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Villafuerte B, Carrasco-López C, Herranz A, Garzón L, Simón R, Natera-de-Benito D, Alikhani P, Tenorio J, García-Santiago F, Solis M, Del-Pozo Á, Lapunzina P, Ortigoza-Escobar JD, Santisteban P, Moreno JC. A Novel Missense Variant in the NKX2-1 Homeodomain Prevents Transcriptional Rescue by TAZ. Thyroid 2024. [PMID: 38757609 DOI: 10.1089/thy.2023.0593] [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] [Indexed: 05/18/2024]
Abstract
Background: Brain-lung-thyroid syndrome (BLTS) is caused by NKX2-1 haploinsufficiency, resulting in chorea/choreoathetosis, respiratory problems, and hypothyroidism. Genes interacting with NKX2-1 mutants influence its phenotypic variability. We report a novel NKX2-1 missense variant and the modifier function of TAZ/WWTR1 in BLTS. Methods: A child with BLTS underwent next-generation sequencing panel testing for thyroid disorders. His family was genotyped for NKX2-1 variants and screened for germline mosaicism. Mutant NKX2-1 was generated, and transactivation assays were performed on three NKX2-1 target gene promoters. DNA binding capacity and protein-protein interaction were analyzed. Results: The patient had severe BLTS and carried a novel missense variant c.632A>G (p.N211S) in NKX2-1, which failed to bind to specific DNA promoters, reducing their transactivation. TAZ cotransfection did not significantly increase transcription of these genes, although the variant retained its ability to bind to TAZ. Conclusions: We identify a novel pathogenic NKX2-1 variant that causes severe BLTS and is inherited through germline mosaicism. The mutant lacks DNA-binding capacity, impairing transactivation and suggesting that NKX2-1 binding to DNA is essential for TAZ-mediated transcriptional rescue.
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Affiliation(s)
- Beatriz Villafuerte
- Thyroid Molecular Laboratory, Institute for Medical and Molecular Genetics (INGEMM), La Paz University Hospital Research Institute (IdiPAZ), La Paz University Hospital, Madrid, Spain
| | - Carlos Carrasco-López
- "Sols-Morreale" Biomedical Research Institute, Higher Council for Scientific Research (CSIC), Autonomous University of Madrid, Ciberonc, Carlos III Health Institute (ISCIII), Madrid, Spain
| | - Amanda Herranz
- Thyroid Molecular Laboratory, Institute for Medical and Molecular Genetics (INGEMM), La Paz University Hospital Research Institute (IdiPAZ), La Paz University Hospital, Madrid, Spain
| | - Lucía Garzón
- Pediatric Endocrinology Unit, Pediatrics Department, 12 de Octubre University Hospital, Madrid, Spain
| | - Rogelio Simón
- Pediatric Neurology Unit, Pediatrics Department, 12 de Octubre University Hospital, Madrid, Spain
| | - Daniel Natera-de-Benito
- Neuromuscular Diseases Unit, Pediatric Neurology, Sant Joan de Déu Hospital, Barcelona, Spain
| | - Pouya Alikhani
- Thyroid Molecular Laboratory, Institute for Medical and Molecular Genetics (INGEMM), La Paz University Hospital Research Institute (IdiPAZ), La Paz University Hospital, Madrid, Spain
| | - Jair Tenorio
- Institute for Medical and Molecular Genetics (INGEMM), IdiPAZ, Center for Biomedical Research on the Rare Diseases Network (CIBERER), Carlos III Health Institute (ISCIII), ITHACA-European Reference Network, La Paz University Hospital, Madrid, Spain
| | - Fe García-Santiago
