9714690 DOI: 10.3389/fendo.2022.1021704] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/17/2022] [Accepted: 10/31/2022] [Indexed: 11/18/2022] Open
Abstract
The generalized dysfunction of the hypothalamic-pituitary axis in patients with Prader-Willi syndrome (PWS) is the most likely cause of hypogonadism, inadequate growth hormone secretion, excessive appetite and associated obesity, impaired body temperature regulation, and hypothyroidism. The syndrome is also related to an increased risk of central adrenal insufficiency, although its prevalence remains unknown. The results of the studies in which different methods of pharmacological stimulation were used do not provide conclusive outcomes. As a result, there are no clear guidelines with regard to diagnosis, prevention, or long-term care when adrenal insufficiency is suspected in patients with PWS. Currently, most patients with PWS are treated with recombinant human growth hormone (rhGH). It has been confirmed that rhGH therapy has a positive effect on growth, body composition, body mass index (BMI), and potentially on psychomotor development in children with PWS. Additionally, rhGH may reduce the conversion of cortisone to cortisol through inhibition of 11β-hydroxysteroid dehydrogenase type 1. However, its influence on basal adrenal function and adrenal stress response remains unexplained in children with PWS. This paper reviews the literature related to the hypothalamic-pituitary-adrenal axis dysfunction in the PWS patient population with a focus on children.
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Affiliation(s)
- Marcin Jerzy Kusz
- Department of Pediatrics and Pediatric Endocrinology, Medical University of Silesia, Katowice, Poland
- The Faculty of Medical Sciences, The Doctoral School of the Medical University of Silesia, Katowice, Poland
- *Correspondence: Marcin Jerzy Kusz,
| | - Aneta Monika Gawlik
- Department of Pediatrics and Pediatric Endocrinology, Medical University of Silesia, Katowice, Poland
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17
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Papierska L, Rabijewski M, Migda B, Leszczyńska D, Nowak K, Łebek-Szatańska A, Glinicki P, Zgliczyński W. Evaluation of plasma ACTH in the metyrapone test is insufficient for the diagnosis of secondary adrenal insufficiency. Front Endocrinol (Lausanne) 2022; 13:1004129. [PMID: 36440206 PMCID: PMC9684459 DOI: 10.3389/fendo.2022.1004129] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/26/2022] [Accepted: 09/23/2022] [Indexed: 11/11/2022] Open
Abstract
OBJECTIVE To determine whether a single measurement of ACTH instead of less available in daily practice 11-deoxycortisol assay is sufficient to rule out or confirm secondary adrenal insufficiency (SAI) in the short Metyrapone test. DESIGN A retrospective analysis of diagnostic tests (Metyrapone and Synacthen tests) performed at our Center between 2016 and 2018 in patients with suspicion of secondary adrenal insufficiency. MATERIAL AND METHODS In 103 patients short metyrapone test was performed with assessment of 11-deoxycortisol and ACTH concentration after Metyrapone administered at midnight. In 89 of them short Synacthen (SST) test was also done (1 or/and 250 mcg 1-24ACTH). ROC curves have been performed to evaluate the diagnostic performance of ACTH level in metyrapone test as the predictor of secondary adrenal insufficiency (SAI) analysing sensitivity and specificity for various possible thresholds proposed in literature. RESULTS 40 (39%) of examined subjects were diagnosed as SAI, basing on post-Metyrapone 11-deoxycortisol concentration below 70 μg/l. In this group ACTH concentration was 128.1 ng/l (95% CI 96.8-159.4) versus 289.9 ng/l (95% CI 249.1-330.9) in patients with proper adrenal response. There was only a moderate positive correlation between ACTH and 11-deoxycortisol concentrations (r=0.5; p<0.05). The best cut off value of ACTH in relation to 11-deoxycortisol serum concentrations was 147 ng/l - with sensitivity of 73.2% and specificity 83.9%. However, plasma ACTH was>200ng/ml (the highest threshold proposed in literature) in 8 cases (20%) with positive diagnosis of SAI made on the basis of low 11-deoxycortisole and confirmed in short Synacthen test. CONCLUSION Our results indicate that for a valuable evaluation of the results of the metyrapone test, the more readily available plasma ACTH assay cannot replace the measurement of 11-deoxycortisol concentrations.
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Affiliation(s)
- Lucyna Papierska
- Department of Endocrinology, Medical Centre for Postgraduate Education, Warsaw, Poland
- *Correspondence: Lucyna Papierska,
| | - Michał Rabijewski
- Department of Reproductive Health, Medical Centre for Postgraduate Education, Warsaw, Poland
| | - Bartosz Migda
- Diagnostic Ultrasound Lab, Department of Pediatric Radiology, Medical Faculty, Medical University of Warsaw, Warsaw, Poland
| | | | - Karolina Nowak
- Department of Endocrinology, Medical Centre for Postgraduate Education, Warsaw, Poland
| | | | - Piotr Glinicki
- Department of Endocrinology, Medical Centre for Postgraduate Education, Warsaw, Poland
| | - Wojciech Zgliczyński
- Department of Endocrinology, Medical Centre for Postgraduate Education, Warsaw, Poland
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18
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Bos-Roubos A, Wingbermühle E, Biert A, de Graaff L, Egger J. Family Matters: Trauma and Quality of Life in Family Members of Individuals With Prader-Willi Syndrome. Front Psychiatry 2022; 13:897138. [PMID: 35836666 PMCID: PMC9273751 DOI: 10.3389/fpsyt.2022.897138] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/15/2022] [Accepted: 06/02/2022] [Indexed: 11/25/2022] Open
Abstract
BACKGROUND Prader-Willi syndrome (PWS) is a potentially life threatening, genetic developmental disorder that requires lifelong medical treatment and behavioral management. PWS has a major impact on the patient's social environment. In this study, we have explored traumatic life events and symptoms of posttraumatic stress disorder (PTSD) in family members of individuals with PWS. We have also assessed quality of life in relation to trauma manifestations. In addition, we have evaluated demographic characteristics such as living setting of PWS patients as well as PWS symptom severity. METHODS Data of this observational study were obtained by means of the Life Events Checklist DMS-5, the Posttraumatic Stress Disorder Checklist DSM-5, the abbreviated World Health Organization Quality of Life questionnaire, the Lancashire Quality of Life Profile questionnaire, and a short demographic inventory. The study sample includes 98 adults aged 19 to 80 years (M = 49, SD = 15), who are relatives of 69 individuals with PWS aged 0 to 58 years (M = 19, SD = 13). Participants were recruited via the two Dutch patient associations PWS and the Dutch Digital Center of Expertise PWS. RESULTS Life time prevalence of traumatic events (93%) was higher in family members of PWS patients ("PWS relatives") than in the general Dutch population (81%). Of those who reported any traumatic event, almost half reported PWS-related events. The prevalence of probable PTSD was higher in PWS relatives (12.1%) than the general lifetime prevalence of PTSD (worldwide, and in the Netherlands 7.4%). Predominant trauma symptoms in PWS relatives were "negative changes in arousal and reactivity" and "negative changes in cognition and mood;" both significantly negatively related to quality of life. Symptom severity of PWS individuals, as well as the associated trauma symptom severity of their relatives increased with age of the PWS individual. The presence of trauma symptoms was less frequent among relatives of PWS individuals living in a care facility. CONCLUSIONS Having a relative with PWS is associated with higher prevalence of traumatic experiences and greater vulnerability to PTSD. Raising awareness in health care professionals of trauma symptoms in PWS relatives may contribute to effective treatment of their psychosocial stress. In addition, timely interventions might prevent family members from developing psychopathology like PTSD.
