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Güran T, Tezel B, Çakır M, Akıncı A, Orbak Z, Keskin M, Selver Eklioğlu B, Ozon A, Özbek MN, Karagüzel G, Hatipoğlu N, Gürbüz F, Çizmecioğlu FM, Kara C, Şimşek E, Baş F, Aydın M, Darendeliler F. Neonatal Screening for Congenital Adrenal Hyperplasia in Turkey: Outcomes of Extended Pilot Study in 241,083 Infants. J Clin Res Pediatr Endocrinol 2020; 12:287-294. [PMID: 32157855 PMCID: PMC7499135 DOI: 10.4274/jcrpe.galenos.2020.2019.0182] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/01/2022] Open
Abstract
OBJECTIVE Turkish Directorate of Public Health introduced the first pilot screening program for congenital adrenal hyperplasia (CAH) in four Turkish cities in 2017, and in 2018 extended the program, with a slight change in screening strategy, to fourteen cities. To evaluate the performance of the extended study and update previously reported outcomes. METHODS Retrospective, descriptive study. Neonates of ≥32 gestational weeks and ≥1500 gr birth weight from fourteen cities, born between May-December 2018, were included. Screening protocol included one sample, two-tier testing as applied in the previous pilot study. In the first step, 17α-hydroxyprogesterone (17-OHP) was measured by fluoroimmunoassay in dried blood spots (DBS) obtained at 3-5 days of life. Cases with positive initial screening underwent second tier testing by steroid profiling in DBS using liquid chromatographyt-andem mass spectrometry to measure 17-OHP, 21-deoxycortisol (21-S), cortisol (F), 11-deoxycortisol and androstenedione. The babies with a steroid ratio (21-S+17-OHP)/F of ≥0.7 (increased from ≥0.5 in the earlier pilot study) were referred to pediatric endocrinology clinics for diagnostic assessment. RESULTS In the evaluated period, 241,083 newborns were screened. 12,321 (5.11%) required second-tier testing and 880 (0.36%) were referred for clinical assessment, twenty of whom were diagnosed with CAH (10 females, 10 males). Sixteen were diagnosed as classical 21-hydroxylase deficiency (21-OHD) CAH (12 with salt-wasting and four with simple virilising CAH), and four cases were identified with 11β-OHD CAH. No case of salt-wasting CAH was missed by neonatal screening (sensitivity was 100%). The incidence of classical 21-OHD and 11β-OHD in the screened population was 1:15,067 and 1:60,270, respectively. CONCLUSION Turkish neonatal CAH screening effectively led to earlier diagnosis of 21-OHD and 11β-OHD, using steroid profiling as a second-tier test. This will result in improved care of these patients in the future.
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Affiliation(s)
- Tülay Güran
- Marmara University Faculty of Medicine, Department of Paediatric Endocrinology and Diabetes, İstanbul, Turkey,* Address for Correspondence: Marmara University Faculty of Medicine, Department of Paediatric Endocrinology and Diabetes, İstanbul, Turkey Phone: +90 216 625 45 45 E-mail:
| | - Başak Tezel
- Turkish Directorate of Public Health, Ankara, Turkey
| | - Meltem Çakır
- Mersin City Hospital, Clinic of Paediatric Endocrinology and Diabetes, Mersin, Turkey
| | - Ayşehan Akıncı
- İnönü University Faculty of Medicine, Department of Paediatric Endocrinology and Diabetes, Malatya, Turkey
| | - Zerrin Orbak
- Atatürk University Faculty of Medicine, Department of Paediatric Endocrinology and Diabetes, Erzurum, Turkey
| | - Mehmet Keskin
- Gaziantep University Faculty of Medicine, Department of Paediatric Endocrinology and Diabetes, Gaziantep, Turkey
| | - Beray Selver Eklioğlu
- Necmettin Erbakan University, Meram Faculty of Medicine, Department of Paediatric Endocrinology and Diabetes, Konya, Turkey
| | - Alev Ozon
- Hacettepe University Faculty of Medicine, Department of Paediatric Endocrinology and Diabetes, Ankara, Turkey
| | - Mehmet Nuri Özbek
- Gazi Yaşargil Training and Research Hospital, Department of Paediatric Endocrinology and Diabetes, Diyarbakır, Turkey
| | - Gülay Karagüzel
- Karadeniz Techical University Faculty of Medicine, Department of Paediatric Endocrinology and Diabetes, Trabzon, Turkey
| | - Nihal Hatipoğlu
- Erciyes University Faculty of Medicine, Department of Paediatric Endocrinology and Diabetes, Kayseri, Turkey
| | - Fatih Gürbüz
