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Acet F, Sahin G, Uçar AAO, Emirdar V, Karaca E, Durmaz B, Goker ENT, Tavmergen E. In vitro fertilization and preimplantation genetic diagnosis outcomes in mosaic Turner's Syndrome: A retrospective cohort study from a single referral center experience. J Gynecol Obstet Hum Reprod 2022; 51:102405. [DOI: 10.1016/j.jogoh.2022.102405] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/24/2021] [Revised: 04/14/2022] [Accepted: 05/11/2022] [Indexed: 11/28/2022]
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Communicating the diagnosis of Klinefelter syndrome to children and adolescents: when, how, and who? J Community Genet 2022; 13:271-280. [PMID: 35247190 PMCID: PMC9270507 DOI: 10.1007/s12687-022-00585-0] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2021] [Accepted: 02/24/2022] [Indexed: 12/03/2022] Open
Abstract
Klinefelter syndrome (KS) is the most frequent sex chromosome aneuploidy in males. KS diagnosis disclosure has an important impact on diagnosis acceptance and the increase in prenatal diagnostic procedures raises questions regarding communication to children/adolescents. Limited data are currently available on this issue. The aim of the study was to investigate aspects like the best timing (when), topics (how), and healthcare professional (who), which, in the opinion of both KS patients and parents, may be considered the best for diagnosis communication to KS children/adolescents. We also analyzed how participants received the communication in real life and evaluated the differences between the responses given by parents who receive KS diagnosis before or after KS patient birth regarding disclosure of KS communication. KS adult patients, KS mothers, and KS fathers, not belonging to the same family, completed a questionnaire containing quantitative measures (5 points Likert scale), open-ended questions, and multiple choice questions. Parental responses were divided according to the timing at which the communication occurred: prenatal age diagnosis (PRE-D) or postnatal age diagnosis (POST-D). A total of 41 KS adults and 77 KS parents (53 PRE-D, 24 POST-D) were recruited. Most KS patients and most POST-D parents consider that communication should be provided before 14 years of age; most PRE-D parents consider 14–18 years of age the best period for communication. We suggest that communication should occur preferably before 18 years of age by a multidisciplinary team (endocrinologists, psychologists, geneticists, and parents) and that the information should deal not only fertility and hormonal aspects but also metabolic and cognitive features.
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Kim J, Kim MS, Suh BK, Ko CW, Lee KH, Yoo HW, Shin CH, Hwang JS, Kim HS, Chung WY, Kim CJ, Han HS, Jin DK. Recombinant growth hormone therapy in children with Turner Syndrome in Korea: a phase III Randomized Trial. BMC Endocr Disord 2021; 21:243. [PMID: 34893062 PMCID: PMC8662840 DOI: 10.1186/s12902-021-00904-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/31/2021] [Accepted: 11/12/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Short stature is the most consistent characteristic feature of Turner syndrome (TS). To improve final heights of children with TS effectively, it is important to provide them with early and appropriate treatment using growth hormone (GH). The objective of this study was to assess the efficacy and safety of a new recombinant human GH, Growtropin®-II (DA-3002, Dong-A ST Co., Ltd) versus a comparator (Genotropin®, Pfizer Inc.) for Korean children with TS. METHODS This open-label, active-controlled, parallel-group, randomized controlled phase III trial was conducted at 11 hospitals in Korea. Eligible patients (n = 58) were randomized to two groups: 1) DA-3002 group (administrated with DA-3002 at 0.14 IU [0.0450-0.050 mg] /kg/day); and 2) comparator group (administrated with the comparator at 0.14 IU [0.0450-0.050 mg] /kg/day). RESULTS The change from baseline in annualized height velocity (HV) after a 52-week treatment period was 4.15 ± 0.30 cm/year in the DA-3002 group and 4.34 ± 0.29 cm/year in the comparator group. The lower bound of 95% two-sided confidence interval for group difference in the change of annualized HV (- 1.02) satisfied the non-inferiority margin (- 1.5). The change in height standard deviation score (HtSDS) at 52-week was 0.70 ± 0.23 for the DA-3002 group and 0.66 ± 0.39 for the comparator group, showing no significant (p = 0.685) difference between the two groups. The change of skeletal maturity defined as change in bone age/change in chronological age between the two groups was not significantly different (1.25 ± 0.58 for the DA-3002 group and 1.47 ± 0.45 for the comparator group, p = 0.134). Changes from baseline in serum insulin-like growth factor-1 (IGF-1) and insulin-like growth factor binding protein-3 (IGFBP-3) after 52 weeks of treatment did not differ significantly between the two groups (p = 0.565 and p = 0.388, respectively) either. The occurrence of adverse events was not statistically different between groups. CONCLUSIONS This study demonstrates that the efficacy and safety of GH treatment with DA-3002 in children with TS are comparable with those of the comparator. It is expected to analysis the long-term effect of DA-3002 on the increase of final adult height in children with TS and possible late-onset complications in the future. TRIAL REGISTRATION The study was registered at ClinicalTrials.gov. ClinicalTrials.gov identifier: NCT01813630 (19/03/2013).