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Affiliation(s)
- Anja Bos-Roubos
- Centre of Excellence for Neuropsychiatry, Vincent van Gogh Institute for Psychiatry, Venray, Netherlands.,Donders Institute for Brain, Cognition and Behaviour, Radboud University, Nijmegen, Netherlands
| | - Ellen Wingbermühle
- Centre of Excellence for Neuropsychiatry, Vincent van Gogh Institute for Psychiatry, Venray, Netherlands.,Donders Institute for Brain, Cognition and Behaviour, Radboud University, Nijmegen, Netherlands.,Department of Human Genetics, Radboud University Medical Centre, Nijmegen, Netherlands
| | - Anneloes Biert
- Centre of Excellence for Neuropsychiatry, Vincent van Gogh Institute for Psychiatry, Venray, Netherlands
| | - Laura de Graaff
- Department of Internal Medicine, Erasmus University Medical Center, Rotterdam, Netherlands.,Center for Adults With Rare Genetic Syndromes, Erasmus University Medical Center, Rotterdam, Netherlands.,Dutch Center of Reference for Prader-Willi Syndrome, Rotterdam, Netherlands
| | - Jos Egger
- Centre of Excellence for Neuropsychiatry, Vincent van Gogh Institute for Psychiatry, Venray, Netherlands.,Donders Institute for Brain, Cognition and Behaviour, Radboud University, Nijmegen, Netherlands.,Department of Human Genetics, Radboud University Medical Centre, Nijmegen, Netherlands.,Stevig, Specialized and Forensic Care for People With Intellectual Disabilities, Dichterbij, Oostrum, Netherlands
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19
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Síndrome de Prader-Willi: avanzando paso a paso. ENDOCRINOL DIAB NUTR 2022. [DOI: 10.1016/j.endinu.2021.11.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
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20
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Caixàs A. Prader-Willi syndrome: Making progress, one step at a time. ENDOCRINOL DIAB NUTR 2022; 69:1-3. [PMID: 35232554 DOI: 10.1016/j.endien.2022.01.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
Affiliation(s)
- Assumpta Caixàs
- Servicio de Endocrinología y Nutrición, Hospital Universitari Parc Taulí, Institut d'Investigació i Innovació Parc Taulí (I3PT), Departament Medicina Universitat Autònoma de Barcelona, Sabadell, Spain.
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21
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Dubern B, Mosbah H, Pigeyre M, Clément K, Poitou C. Rare genetic causes of obesity: diagnosis and management in clinical care. ANNALES D'ENDOCRINOLOGIE 2021; 83:63-72. [PMID: 34953778 DOI: 10.1016/j.ando.2021.12.003] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Rare genetic forms of obesity are linked to impaired energy balance (i.e., eating behaviour and energy expenditure) involving hypothalamic pathways. More than 60 genes coding for proteins located in the hypothalamic leptin/melanocortin pathway contribute to the development of these rare forms of obesity. The ambition of the French National Protocol for the Diagnosis and Care (PNDS) of Obesity of Rare Causes was to establish practical recommendations for assessment and management at all ages. This report is available on the website of the French Health Authority (HAS). In addition to severe obesity, patients often display obesity-related comorbidities and neuropsychological/psychiatric disorders. These complex conditions make clinical management particularly challenging. Early diagnosis is critical for the organization of coordinated specialized multidisciplinary care, with mandatory interaction between caregivers, social partners and families. Strategies to prevent aggravation of obesity consist in limiting access to food, establishing a reassuring daily eating environment, and the practice of sustained adapted supervised daily physical activity. The implementation of genetic diagnosis in clinical practice now enables a personalized medicine approach with access to new drug therapies, and improves the analysis of the risk/benefit ratio of bariatric surgery.
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Affiliation(s)
- Béatrice Dubern
- Paris Public Hospitals, PRADORT Competence Centre, Department of Paediatric Nutrition and Gastroenterology, CHU Trousseau, Paris, France; Sorbonne University/INSERM, Research Unit: Nutrition and Obesities; Systemic Approaches, NutriOmics, Paris, France
| | - Héléna Mosbah
- Paris Public Hospitals, Reference Centre for Rare Diseases PRADORT (PRADer-Willi Syndrome and other Rare Obesities with Eating Disorders), Nutrition Department, Pitié-Salpêtrière hospital, Paris, France
| | - Marie Pigeyre
- Population Health Research Institute, David Braley Cardiac, Vascular and Stroke Research Institute, Hamilton, ON, Canada; Department of Medicine, McMaster University, Michael G. DeGroote School of Medicine, Hamilton, ON, Canada
| | - Karine Clément
- Sorbonne University/INSERM, Research Unit: Nutrition and Obesities; Systemic Approaches, NutriOmics, Paris, France; Paris Public Hospitals, Reference Centre for Rare Diseases PRADORT (PRADer-Willi Syndrome and other Rare Obesities with Eating Disorders), Nutrition Department, Pitié-Salpêtrière hospital, Paris, France
| | - Christine Poitou
- Sorbonne University/INSERM, Research Unit: Nutrition and Obesities; Systemic Approaches, NutriOmics, Paris, France; Paris Public Hospitals, Reference Centre for Rare Diseases PRADORT (PRADer-Willi Syndrome and other Rare Obesities with Eating Disorders), Nutrition Department, Pitié-Salpêtrière hospital, Paris, France.