- Çukurova University Faculty of Medicine, Department of Paediatric Endocrinology and Diabetes, Adana, Turkey
| | - Filiz Mine Çizmecioğlu
- Kocaeli University Faculty of Medicine, Department of Paediatric Endocrinology and Diabetes, Kocaeli, Turkey
| | - Cengiz Kara
- Ondokuz Mayıs University Faculty of Medicine, Department of Paediatric Endocrinology and Diabetes, Samsun, Turkey
| | - Enver Şimşek
- Osmangazi University Faculty of Medicine, Department of Paediatric Endocrinology and Diabetes, Eskişehir, Turkey
| | - Firdevs Baş
- İstanbul University İstanbul Faculty of Medicine, Department of Paediatric Endocrinology, İstanbul, Turkey
| | - Murat Aydın
- Ondokuz Mayıs University Faculty of Medicine, Department of Paediatric Endocrinology and Diabetes, Samsun, Turkey
| | - Feyza Darendeliler
- İstanbul University İstanbul Faculty of Medicine, Department of Paediatric Endocrinology, İstanbul, Turkey
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Speiser PW, Arlt W, Auchus RJ, Baskin LS, Conway GS, Merke DP, Meyer-Bahlburg HFL, Miller WL, Murad MH, Oberfield SE, White PC. Congenital Adrenal Hyperplasia Due to Steroid 21-Hydroxylase Deficiency: An Endocrine Society Clinical Practice Guideline. J Clin Endocrinol Metab 2018; 103:4043-4088. [PMID: 30272171 PMCID: PMC6456929 DOI: 10.1210/jc.2018-01865] [Citation(s) in RCA: 554] [Impact Index Per Article: 92.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/27/2018] [Accepted: 08/27/2018] [Indexed: 01/29/2023]
Abstract
Objective To update the congenital adrenal hyperplasia due to steroid 21-hydroxylase deficiency clinical practice guideline published by the Endocrine Society in 2010. Conclusions The writing committee presents updated best practice guidelines for the clinical management of congenital adrenal hyperplasia based on published evidence and expert opinion with added considerations for patient safety, quality of life, cost, and utilization.
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Affiliation(s)
- Phyllis W Speiser
- Cohen Children’s Medical Center of New York, New York, New York
- Zucker School of Medicine at Hofstra/Northwell, Hempstead, New York
| | - Wiebke Arlt
- University of Birmingham, Birmingham, United Kingdom
| | | | | | | | - Deborah P Merke
- National Institutes of Health Clinical Center, Bethesda, Maryland
- Eunice Kennedy Shriver National Institute of Child Health and Human Development, Bethesda, Maryland
| | - Heino F L Meyer-Bahlburg
- New York State Psychiatric Institute, Vagelos College of Physicians & Surgeons of Columbia University, New York, New York
| | - Walter L Miller
- University of California San Francisco, San Francisco, California
| | - M Hassan Murad
- Mayo Clinic’s Evidence-Based Practice Center, Rochester, Minnesota
| | - Sharon E Oberfield
- NewYork–Presbyterian, Columbia University Medical Center, New York, New York
| | - Perrin C White
- University of Texas Southwestern Medical Center, Dallas, Texas
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Milyani AA, Al-Agha AE, Al-Zanbagi M. Initial presentations and associated clinical findings in patients with classical congenital adrenal hyperplasia. J Pediatr Endocrinol Metab 2018; 31:671-673. [PMID: 29750654 DOI: 10.1515/jpem-2018-0029] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/17/2018] [Accepted: 04/05/2018] [Indexed: 11/15/2022]
Abstract
BACKGROUND The objective of this study was to investigate the initial presenting features of children with classical congenital adrenal hyperplasia (CAH). METHODS This is a descriptive retrospective study over a period of 5 years. Data analysis was performed using Statistical Package for Social Science. RESULTS Ambiguous genitalia (AG) was the commonest initial presentation marking 50.7% of the patients. On the other hand, 33.3% presented with a salt-losing crisis, 4.1% of whom presented with shock, while 14.5% had a combined presentation of both AG and a salt-losing crisis. CONCLUSIONS CAH should be highly suspected in all females born with AG. Contrarily, affected male newborns more frequently present with a salt-losing crisis, and considering the recent institution of newborn screening in Saudi Arabia, earlier detection in these children is anticipated.