- Cytogenetics Section, Institute for Medical and Molecular Genetics (INGEMM), Center for Biomedical Research on the Rare Diseases Network (CIBERER), Carlos III Health Institute (ISCIII), La Paz University Hospital, Madrid, Spain
| | - Mario Solis
- Bioinformatics Section, Institute for Medical and Molecular Genetics (INGEMM), IdiPAZ, Center for Biomedical Research on the Rare Diseases Network (CIBERER), Carlos III Health Institute (ISCIII), La Paz University Hospital, Madrid, Spain
| | - Ángela Del-Pozo
- Bioinformatics Section, Institute for Medical and Molecular Genetics (INGEMM), IdiPAZ, Center for Biomedical Research on the Rare Diseases Network (CIBERER), Carlos III Health Institute (ISCIII), La Paz University Hospital, Madrid, Spain
| | - Pablo Lapunzina
- Institute for Medical and Molecular Genetics (INGEMM), IdiPAZ, Center for Biomedical Research on the Rare Diseases Network (CIBERER), Carlos III Health Institute (ISCIII), ITHACA-European Reference Network, La Paz University Hospital, Madrid, Spain
| | | | - Pilar Santisteban
- "Sols-Morreale" Biomedical Research Institute, Higher Council for Scientific Research (CSIC), Autonomous University of Madrid, Ciberonc, Carlos III Health Institute (ISCIII), Madrid, Spain
| | - José C Moreno
- Thyroid Molecular Laboratory, Institute for Medical and Molecular Genetics (INGEMM), La Paz University Hospital Research Institute (IdiPAZ), La Paz University Hospital, Madrid, Spain
- Unit 735, Center for Biomedical Research on the Rare Diseases Network (CIBERER), Carlos III Health Institute (ISCIII), Madrid, Spain
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2
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Brûlé E, Zhou X, Wang Y, Buddle ERS, Ongaro L, Loka M, Boelen A, Bernard DJ. The hypothalamic-pituitary-thyroid axis is intact in male insulin receptor substrate 4 knockout mice. Eur Thyroid J 2024; 13:ETJ-23-0054. [PMID: 38271814 PMCID: PMC10895334 DOI: 10.1530/etj-23-0054] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/22/2023] [Accepted: 01/25/2024] [Indexed: 01/27/2024] Open
Abstract
OBJECTIVE Loss of function mutations in the insulin receptor substrate 4 (IRS4) gene cause a rare form of X-linked congenital central hypothyroidism in boys and men. Affected individuals show decreased thyroid-stimulation hormone (TSH) secretion. Members of the IRS family canonically act as scaffold proteins between tyrosine kinase receptors and downstream effectors. How loss of IRS4 affects TSH synthesis or secretion is unresolved. We therefore assessed IRS4's role in the hypothalamic-pituitary-thyroid axis of Irs4 knockout mice. METHODS We generated two global Irs4 knockout mouse lines harboring either two or four base-pair deletions that result in frameshifts and loss of most of the IRS4 protein. RESULTS Under normal laboratory conditions, Irs4 knockout males did not exhibit impairments in pituitary expression of TSH subunit genes (Tshb or Cga) or in the thyrotropin-releasing hormone (TRH) receptor. Additionally, their serum thyroid hormone, T3 (triiodothyronine) and T4 (thyroxine), and hypothalamic Trh expression levels were normal. When Irs4 knockouts were rendered hypothyroid with a low-iodine diet supplemented with propylthiouracil (PTU) for 3 weeks, their serum TSH increased similarly to wild-type males. CONCLUSIONS Overall, Irs4 knockout mice do not exhibit central hypothyroidism or otherwise appear to phenocopy IRS4 deficient patients. Compensation by another IRS protein may explain euthyroidism in these animals.