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22
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Rosenberg AGW, Pater MRA, Pellikaan K, Davidse K, Kattentidt-Mouravieva AA, Kersseboom R, Bos-Roubos AG, van Eeghen A, Veen JMC, van der Meulen JJ, van Aalst-van Wieringen N, Hoekstra FME, van der Lely AJ, de Graaff LCG. What Every Internist-Endocrinologist Should Know about Rare Genetic Syndromes in Order to Prevent Needless Diagnostics, Missed Diagnoses and Medical Complications: Five Years of 'Internal Medicine for Rare Genetic Syndromes'. J Clin Med 2021; 10:jcm10225457. [PMID: 34830739 PMCID: PMC8622899 DOI: 10.3390/jcm10225457] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2021] [Revised: 11/11/2021] [Accepted: 11/17/2021] [Indexed: 02/06/2023] Open
Abstract
Patients with complex rare genetic syndromes (CRGS) have combined medical problems affecting multiple organ systems. Pediatric multidisciplinary (MD) care has improved life expectancy, however, transfer to internal medicine is hindered by the lack of adequate MD care for adults. We have launched an MD outpatient clinic providing syndrome-specific care for adults with CRGS, which, to our knowledge, is the first one worldwide in the field of internal medicine. Between 2015 and 2020, we have treated 720 adults with over 60 syndromes. Eighty-nine percent of the syndromes were associated with endocrine problems. We describe case series of missed diagnoses and patients who had undergone extensive diagnostic testing for symptoms that could actually be explained by their syndrome. Based on our experiences and review of the literature, we provide an algorithm for the clinical approach of health problems in CRGS adults. We conclude that missed diagnoses and needless invasive tests seem common in CRGS adults. Due to the increased life expectancy, an increasing number of patients with CRGS will transfer to adult endocrinology. Internist-endocrinologists (in training) should be aware of their special needs and medical pitfalls of CRGS will help prevent the burden of unnecessary diagnostics and under- and overtreatment.
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Affiliation(s)
- Anna G. W. Rosenberg
- Department of Internal Medicine, Division of Endocrinology, Erasmus MC, University Medical Center Rotterdam, 3015 GD Rotterdam, The Netherlands; (A.G.W.R.); (M.R.A.P.); (K.P.); (K.D.); (F.M.E.H.); (A.J.v.d.L.)
- Dutch Center of Reference for Prader-Willi Syndrome, 3015 GD Rotterdam, The Netherlands
| | - Minke R. A. Pater
- Department of Internal Medicine, Division of Endocrinology, Erasmus MC, University Medical Center Rotterdam, 3015 GD Rotterdam, The Netherlands; (A.G.W.R.); (M.R.A.P.); (K.P.); (K.D.); (F.M.E.H.); (A.J.v.d.L.)
| | - Karlijn Pellikaan
- Department of Internal Medicine, Division of Endocrinology, Erasmus MC, University Medical Center Rotterdam, 3015 GD Rotterdam, The Netherlands; (A.G.W.R.); (M.R.A.P.); (K.P.); (K.D.); (F.M.E.H.); (A.J.v.d.L.)
- Dutch Center of Reference for Prader-Willi Syndrome, 3015 GD Rotterdam, The Netherlands
| | - Kirsten Davidse
- Department of Internal Medicine, Division of Endocrinology, Erasmus MC, University Medical Center Rotterdam, 3015 GD Rotterdam, The Netherlands; (A.G.W.R.); (M.R.A.P.); (K.P.); (K.D.); (F.M.E.H.); (A.J.v.d.L.)
- Dutch Center of Reference for Prader-Willi Syndrome, 3015 GD Rotterdam, The Netherlands
| | | | - Rogier Kersseboom
- Stichting Zuidwester, 3241 LB Middelharnis, The Netherlands; (A.A.K.-M.); (R.K.)
| | - Anja G. Bos-Roubos
- Center of Excellence for Neuropsychiatry, Vincent van Gogh, 5803 DN Venray, The Netherlands;
| | - Agnies van Eeghen
- ‘s Heeren Loo, Care Group, 3818 LA Amersfoort, The Netherlands;
- Department of Pediatrics, Amsterdam University Medical Center, 1105 AZ Amsterdam, The Netherlands
- Academic Center for Growth Disorders, Erasmus MC, University Medical Center Rotterdam, 3015 GD Rotterdam, The Netherlands
| | - José M. C. Veen
- ‘s Heeren Loo, Care Providing Agency, 6733 SC Wekerom, The Netherlands; (J.M.C.V.); (J.J.v.d.M.)
| | - Jiske J. van der Meulen
- ‘s Heeren Loo, Care Providing Agency, 6733 SC Wekerom, The Netherlands; (J.M.C.V.); (J.J.v.d.M.)
| | - Nina van Aalst-van Wieringen
- Department of Physical Therapy, Erasmus MC, University Medical Center Rotterdam, 3015 GD Rotterdam, The Netherlands;
| | - Franciska M. E. Hoekstra
- Department of Internal Medicine, Division of Endocrinology, Erasmus MC, University Medical Center Rotterdam, 3015 GD Rotterdam, The Netherlands; (A.G.W.R.); (M.R.A.P.); (K.P.); (K.D.); (F.M.E.H.); (A.J.v.d.L.)
- Department of Internal Medicine, Reinier de Graaf Hospital, 2625 AD Delft, The Netherlands
| | - Aart J. van der Lely
- Department of Internal Medicine, Division of Endocrinology, Erasmus MC, University Medical Center Rotterdam, 3015 GD Rotterdam, The Netherlands; (A.G.W.R.); (M.R.A.P.); (K.P.); (K.D.); (F.M.E.H.); (A.J.v.d.L.)
| | - Laura C. G. de Graaff
- Department of Internal Medicine, Division of Endocrinology, Erasmus MC, University Medical Center Rotterdam, 3015 GD Rotterdam, The Netherlands; (A.G.W.R.); (M.R.A.P.); (K.P.); (K.D.); (F.M.E.H.); (A.J.v.d.L.)