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Affiliation(s)
- Jinsup Kim
- Department of Pediatrics, Hanyang University Medical Center, Hanyang University College of Medicine, Seoul, South Korea
| | - Min-Sun Kim
- Department of Pediatrics, Samsung Medical Center, Sungkyunkwan University School of Medicine, 81 Irwon-Ro Gangnam-gu, Seoul, 06351, South Korea
| | - Byung-Kyu Suh
- Department of Pediatrics, Seoul St. Mary's Hospital, The Catholic University of Korea, Seoul, South Korea
| | - Cheol Woo Ko
- Department of Pediatrics, Kyungpook National University Hospital, Daegu, Republic of Korea
| | - Kee-Hyoung Lee
- Department of Pediatrics, Korea University Anam Hospital, Seoul, South Korea
| | - Han-Wook Yoo
- Department of Pediatrics, Medical Genetics Clinic and Laboratory, Asan Medical Center Children's Hospital, University of Ulsan College of Medicine, Seoul, South Korea
| | - Choong Ho Shin
- Department of Pediatrics, Seoul National University Children's Hospital, Seoul, South Korea
| | - Jin Soon Hwang
- Department of Pediatrics, Ajou University Hospital, Suwon, South Korea
| | - Ho-Seong Kim
- Department of Pediatrics, Severance Hospital, Yonsei University College of Medicine, Seoul, South Korea
| | - Woo Yeong Chung
- Department of Pediatrics, Inje University Busan Paik Hospital, Busan, South Korea
| | - Chan Jong Kim
- Department of Pediatrics, Chonnam National University Hospital, Gwangju, South Korea
| | - Heon-Seok Han
- Department of Pediatrics, Chungbuk National University Hospital, Cheongju, South Korea
| | - Dong-Kyu Jin
- Department of Pediatrics, Samsung Medical Center, Sungkyunkwan University School of Medicine, 81 Irwon-Ro Gangnam-gu, Seoul, 06351, South Korea.
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Bryant PH, Jacoby D, Bunch M, Speck PM. Turner syndrome mosaicism: Challenges in identification and management in primary care. J Am Assoc Nurse Pract 2021; 34:400-404. [PMID: 34628444 DOI: 10.1097/jxx.0000000000000643] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2021] [Accepted: 07/12/2021] [Indexed: 11/25/2022]
Abstract
ABSTRACT The spectrum of Turner syndrome (TS) includes Turner syndrome mosaicism (TSM), which is typically a nonhereditary chromosomal abnormality. Turner syndrome mosaicism presents uncommonly to primary care providers (PCPs), who often fail to recognize the subtle signs. The average age at diagnosis for common TS and TSM karyotype is 5.4 years, averaging 7.3 years. Often genetic confirmation, management, and recommended surveillance are delayed. Oftentimes, the PCP suspects a genetic etiology of an unusual phenotype, such as pinna placement or other unusual ear configurations, webbed neck with low posterior hairline, wide-spaced nipples, or short stature among other presentations. The PCP or geneticist orders diagnostic studies to confirm the diagnosis, such as a karyotype. After diagnosis, the PCP refers to the geneticist who initiates surveillance and makes recommendations for management. There are potential neurocognitive, cardiovascular, renal, reproductive, and endocrine issues. Treatment literature is vague and parental concerns are linked to quality mental health and quality of life for the family member with TS or TSM. The purpose of this article was to use a case study to introduce the topic of TS and TSM and to assist the PCP in the identification and management of patient and family concerns.