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Affiliation(s)
- Emilie Brûlé
- Department of Anatomy and Cell Biology, McGill University, Montreal, Quebec, Canada
| | - Xiang Zhou
- Department of Pharmacology and Therapeutics, McGill University, Montreal, Quebec, Canada
| | - Ying Wang
- Department of Pharmacology and Therapeutics, McGill University, Montreal, Quebec, Canada
| | - Evan R S Buddle
- Department of Pharmacology and Therapeutics, McGill University, Montreal, Quebec, Canada
| | - Luisina Ongaro
- Department of Pharmacology and Therapeutics, McGill University, Montreal, Quebec, Canada
| | - Mary Loka
- Integrated Program in Neuroscience, McGill University, Montreal, Quebec, Canada
| | - Anita Boelen
- Endocrine Laboratory, Department of Laboratory Medicine, University of Amsterdam, Amsterdam Gastroenterology, Endocrinology & Metabolism Research Institute, Amsterdam, The Netherlands
| | - Daniel J Bernard
- Department of Anatomy and Cell Biology, McGill University, Montreal, Quebec, Canada
- Department of Pharmacology and Therapeutics, McGill University, Montreal, Quebec, Canada
- Integrated Program in Neuroscience, McGill University, Montreal, Quebec, Canada
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3
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Lauffer P, Naafs JC, Bikker H, Garrelfs MR, Mooij CF, Boelen A, Zwaveling-Soonawala N, van Trotsenburg AS. Further delineation of central congenital hypothyroidism due to variants in TBL1X and IRS4. Thyroid 2023. [PMID: 36860195 DOI: 10.1089/thy.2022.0675] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/03/2023]
Affiliation(s)
- Peter Lauffer
- Amsterdam Universitair Medische Centra, 522567, Emma Children's Hospital/Department of Paediatric Endocrinology, Meibergdreef 9, Amsterdam, Netherlands, 1081 HV;
| | - Jolanda C Naafs
- Amsterdam UMC - Locatie AMC, 26066, Pediatric Endocrinology, Meibergdreef 9, Amsterdam, Netherlands, 1105 AZ;
| | - Hennie Bikker
- Amsterdam UMC - Locatie AMC, 26066, Amsterdam, North Holland, Netherlands;
| | - Mark R Garrelfs
- Amsterdam Universitair Medische Centra, 522567, Emma Children's Hospital/Department of Paediatric Endocrinology, Amsterdam, Netherlands;
| | - Christiaan F Mooij
- Amsterdam UMC, 522567, Pediatric Endocrinology, Meibergdreef 9, Amsterdam, Netherlands, 1105 AZ;
| | - Anita Boelen
- Academic Medical Center, 26066, Endocrinology Laboratory, Amsterdam, Netherlands;
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4
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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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Lauffer P, Zwaveling-Soonawala N, Naafs JC, Boelen A, van Trotsenburg ASP. Diagnosis and Management of Central Congenital Hypothyroidism. Front Endocrinol (Lausanne) 2021; 12:686317. [PMID: 34566885 PMCID: PMC8458656 DOI: 10.3389/fendo.2021.686317] [Citation(s) in RCA: 22] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/26/2021] [Accepted: 07/13/2021] [Indexed: 11/21/2022] Open
Abstract
Central congenital hypothyroidism (CH) is defined as thyroid hormone (TH) deficiency at birth due to insufficient stimulation by the pituitary of the thyroid gland. The incidence of central CH is currently estimated at around 1:13,000. Central CH may occur in isolation, but in the majority of cases (60%) it is part of combined pituitary hormone deficiencies (CPHD). In recent years several novel genetic causes of isolated central CH have been discovered (IGSF1, TBL1X, IRS4), and up to 90% of isolated central CH cases can be genetically explained. For CPHD the etiology usually remains unknown, although pituitary stalk interruption syndrome does seem to be the most common anatomic pituitary malformation associated with CPHD. Recent studies have shown that central CH is a more severe condition than previously thought, and that early detection and treatment leads to good neurodevelopmental outcome. However, in the neonatal period the clinical diagnosis is often missed despite hospital admission because of feeding problems, hypoglycemia and prolonged jaundice. This review provides an update on the etiology and prognosis of central CH, and a practical approach to diagnosis and management of this intriguing condition.