- Dutch Center of Reference for Prader-Willi Syndrome, 3015 GD Rotterdam, The Netherlands
- Academic Center for Growth Disorders, Erasmus MC, University Medical Center Rotterdam, 3015 GD Rotterdam, The Netherlands
- ENCORE—Dutch Center of Reference for Neurodevelopmental Disorders, 3015 GD Rotterdam, The Netherlands
- Dutch Center of Reference for Turner Syndrome, 3015 GD Rotterdam, The Netherlands
- Dutch Center of Reference for Disorders of Sex Development, 3015 GD Rotterdam, The Netherlands
- Correspondence:
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Clerc A, Coupaye M, Mosbah H, Pinto G, Laurier V, Mourre F, Merrien C, Diene G, Poitou C, Tauber M. Diabetes Mellitus in Prader-Willi Syndrome: Natural History during the Transition from Childhood to Adulthood in a Cohort of 39 Patients. J Clin Med 2021; 10:jcm10225310. [PMID: 34830599 PMCID: PMC8625265 DOI: 10.3390/jcm10225310] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2021] [Revised: 10/28/2021] [Accepted: 11/09/2021] [Indexed: 02/05/2023] Open
Abstract
Type 2 diabetes mellitus (T2DM) affects 20% of patients with Prader-Willi syndrome (PWS), with many cases diagnosed during the transition period. Our aim was to describe the natural history of T2DM in patients with PWS before the age of 25 years and to develop screening and preventive strategies. Thirty-nine patients followed in the French PWS Reference Center were included (median age 25.6 years [23.7; 31.7]). Twenty-one had been treated with growth hormone (GH), fifteen had not, and three had an unknown status. The median age at T2DM diagnosis was 16.8 years (11–24) and the median BMI was 39 kg/m2 [34.6; 45], with 34/35 patients living with obesity. The patients displayed frequent psychiatric (48.3% hospitalization,) and metabolic (56.4% hypertriglyceridemia,) comorbidities and a parental history of T2DM (35.7%) or overweight (53.6%) compared to the PWS general population. There was no difference in BMI and metabolic complications between the GH-treated and non-GH-treated groups at T2DM diagnosis. Patients with PWS who develop early T2DM have severe obesity, a high frequency of psychiatric and metabolic disorders, and a family history of T2DM and overweight. These results underline the need for early identification of patients at risk, prevention of obesity, and repeated blood glucose monitoring during the transition period.
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Affiliation(s)
- Alice Clerc
- Centre de Référence Maladies Rares (PRADORT, Syndrome de Prader-Willi et Autres Formes Rares d’Obésité avec Troubles du Comportement Alimentaire), Service d’Endocrinologie, Obésités, Maladies Osseuses, Génétique et Gynécologie Médicale, Hôpital des Enfants, 31059 Toulouse, France; (A.C.); (G.D.)
| | - Muriel Coupaye
- Assistance Publique-Hôpitaux de Paris, Centre de Référence Maladies Rares (PRADORT, Syndrome de Prader-Willi et Autres Formes Rares d’Obésité avec Troubles du Comportement Alimentaire), Service de Nutrition, Hôpital Pitié-Salpêtrière, 75013 Paris, France; (M.C.); (H.M.); (C.P.)
| | - Héléna Mosbah
- Assistance Publique-Hôpitaux de Paris, Centre de Référence Maladies Rares (PRADORT, Syndrome de Prader-Willi et Autres Formes Rares d’Obésité avec Troubles du Comportement Alimentaire), Service de Nutrition, Hôpital Pitié-Salpêtrière, 75013 Paris, France; (M.C.); (H.M.); (C.P.)
| | - Graziella Pinto
- Assistance Publique-Hôpitaux de Paris, Service d’Endocrinologie, Gynécologie et Diabétologie Pédiatrique, Hôpital Necker-Enfants Malades, 75743 Paris, France;
| | - Virginie Laurier
- Assistance Publique-Hôpitaux de Paris, Centre de Référence Maladies Rares (PRADORT, Syndrome de Prader-Willi et Autres Formes Rares d’Obésité avec Troubles du Comportement Alimentaire), Hôpital Marin d’Hendaye, 64701 Hendaye, France; (V.L.); (F.M.); (C.M.)
| | - Fabien Mourre
- Assistance Publique-Hôpitaux de Paris, Centre de Référence Maladies Rares (PRADORT, Syndrome de Prader-Willi et Autres Formes Rares d’Obésité avec Troubles du Comportement Alimentaire), Hôpital Marin d’Hendaye, 64701 Hendaye, France; (V.L.); (F.M.); (C.M.)
| | - Christine Merrien
- Assistance Publique-Hôpitaux de Paris, Centre de Référence Maladies Rares (PRADORT, Syndrome de Prader-Willi et Autres Formes Rares d’Obésité avec Troubles du Comportement Alimentaire), Hôpital Marin d’Hendaye, 64701 Hendaye, France; (V.L.); (F.M.); (C.M.)
| | - Gwenaëlle Diene
- Centre de Référence Maladies Rares (PRADORT, Syndrome de Prader-Willi et Autres Formes Rares d’Obésité avec Troubles du Comportement Alimentaire), Service d’Endocrinologie, Obésités, Maladies Osseuses, Génétique et Gynécologie Médicale, Hôpital des Enfants, 31059 Toulouse, France; (A.C.); (G.D.)
- Inserm UMR 1295—CERPOP (Centre d’Epidémiologie et de Recherche en Santé des POPulations), Équipe SPHERE (Santé Périnatale, Pédiatrique et des Adolescents: Approche Épidémiologique et Évaluative), Université Toulouse III Paul Sabatier, 31062 Toulouse, France
| | - Christine Poitou
- Assistance Publique-Hôpitaux de Paris, Centre de Référence Maladies Rares (PRADORT, Syndrome de Prader-Willi et Autres Formes Rares d’Obésité avec Troubles du Comportement Alimentaire), Service de Nutrition, Hôpital Pitié-Salpêtrière, 75013 Paris, France; (M.C.); (H.M.); (C.P.)
- UMRS 1269, Faculté de Médecine Sorbonne Université, INSERM, Nutrition et Obésité: Approches Systémiques «NutriOmics», 75006 Paris, France
| | - Maithé Tauber
- Centre de Référence Maladies Rares (PRADORT, Syndrome de Prader-Willi et Autres Formes Rares d’Obésité avec Troubles du Comportement Alimentaire), Service d’Endocrinologie, Obésités, Maladies Osseuses, Génétique et Gynécologie Médicale, Hôpital des Enfants, 31059 Toulouse, France; (A.C.); (G.D.)