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Affiliation(s)
- Pamela H Bryant
- Department of Family/Community and Health Services, University of Alabama at Birmingham School of Nursing, Birmingham, Alabama
| | - Delwin Jacoby
- Division of Genetics and Metabolism, Department of Pediatrics, College of Medicine, University of Kentucky, Lexington, Kentucky
| | - Miriam Bunch
- Division of Genetics and Metabolism, Department of Pediatrics, College of Medicine, University of Kentucky, Lexington, Kentucky
| | - Patricia M Speck
- Department of Family/Community and Health Services, University of Alabama at Birmingham School of Nursing, Birmingham, Alabama
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Güzel Erdal G, Balkan M. Turner Syndrome with Isochromosome Xq. J Pediatr Genet 2020; 9:243-245. [PMID: 32765927 DOI: 10.1055/s-0039-3399496] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2019] [Accepted: 09/30/2019] [Indexed: 02/06/2023]
Abstract
Short stature and growth retardation in girls commonly occur in patients with Turner syndrome. We present a 19-year-old-girl with primary amenorrhea and growth retardation, who has a mosaic karyotype, 46X,i(Xq)[17]/45,X[8]. Classic Turner syndrome has a more severe phenotype than variant causes of Turner syndrome. We present a patient with 46,X,i(Xq) karyotype and compare the clinical and laboratory findings with the classic description of Turner syndrome. Our patient has normal social and psychomotor skills unlike previously reported cases in the literature. This case expands the phenotype-genotype description of Turner syndrome, which makes it an important contribution to the literature.
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Affiliation(s)
- Gülbahar Güzel Erdal
- Department of Medical Biology and Genetics, Faculty of Medicine, Dicle University, Diyarbakır, Turkey
| | - Mahmut Balkan
- Department of Medical Biology and Genetics, Faculty of Medicine, Dicle University, Diyarbakır, Turkey
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Bauer AJ, Wassner AJ. Thyroid hormone therapy in congenital hypothyroidism and pediatric hypothyroidism. Endocrine 2019; 66:51-62. [PMID: 31350727 DOI: 10.1007/s12020-019-02024-6] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/09/2019] [Accepted: 07/17/2019] [Indexed: 12/11/2022]
Abstract
The evaluation and management of hypothyroidism in children are similar to adults, but there are important differences based on the dependence on normal thyroid function for neurocognitive and physical development. In the pediatric population, hypothyroidism is frequently categorized as congenital or acquired hypothyroidism, depending on the age of presentation and the underlying etiology. The evaluation and management of children and adolescents with hypothyroidism are determined by the etiology as well as by the age at diagnosis, severity of the hypothyroidism, and the response to thyroid hormone replacement therapy. Children and adolescents require higher weight-based doses for thyroid hormone replacement than do adults, likely due to a shorter half-life of thyroxine (T4) and triiodothyronine (T3) in children, but weight-based dose requirements decrease as the child advances into adulthood. Multiple gaps in knowledge remains regarding how to optimize the treatment of hypothyroidism in pediatric patients, including (but not limited to) the selection of patients with subclinical hypothyroidism for treatment, and the potential benefit of combined LT3/LT4 therapy for patients with persistent symptoms and/or low T3 on LT4 monotherapy. The life-long impact on growth and development, and potentially on long-term cardiovascular and psychosocial health, are significant and highlight the importance of future prospective studies in pediatric patients to explore these areas of uncertainty.