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Affiliation(s)
- Peter Lauffer
- Emma Children’s Hospital, Amsterdam University Medical Centers (UMC), Department of Pediatric Endocrinology, University of Amsterdam, Amsterdam, Netherlands
| | - Nitash Zwaveling-Soonawala
- Emma Children’s Hospital, Amsterdam University Medical Centers (UMC), Department of Pediatric Endocrinology, University of Amsterdam, Amsterdam, Netherlands
| | - Jolanda C. Naafs
- Emma Children’s Hospital, Amsterdam University Medical Centers (UMC), Department of Pediatric Endocrinology, University of Amsterdam, Amsterdam, Netherlands
| | - Anita Boelen
- Endocrine Laboratory, Amsterdam UMC, University of Amsterdam, Amsterdam, Netherlands
| | - A. S. Paul van Trotsenburg
- Emma Children’s Hospital, Amsterdam University Medical Centers (UMC), Department of Pediatric Endocrinology, University of Amsterdam, Amsterdam, Netherlands
- *Correspondence: A. S. Paul van Trotsenburg,
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6
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Chiari Malformation and Attention Deficit Hyperactivity Disorder. Case Rep Med 2020; 2020:2694956. [PMID: 33029147 PMCID: PMC7527903 DOI: 10.1155/2020/2694956] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2020] [Revised: 09/05/2020] [Accepted: 09/12/2020] [Indexed: 01/16/2023] Open
Abstract
Attention deficit hyperactivity disorder (ADHD) is a neurodevelopmental condition characterized by inattention, hyperactivity, and impulsivity. Chiari malformations (CM), first described approximately a hundred years ago, refer to a spectrum of hindbrain malformations characterized by cerebellar herniation through the foramen magnum. We present the case of a 28-year-old woman with ADHD and concurrent Chiari malformation type I (CM-I) that was diagnosed by CT scan. There is growing evidence supporting the role of the cerebellum and its associated structures in the pathophysiology of ADHD. Thus, a cerebellar malformation such as CM may impact neurological circuitry in a manner favoring the development of a neuropsychiatric disorder such as ADHD. Our case highlights the need for further studies pertaining to the role of the cerebellum in the pathophysiology of ADHD and the importance of considering the presence of CM when evaluating a patient with ADHD.
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7
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Sun Z, Xu Y. Nuclear Receptor Coactivators (NCOAs) and Corepressors (NCORs) in the Brain. Endocrinology 2020; 161:5843759. [PMID: 32449767 PMCID: PMC7351129 DOI: 10.1210/endocr/bqaa083] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/06/2020] [Accepted: 05/20/2020] [Indexed: 01/20/2023]
Abstract
Nuclear receptor coactivators (NCOAs) and corepressors (NCORs) bind to nuclear hormone receptors in a ligand-dependent manner and mediate the transcriptional activation or repression of the downstream target genes in response to hormones, metabolites, xenobiotics, and drugs. NCOAs and NCORs are widely expressed in the mammalian brain. Studies using genetic animal models started to reveal pivotal roles of NCOAs/NCORs in the brain in regulating hormonal signaling, sexual behaviors, consummatory behaviors, exploratory and locomotor behaviors, moods, learning, and memory. Genetic variants of NCOAs or NCORs have begun to emerge from human patients with obesity, hormonal disruption, intellectual disability, or autism spectrum disorders. Here we review recent studies that shed light on the function of NCOAs and NCORs in the central nervous system.