- Institut Toulousain des Maladies Infectieuses et Inflammatoires (Infinity) INSERM UMR1291—CNRS UMR5051—Université Toulouse III, 31062 Toulouse, France
- Correspondence:
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Damen L, Donze SH, Grootjen LN, Hokken-Koelega ACS. Long-term cortisol levels in hair of children and adolescents with Prader-Willi Syndrome. Psychoneuroendocrinology 2021; 132:105335. [PMID: 34225184 DOI: 10.1016/j.psyneuen.2021.105335] [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: 01/10/2021] [Revised: 05/06/2021] [Accepted: 06/15/2021] [Indexed: 10/21/2022]
Abstract
CONTEXT Prader-Willi syndrome (PWS) is characterized by hypothalamic dysfunction. In children with PWS, stress-induced central adrenal insufficiency (CAI) has been described, however, daily life cortisol production may be normal. Hair cortisol concentration (HCC) is a marker of long-term systemic cortisol production. Cortisol awakening response (CAR) is the increase in cortisol level after awakening. A negative CAR might suggest hypothalamic-pituitary-adrenal (HPA)-axis reactivity problems. Little is known about HCC and CAR in children with PWS. OBJECTIVE To investigate long-term cortisol levels in hair and CAR in children with PWS. DESIGN Cross-sectional study. PATIENTS 41 children with PWS. SETTING Dutch PWS Reference Center. MAIN OUTCOME MEASURES HCC and salivary cortisol measured by LCMS. RESULTS Median (IQR) HCC was 1.90 (1.02-3.30) pg/mg at a median (IQR) age of 14.5 (8.20-19.0) years, with median HCC in age-matched references being 2.63 pg/mg. Five patients (13.2%) had HCC < 2.5th percentile for age and these patients had a repeatedly negative CAR. Median HCC was significantly lower in patients with negative CAR than in patients with normal CAR (1.00 (0.22-1.59) vs. 2.25 (1.47-3.26) pg/mg, p = 0.007). One patient had both HCC < 2.5th percentile and repeatedly low morning salivary cortisol levels and negative CAR, and was diagnosed with adrenal insufficiency by overnight metyrapone test. CONCLUSIONS HCC were normal in the majority of children with PWS. Our data suggest that children with HCC < 2.5th percentile and (repeatedly) negative CAR might possibly have adrenal insufficiency or delayed HPA-axis responsiveness.
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Affiliation(s)
- L Damen
- Dutch Growth Research Foundation, Rotterdam, The Netherlands; Department of Pediatrics, Subdivision of Endocrinology Erasmus University Medical Center-Sophia Children's Hospital, Rotterdam, The Netherlands; Dutch Reference Center for Prader-Willi Syndrome, The Netherlands.
| | - S H Donze
- Dutch Growth Research Foundation, Rotterdam, The Netherlands; Department of Pediatrics, Subdivision of Endocrinology Erasmus University Medical Center-Sophia Children's Hospital, Rotterdam, The Netherlands; Dutch Reference Center for Prader-Willi Syndrome, The Netherlands
| | - L N Grootjen
- Dutch Growth Research Foundation, Rotterdam, The Netherlands; Department of Pediatrics, Subdivision of Endocrinology Erasmus University Medical Center-Sophia Children's Hospital, Rotterdam, The Netherlands; Dutch Reference Center for Prader-Willi Syndrome, The Netherlands
| | - A C S Hokken-Koelega
- Dutch Growth Research Foundation, Rotterdam, The Netherlands; Department of Pediatrics, Subdivision of Endocrinology Erasmus University Medical Center-Sophia Children's Hospital, Rotterdam, The Netherlands; Dutch Reference Center for Prader-Willi Syndrome, The Netherlands
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25
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Shukur HH, Hussain-Alkhateeb L, Farholt S, Nørregaard O, Jørgensen AP, Hoybye C. Effects of Growth Hormone Treatment on Sleep-Related Parameters in Adults With Prader-Willi Syndrome. J Clin Endocrinol Metab 2021; 106:e3634-e3643. [PMID: 33950234 PMCID: PMC8372636 DOI: 10.1210/clinem/dgab300] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/09/2021] [Indexed: 12/15/2022]
Abstract
CONTEXT Prader-Willi syndrome (PWS) is a rare, genetic, multisymptom, neurodevelopmental disease due to lack of the expression of the paternal genes in the q11 to q13 region of chromosome 15. The main characteristics of PWS are muscular hypotonia, hyperphagia, obesity, behavioral problems, cognitive disabilities, and endocrine deficiencies, including growth hormone (GH) deficiency. Sleep apnea and abnormal sleep patterns are common in PWS. GH treatment might theoretically have a negative impact on respiration. OBJECTIVE Here we present the effect of GH treatment on polysomnographic measurements. METHODS Thirty-seven adults, 15 men and 22 women, with confirmed PWS were randomly assigned to 1 year of GH treatment (n = 19) or placebo (n = 18) followed by 2 years of GH treatment to all. Polysomnographic measurements were performed every 6 months. A mixed-effect regression model was used for comparison over time in the subgroup that received GH for 3 years. RESULTS At baseline median age was 29.5 years, body mass index 27.1, insulin-like growth factor 115 µg/L, apnea-hypopnea index (AHI) 1.4 (range, 0.0-13.9), and sleep efficiency (SE) 89.0% (range, 41.0%-99.0%). No differences in sleep or respiratory parameters were seen between GH- and placebo-treated patients. SE continuously improved throughout the study, also after adjustment for BMI, and the length of the longest apnea increased. AHI inconsistently increased within normal range. CONCLUSION SE improved during GH treatment and no clinical, significantly negative impact on respiration was seen. The etiology of breathing disorders is multifactorial and awareness of them should always be present in adults with PWS with or without GH treatment.
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Affiliation(s)
- Hasanain Hamid Shukur
- Department of Molecular Medicine and Surgery, Karolinska Institute, Stockholm, Solna SE-171 76, Sweden
- Correspondence: Hasanain Hamid Shukur, MD, Department of Molecular Medicine and Surgery, Karolinska Institute, L1:00, Anna Steckséns gata 53, Stockholm, Solna SE-171 76, Sweden.
| | - Laith Hussain-Alkhateeb
- Global Health, School of Public Health and Community Medicine, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, 40530 Gothenburg, Sweden
| | - Stense Farholt
- Center for Rare Diseases, Department of Pediatric and Adolescent Medicine, Aarhus University Hospital, DK-8200 Aarhus N, Denmark
| | - Ole Nørregaard
- Danish Respiratory Center West, Department of Anaesthesiology and Intensive Care, Aarhus University Hospital, DK-8200 Aarhus N, Denmark
| | - Anders Palmstrøm Jørgensen
- Section of Specialized Endocrinology, Department of Endocrinology, Oslo University Hospital, Rikshospitalet, 0424 Oslo, Norway
| | - Charlotte Hoybye
- Department of Molecular Medicine and Surgery, Karolinska Institute, Stockholm, Solna SE-171 76, Sweden
- Department of Endocrinology, Karolinska University Hospital, SE-171 76 Stockholm, Sweden
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Coupaye M, Pellikaan K, Goldstone AP, Crinò A, Grugni G, Markovic TP, Høybye C, Caixàs A, Mosbah H, De Graaff LCG, Tauber M, Poitou C. Hyponatremia in Children and Adults with Prader-Willi Syndrome: A Survey Involving Seven Countries. J Clin Med 2021; 10:jcm10163555. [PMID: 34441851 PMCID: PMC8396837 DOI: 10.3390/jcm10163555] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2021] [Revised: 08/06/2021] [Accepted: 08/09/2021] [Indexed: 11/17/2022] Open
Abstract
In Prader–Willi syndrome (PWS), conditions that are associated with hyponatremia are common, such as excessive fluid intake (EFI), desmopressin use and syndrome of inappropriate antidiuretic hormone (SIADH) caused by psychotropic medication. However, the prevalence of hyponatremia in PWS has rarely been reported. Our aim was to describe the prevalence and severity of hyponatremia in PWS. In October 2020, we performed a retrospective study based on the medical records of a large cohort of children and adults with PWS from seven countries. Among 1326 patients (68% adults), 34 (2.6%) had at least one episode of mild or moderate hyponatremia (125 ≤ Na < 135 mmol/L). The causes of non-severe hyponatremia were often multi-factorial, including psychotropic medication in 32%, EFI in 24% and hyperglycemia in 12%. No obvious cause was found in 29%. Seven (0.5%) adults experienced severe hyponatremia (Na < 125 mmol/L). Among these, five recovered completely, but two died. The causes of severe hyponatremia were desmopressin treatment for nocturnal enuresis (n = 2), EFI (n = 2), adrenal insufficiency (n = 1), diuretic treatment (n = 1) and unknown (n = 1). In conclusion, severe hyponatremia was very rare but potentially fatal in PWS. Desmopressin treatment for nocturnal enuresis should be avoided. Enquiring about EFI and monitoring serum sodium should be included in the routine follow-ups of patients with PWS.