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Affiliation(s)
| | - Abdulmoein Eid Al-Agha
- Professor of Paediatric Endocrinology, King Abdulaziz University Hospital, Paediatric Department, P.O. Box 80215, Jeddah 21589, Saudi Arabia, Fax: +966 2 640 3841, +966 2 6408353
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Pearce M, DeMartino L, McMahon R, Hamel R, Maloney B, Stansfield DM, McGrath EC, Occhionero A, Gearhart A, Caggana M, Tavakoli NP. Newborn screening for congenital adrenal hyperplasia in New York State. Mol Genet Metab Rep 2016; 7:1-7. [PMID: 27331001 PMCID: PMC4908061 DOI: 10.1016/j.ymgmr.2016.02.005] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2016] [Revised: 02/19/2016] [Accepted: 02/20/2016] [Indexed: 11/17/2022] Open
Abstract
From 2007 to 2014 the New York State (NYS) Newborn Screening (NBS) program screened 2 million newborns for congenital adrenal hyperplasia (CAH). The data was analyzed to determine factors that affect 17α-hydroxyprogesterone levels and assist in developing algorithm changes that would improve the positive predictive value of the methodology being used. The concentration of 17-OHP in dried blood spots was measured using the AutoDELFIA Neonatal 17-OHP kit (Perkin Elmer, Turku, Finland). During the 8 year period of this study 2476 babies were referred, 105 babies were diagnosed with CAH (90 with the salt-wasting (SW), 8 with simple virilizing (SV), 5 with non-classical CAH, and 2 with another enzyme deficiency) and, 14 with possible CAH. Three false negative cases with SV-CAH were reported to the program. Of the total 108 known cases, 74 (69%) infants were detected by newborn screening in the absence of clinical information, or, known family history. The incidence of CAH in NYS is 1 in 18,170 with a ratio of SW to SV of 8.2:1. The incidence of CAH is lower in Black infants than in White, Hispanic and Asian infants. Despite a lower mean birth weight, female infants have a lower mean 17-OHP value than male infants and are under-represented in the referred category. As per other NBS programs the false positive rate is exacerbated by prematurity/low birth weight and by over-early specimen collection.
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Affiliation(s)
- Melissa Pearce
- Division of Genetics, Wadsworth Center, New York State Department of Health, Albany, NY, USA
| | - Lenore DeMartino
- Division of Genetics, Wadsworth Center, New York State Department of Health, Albany, NY, USA
| | - Rebecca McMahon
- Division of Genetics, Wadsworth Center, New York State Department of Health, Albany, NY, USA
| | - Rhonda Hamel
- Division of Genetics, Wadsworth Center, New York State Department of Health, Albany, NY, USA
| | - Breanne Maloney
- Division of Genetics, Wadsworth Center, New York State Department of Health, Albany, NY, USA
| | | | - Emily C McGrath
- Division of Genetics, Wadsworth Center, New York State Department of Health, Albany, NY, USA
| | - Amanda Occhionero
- Division of Genetics, Wadsworth Center, New York State Department of Health, Albany, NY, USA
| | - Adam Gearhart
- Division of Genetics, Wadsworth Center, New York State Department of Health, Albany, NY, USA
| | - Michele Caggana
- Division of Genetics, Wadsworth Center, New York State Department of Health, Albany, NY, USA
| | - Norma P Tavakoli
- Division of Genetics, Wadsworth Center, New York State Department of Health, Albany, NY, USA; Department of Biomedical Sciences, School of Public Health, State University of New York, Albany, NY, USA
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