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Affiliation(s)
- Zheng Sun
- Department of Molecular and Cellular Biology; Baylor College of Medicine, Houston, Texas
- Department of Medicine, Division of Diabetes, Endocrinology and Metabolism; Baylor College of Medicine, Houston, Texas
- Correspondence: Zheng Sun, PhD, Baylor College of Medicine, One Baylor Plaza, Houston, TX 77030. E-mail: ; or Yong Xu, PhD, Baylor College of Medicine, One Baylor Plaza, Houston, TX 77030. E-mail:
| | - Yong Xu
- Department of Molecular and Cellular Biology; Baylor College of Medicine, Houston, Texas
- USDA/ARS Children’s Nutrition Research Center, Department of Pediatrics; Baylor College of Medicine, Houston, Texas
- Correspondence: Zheng Sun, PhD, Baylor College of Medicine, One Baylor Plaza, Houston, TX 77030. E-mail: ; or Yong Xu, PhD, Baylor College of Medicine, One Baylor Plaza, Houston, TX 77030. E-mail:
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8
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Abstract
PURPOSE OF REVIEW The present review summarizes recent advances in the diagnosis and management of patients with congenital hypothyroidism. RECENT FINDINGS Although most newborn screening strategies are designed to detect severe primary hypothyroidism that presents shortly after birth, some infants display a pattern of delayed TSH rise despite normal initial newborn screening. Recent studies suggest that delayed TSH rise may be more common and more severe than previously recognized. Although much less common than primary hypothyroidism, central congenital hypothyroidism is as likely to be of moderate or severe degree, which has implications for its detection and treatment. The discovery of new genetic causes of central congenital hypothyroidism, including the X-linked genes IGSF1, TBL1X, and IRS4, has begun to expand our understanding of thyroid axis regulation. Recent long-term data indicate that current treatment recommendations for congenital hypothyroidism result in grossly normal neurocognitive outcomes even in severely affected patients, and that overtreatment may not be as harmful as previously suspected. Liquid levothyroxine is now commercially available in the United States, but more studies are needed to determine optimal dosing using this formulation. SUMMARY Prompt identification and adequate treatment of patients with congenital hypothyroidism is critical to optimize outcomes. New information continues to accumulate about how to improve detection of congenital hypothyroidism in specific subgroups of infants (particularly those with delayed TSH rise and central hypothyroidism) and about treatment of patients with this disorder.
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Affiliation(s)
- Christine E Cherella
- Thyroid Center, Boston Children's Hospital, Harvard Medical School, Boston, Massachusetts, USA
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9
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Tajima T, Nakamura A, Oguma M, Yamazaki M. Recent advances in research on isolated congenital central hypothyroidism. Clin Pediatr Endocrinol 2019; 28:69-79. [PMID: 31384098 PMCID: PMC6646241 DOI: 10.1297/cpe.28.69] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/18/2019] [Accepted: 04/21/2019] [Indexed: 12/14/2022] Open
Abstract
Congenital central hypothyroidism (C-CH) is caused by defects in the secretion of
thyrotropin-releasing hormone (TRH) and/or TSH, leading to an impairment in the release of
hormones from the thyroid. The causes of C-CH include congenital anomalies of the
hypothalamic-pituitary regions and several genetic defects. In terms of endocrinology,
C-CH is divided into two categories: (1) accompanied
by another pituitary hormone deficiency and called combined pituitary hormone deficiency,
and (2) isolated C-CH, showing mainly TSH
deficiency. For isolated C-CH, a mutation in the TSH gene (TSHB) encoding
the β-subunit of the protein was first found in 1990 by Japanese researchers, and
thereafter several mutations in TSHB have been reported. Mutations in the
thyrotropin-releasing hormone receptor gene (TRHR), as well as genetic
defects in immunoglobulin superfamily 1 (IGSF1), have also been
identified. It was recently found that isolated C-CH is caused by mutations in transducin
β-like 1 X-linked and insulin receptor substrate 4. It is noted that all patients with
TSHB deficiency and some with IGSF1 deficiency show severe hypothyroidism soon after
birth. Among the causes of C-CH, high frequency of mutations in IGSF1 is
the most prevalent. This review focuses on recent findings on isolated C-CH.
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Affiliation(s)
- Toshihiro Tajima
- Jichi Medical University Children's Medical Center Tochigi, Shimotsuke, Japan
| | - Akie Nakamura
- Department of Pediatrics Hokkaido University School of Medicine, Sapporo, Japan
| | - Makiko Oguma
- Jichi Medical University Children's Medical Center Tochigi, Shimotsuke, Japan
| | - Masayo Yamazaki
- Jichi Medical University Children's Medical Center Tochigi, Shimotsuke, Japan
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