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Affiliation(s)
- Muriel Coupaye
- Assistance Publique-Hôpitaux de Paris, Rare Diseases Center of Reference ‘Prader-Willi Syndrome and Obesity with Eating Disorders’ (PRADORT), Nutrition Department, Pitié-Salpêtrière Hospital, F-75013 Paris, France; (H.M.); (C.P.)
- International Network for Research, Management & Education on Adults with Prader-Willi Syndrome; (A.P.G.); (A.C.); (G.G.); (T.P.M.); (C.H.); (A.C.); (L.C.G.D.G.)
- European Reference Network on Rare Endocrine Conditions; (L.C.G.D.G.); (M.T.)
- Correspondence: ; Tel.: +33-(0)-142175771
| | - Karlijn Pellikaan
- Department of Internal Medicine, Division of Endocrinology, Erasmus Medical Center, University Medical Centre Rotterdam, 3015 GD Rotterdam, The Netherlands; (K.P.); (L.C.G.D.G.)
- Department of Internal Medicine, Division of Endocrinology, Center for Adults with Rare Genetic Syndromes, Erasmus Medical Center, University Medical Center Rotterdam, 3015 GD Rotterdam, The Netherlands; (K.P.); (L.C.G.D.G.)
- Dutch Center of Reference for Prader-Willi Syndrome, 3015 GD Rotterdam, The Netherlands; (K.P.); (L.C.G.D.G.)
- Academic Centre for Growth Disorders, Erasmus Medical Center, University Medical Centre Rotterdam, 3015 GD Rotterdam, The Netherlands; (K.P.); (L.C.G.D.G.)
| | - Anthony P. Goldstone
- International Network for Research, Management & Education on Adults with Prader-Willi Syndrome; (A.P.G.); (A.C.); (G.G.); (T.P.M.); (C.H.); (A.C.); (L.C.G.D.G.)
- PsychoNeuroEndocrinology Research Group, Centre for Neuropsychopharmacology, Division of Psychiatry, and Computational, Cognitive and Clinical Neuroimaging Laboratory, Department of Brain Sciences, Faculty of Medicine, Imperial College London; Department of Endocrinology, Imperial College Healthcare NHS Trust; Hammersmith Hospital, London W12 0NN, UK
| | - Antonino Crinò
- International Network for Research, Management & Education on Adults with Prader-Willi Syndrome; (A.P.G.); (A.C.); (G.G.); (T.P.M.); (C.H.); (A.C.); (L.C.G.D.G.)
- Reference Center for Prader-Willi Syndrome, Bambino Gesù Hospital, Research Institute, 00050 Palidoro, Italy
| | - Graziano Grugni
- International Network for Research, Management & Education on Adults with Prader-Willi Syndrome; (A.P.G.); (A.C.); (G.G.); (T.P.M.); (C.H.); (A.C.); (L.C.G.D.G.)
- European Reference Network on Rare Endocrine Conditions; (L.C.G.D.G.); (M.T.)
- Divison of Auxology, Istituto Auxologico Italiano, IRCCS, 28824 Piancavallo, Italy
| | - Tania P. Markovic
- International Network for Research, Management & Education on Adults with Prader-Willi Syndrome; (A.P.G.); (A.C.); (G.G.); (T.P.M.); (C.H.); (A.C.); (L.C.G.D.G.)
- Metabolism & Obesity Services, Royal Prince Alfred Hospital, Camperdown, NSW 2050, Australia
- Charles Perkins Centre, Faculty of Medicine and Health, University of Sydney, Sydney, NSW 2006, Australia
| | - Charlotte Høybye
- International Network for Research, Management & Education on Adults with Prader-Willi Syndrome; (A.P.G.); (A.C.); (G.G.); (T.P.M.); (C.H.); (A.C.); (L.C.G.D.G.)
- European Reference Network on Rare Endocrine Conditions; (L.C.G.D.G.); (M.T.)
- Department of Molecular Medicine and Surgery, and Department of Endocrinology, Karolinska Institute and Karolinska University Hospital, 171 76 Stockholm, Sweden
| | - Assumpta Caixàs
- International Network for Research, Management & Education on Adults with Prader-Willi Syndrome; (A.P.G.); (A.C.); (G.G.); (T.P.M.); (C.H.); (A.C.); (L.C.G.D.G.)
- Department of Endocrinology and Nutrition, Hospital Universitari Parc Taulí, Institut d’Investigació i Innovació Parc Taulí (I3PT), Universitat Autònoma de Barcelona, 08208 Sabadell, Spain
| | - Helena Mosbah
- Assistance Publique-Hôpitaux de Paris, Rare Diseases Center of Reference ‘Prader-Willi Syndrome and Obesity with Eating Disorders’ (PRADORT), Nutrition Department, Pitié-Salpêtrière Hospital, F-75013 Paris, France; (H.M.); (C.P.)
- European Reference Network on Rare Endocrine Conditions; (L.C.G.D.G.); (M.T.)
| | - Laura C. G. De Graaff
- International Network for Research, Management & Education on Adults with Prader-Willi Syndrome; (A.P.G.); (A.C.); (G.G.); (T.P.M.); (C.H.); (A.C.); (L.C.G.D.G.)
- European Reference Network on Rare Endocrine Conditions; (L.C.G.D.G.); (M.T.)
- Department of Internal Medicine, Division of Endocrinology, Erasmus Medical Center, University Medical Centre Rotterdam, 3015 GD Rotterdam, The Netherlands; (K.P.); (L.C.G.D.G.)
- Department of Internal Medicine, Division of Endocrinology, Center for Adults with Rare Genetic Syndromes, Erasmus Medical Center, University Medical Center Rotterdam, 3015 GD Rotterdam, The Netherlands; (K.P.); (L.C.G.D.G.)
- Dutch Center of Reference for Prader-Willi Syndrome, 3015 GD Rotterdam, The Netherlands; (K.P.); (L.C.G.D.G.)
- Academic Centre for Growth Disorders, Erasmus Medical Center, University Medical Centre Rotterdam, 3015 GD Rotterdam, The Netherlands; (K.P.); (L.C.G.D.G.)
| | - Maithé Tauber
- European Reference Network on Rare Endocrine Conditions; (L.C.G.D.G.); (M.T.)
- Rare Diseases Center of Reference ‘Prader-Willi Syndrome and Obesity with Eating Disorders’ (PRADORT), Department of Endocrinology, Bone Diseases, Genetics, and Gynecology, Children’s Hospital, Institut Toulousain des Maladies Infectieuses et Inflammatoires (Infinity) INSERM UMR1291—CNRS UMR5051—Université Toulouse III, F-31000 Toulouse, France
| | - Christine Poitou
- Assistance Publique-Hôpitaux de Paris, Rare Diseases Center of Reference ‘Prader-Willi Syndrome and Obesity with Eating Disorders’ (PRADORT), Nutrition Department, Pitié-Salpêtrière Hospital, F-75013 Paris, France; (H.M.); (C.P.)
- International Network for Research, Management & Education on Adults with Prader-Willi Syndrome; (A.P.G.); (A.C.); (G.G.); (T.P.M.); (C.H.); (A.C.); (L.C.G.D.G.)
- European Reference Network on Rare Endocrine Conditions; (L.C.G.D.G.); (M.T.)
- INSERM, Nutrition and Obesities: Systemic Approaches (NutriOmics), Research Unit, Sorbonne University, F-75013 Paris, France
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Tauber M, Hoybye C. Endocrine disorders in Prader-Willi syndrome: a model to understand and treat hypothalamic dysfunction. Lancet Diabetes Endocrinol 2021; 9:235-246. [PMID: 33647242 DOI: 10.1016/s2213-8587(21)00002-4] [Citation(s) in RCA: 66] [Impact Index Per Article: 22.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/07/2020] [Revised: 12/22/2020] [Accepted: 12/23/2020] [Indexed: 12/15/2022]
Abstract
Prader-Willi syndrome is a rare genetic neurodevelopmental disorder resulting from the loss of expression of maternally imprinted genes located in the paternal chromosomal region, 15q11-13. Impaired hypothalamic development and function is the cause of most of the phenotypes comprising the developmental trajectory of Prader-Willi syndrome: from anorexia at birth to excessive weight gain preceding hyperphagia, and early severe obesity with hormonal deficiencies, behavioural problems, and dysautonomia. Growth hormone deficiency, hypogonadism, hypothyroidism, premature adrenarche, corticotropin deficiency, precocious puberty, and glucose metabolism disorders are the main endocrine dysfunctions observed. Additionally, as a result of hypothalamic dysfunction, oxytocin and ghrelin systems are impaired in most patients. Standard pituitary and gonadal hormone replacement therapies are required. In this Review, we discuss Prader-Willi syndrome as a model of hypothalamic dysfunction, and provide a comprehensive description of the accumulated knowledge on genetics, pathophysiology, and treatment approaches of this rare disorder.
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Affiliation(s)
- Maithé Tauber
- Centre de Référence du Syndrome de Prader-Willi, Hôpital des Enfants, Toulouse, France; Axe Pédiatrique du CIC 9302/INSERM, Hôpital des Enfants, Toulouse, France; Institut Toulousain des Maladies Infectieuses et Inflammatoires, INSERM UMR1291, CNRS UMR5051, Université Toulouse III, Toulouse, France, France; International Prader-Willi Syndrome Organisation, Cambridge, UK.
| | - Charlotte Hoybye
- International Prader-Willi Syndrome Organisation, Cambridge, UK; Department of Endocrinology, Karolinska University Hospital and Department of Molecular Medicine and Surgery, Karolinska Institute, Stockholm, Sweden
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Salvatoni A, Nosetti L, Salvatore S, Agosti M. Benefits of multidisciplinary care in Prader-Willi syndrome. Expert Rev Endocrinol Metab 2021; 16:63-71. [PMID: 33724138 DOI: 10.1080/17446651.2021.1898375] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/15/2020] [Accepted: 03/01/2021] [Indexed: 01/25/2023]
Abstract
Introduction: Prader-Willi syndrome (PWS) is the most well-known condition of genetic obesity. Over the past 20 years, advances have been achieved in the diagnosis and treatment of PWS with a significant improvement in prognosis.Areas covered: This review focuses on the benefits of multidisciplinary approach in children and adolescents with PWS. In particular, the neonatologist and geneticist play a key role in early diagnosis and the clinical follow-up of the PWS patient must be guaranteed by a team including pediatric endocrinologist, psychologist, nutritionist/dietician, neurologist/neuropsychiatrist, sleep specialist, ears, nose and throat specialist (ENT), lung specialist, dentist, orthopedist and ophthalmologist and, eventually, gastroenterologist. We searched PubMed and critically summarized what has been reported in the last 10 years on PWS.Expert opinion: The multidisciplinary care in association with an early diagnosis and GH treatment postpones overweight development and decreases prevalence of obesity in individuals with PWS. Further prognostic improvements are expected through the selection of teams particularly experienced in the management of individuals with PWS and the discovery of new drugs.
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Affiliation(s)
| | - Luana Nosetti
- Pediatric Department, Insubria University, Varese, Italy
| | | | - Massimo Agosti
- Pediatric Department, Insubria University, Varese, Italy
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Pellikaan K, Rosenberg AGW, Kattentidt-Mouravieva AA, Kersseboom R, Bos-Roubos AG, Veen-Roelofs JMC, van Wieringen N, Hoekstra FME, van den Berg SAA, van der Lely AJ, de Graaff LCG. Missed Diagnoses and Health Problems in Adults With Prader-Willi Syndrome: Recommendations for Screening and Treatment. J Clin Endocrinol Metab 2020; 105:5900721. [PMID: 32877518 PMCID: PMC7553248 DOI: 10.1210/clinem/dgaa621] [Citation(s) in RCA: 36] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/15/2020] [Accepted: 08/29/2020] [Indexed: 12/11/2022]
Abstract
CONTEXT Prader-Willi syndrome (PWS) is a complex hypothalamic disorder, combining hyperphagia, hypotonia, intellectual disability, and pituitary hormone deficiencies. Annual mortality of patients with PWS is high (3%). In half of the patients, the cause of death is obesity related and/or of cardiopulmonary origin. Health problems leading to this increased mortality often remain undetected due to the complexity and rareness of the syndrome. OBJECTIVE To assess the prevalence of health problems in adults with PWS retrospectively. PATIENTS, DESIGN, AND SETTING We systematically screened 115 PWS adults for undiagnosed health problems. All patients visited the multidisciplinary outpatient clinic for rare endocrine syndromes at the Erasmus University Medical Center, Rotterdam, Netherlands. We collected the results of medical questionnaires, interviews, physical examinations, biochemical measurements, polygraphy, polysomnography, and radiology. MAIN OUTCOME MEASURES Presence or absence of endocrine and nonendocrine comorbidities in relation to living situation, body mass index, genotype, and demographic factors. RESULTS Seventy patients (61%) had undiagnosed health problems, while 1 in every 4 patients had multiple undiagnosed health problems simultaneously. All males and 93% of females had hypogonadism, 74% had scoliosis, 18% had hypertension, 19% had hypercholesterolemia, 17% had type 2 diabetes mellitus, and 17% had hypothyroidism. Unfavorable lifestyles were common: 22% exercised too little (according to PWS criteria) and 37% did not see a dietitian. CONCLUSIONS Systematic screening revealed many undiagnosed health problems in PWS adults. Based on patient characteristics, we provide an algorithm for diagnostics and treatment, with the aim to prevent early complications and reduce mortality in this vulnerable patient group.
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Affiliation(s)
- Karlijn Pellikaan
- Internal Medicine, Division of Endocrinology, Erasmus MC, University Medical Center Rotterdam, GD Rotterdam, Netherlands
| | - Anna G W Rosenberg
- Internal Medicine, Division of Endocrinology, Erasmus MC, University Medical Center Rotterdam, GD Rotterdam, Netherlands
| | | | | | - Anja G Bos-Roubos
- Vincent van Gogh, Center of Excellence for Neuropsychiatry, DN Venray, Netherlands
| | | | - Nina van Wieringen
- Department of Physical Therapy, Erasmus MC, University Medical Center Rotterdam, GD Rotterdam, Netherlands
| | - Franciska M E Hoekstra
- Internal Medicine, Division of Endocrinology, Erasmus MC, University Medical Center Rotterdam, GD Rotterdam, Netherlands
- Department of Internal Medicine, Reinier de Graaf Hospital, AD Delft, Netherlands
| | - Sjoerd A A van den Berg
- Department of Clinical Chemistry, Erasmus MC, University Medical Center Rotterdam, GD Rotterdam, Netherlands
| | - Aart Jan van der Lely
- Internal Medicine, Division of Endocrinology, Erasmus MC, University Medical Center Rotterdam, GD Rotterdam, Netherlands
| | - Laura C G de Graaff
- Internal Medicine, Division of Endocrinology, Erasmus MC, University Medical Center Rotterdam, GD Rotterdam, Netherlands
- Academic Center for Growth Disorders, Erasmus MC, University Medical Center Rotterdam, GD Rotterdam, Netherlands
- Dutch Center of Reference for Prader-Willi Syndrome, GD Rotterdam, Netherlands
- Correspondence and Reprint Requests: Laura de Graaff, MD, PhD, Dept. of Internal Medicine, Erasmus MC, University Medical Center, Dr. Molewaterplein 40, 3015 GD Rotterdam, Netherlands. E-mail:
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Shukur HH, de Rijke YB, van Rossum EFC, Hussain-Alkhateeb L, Höybye C. Hair cortisol-a method to detect chronic cortisol levels in patients with Prader-Willi syndrome. BMC Endocr Disord 2020; 20:166. [PMID: 33167936 PMCID: PMC7654170 DOI: 10.1186/s12902-020-00646-w] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/28/2020] [Accepted: 10/26/2020] [Indexed: 12/17/2022] Open
Abstract
BACKGROUND Prader-Willi syndrome (PWS) is a multisymptomatic, rare, genetic, neurodevelopmental disorder in adults mainly characterized by hyperphagia, cognitive dysfunction, behavioral problems and risk of morbid obesity. Although endocrine insufficiencies are common, hypocortisolism is rare and knowledge on long-term cortisol concentrations is lacking. The aim of this study was to evaluate long-term cortisol levels in PWS by measurements of hair cortisol. METHODS Twenty-nine adults with PWS, 15 men and 14 women, median age 29 years, median BMI 27 kg/m2, were included. Scalp hair samples were analyzed for cortisol content using liquid-chromatography tandem-mass spectrometry. In addition, a questionnaire on auxology, medication and stress were included. For comparison, 105 age- and sex-matched participants from the population-based Lifelines Cohort study were included as controls. The mean hair cortisol between the groups were compared and associations between BMI and stress were assessed by a generalized linear regression model. RESULTS In the PWS group large variations in hair cortisol was seen. Mean hair cortisol was 12.8 ± 25.4 pg/mg compared to 3.8 ± 7.3 pg/mg in controls (p = 0.001). The linear regression model similarly showed higher cortisol levels in patients with PWS, which remained consistent after adjusting for BMI and stress (p = 0.023). Furthermore, hair cortisol increased with BMI (p = 0.012) and reported stress (p = 0.014). CONCLUSION Long-term cortisol concentrations were higher in patients with PWS compared to controls and increased with BMI and stress, suggesting an adequate cortisol response to chronic stress. Hair cortisol demonstrate promising applications in the context of PWS treatment and disease management.
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Affiliation(s)
- Hasanain Hamid Shukur
- Department of Molecular Medicine and Surgery, Karolinska Institute, Stockholm, Sweden.
| | - Yolanda B de Rijke
- Department of Clinical Chemistry, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands
- Obesity Center CGG, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - Elisabeth F C van Rossum
- Department of Medicine, Division of Endocrinology, Erasmus MC, University medical Center Rotterdam, Rotterdam, The Netherlands
- Obesity Center CGG, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - Laith Hussain-Alkhateeb
- School of Public Health and Community Medicine, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Charlotte Höybye
- Department of Molecular Medicine and Surgery, Karolinska Institute, Stockholm, Sweden
- Patient Area Endocrinology and Nephrology, Inflammation and Infection Theme, Karolinska University Hospital, Stockholm, Sweden
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