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Affiliation(s)
- Andrew J Bauer
- The Thyroid Center, Division of Endocrinology and Diabetes, The Children's Hospital of Philadelphia, The Perelman School of Medicine, The University of Pennsylvania, 3500 Civic Center Boulevard, Buerger Center, 12-149, Philadelphia, PA, 19104, USA.
| | - Ari J Wassner
- Thyroid Program, Division of Endocrinology, Boston Children's Hospital, Harvard Medical School, 333 Longwood Avenue, 2nd floor, Boston, MA, 02115, USA
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Siller AF, Shimony A, Shinawi M, Amarillo I, Dehner LP, Semenkovich K, Arbeláez AM. Inherited Deletion of 1q, Hyperparathyroidism and Signs of Y-chromosomal Influence in a Patient with Turner Syndrome. J Clin Res Pediatr Endocrinol 2019; 11:88-93. [PMID: 29739732 PMCID: PMC6398186 DOI: 10.4274/jcrpe.galenos.2018.2018.0005] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [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
We report a detailed phenotypic, cytogenetic and molecular characterization of a patient prenatally diagnosed with Turner syndrome (TS). In addition to having typical TS clinical characteristics including webbed neck, high arched palate and coarctation of the aorta, the patient had features less frequently seen in TS. These included recurrent parathyroid adenomas, growth along the 75th-90th centiles on the TS height curve despite minimal treatment with growth hormone, behavioral problems and evidence of gonadal dysgenesis with testicular-like structures, such as seminiferous tubules lined by Sertoli cells and a contiguous nodule of Leydig cells. While fluorescence in situ hybridization (FISH) failed to detect Y-chromosome material in gonadal tissue or blood samples, chromosomal microarray analysis (CMA) confirmed X monosomy and a 4.69 Mb copy number loss on 1q31.2q31.3 (bp 192,715,814 to 197,401,180). This region contains the CDC73 gene which has been associated with hyperparathyroidism-jaw tumor syndrome, features of which include recurrent, functional parathyroid adenomas and behavioral issues. This case illustrates how atypical features in a TS patient, such as robust growth and recurrent parathyroid adenomas, may suggest an underlying molecular etiology that should be explored by additional genetic diagnostic modalities. It is therefore appropriate in such cases to conduct further genetic testing, such as CMA and FISH, to explore other diagnostic possibilities and possibly prevent further complications.
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Affiliation(s)
- Alejandro F. Siller
- Washington University Faculty of Medicine, Department of Pediatrics, Washington, USA
| | - Alex Shimony
- Washington University Faculty of Medicine, Department of Pediatrics, Washington, USA
| | - Marwan Shinawi
- Washington University Faculty of Medicine, Department of Pediatrics, Washington, USA
| | - Ina Amarillo
- Washington University Faculty of Medicine, Department of Pathology and Immunology, Washington, USA
| | - Louis P. Dehner
- Washington University Faculty of Medicine, Department of Pathology and Immunology, Washington, USA
| | - Katherine Semenkovich
- Washington University Faculty of Medicine, Department of Pediatrics, Washington, USA
| | - Ana María Arbeláez
- Washington University Faculty of Medicine, Department of Pediatrics, Washington, USA,* Address for Correspondence: Washington University Faculty of Medicine, Department of Pediatrics, Washington, USA Phone: +3144546051 E-mail:
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Kelley JC, Gutmark-Little I, Backeljauw P, Bamba V. Increased Non-High-Density Lipoprotein Cholesterol in Children and Young Adults with Turner Syndrome Is Not Explained By BMI Alone. Horm Res Paediatr 2018; 88:208-214. [PMID: 28768282 DOI: 10.1159/000477761] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/20/2017] [Accepted: 05/23/2017] [Indexed: 12/28/2022] Open
Abstract
BACKGROUND Turner syndrome (TS) is associated with an increased risk of cardiovascular disease. Non-high-density lipoprotein cholesterol (non-HDL-C) is a convenient measure of atherogenicity (normal concentration <120 mg/dL) but has not been investigated in TS. We aim to evaluate non-HDL-C patterns in a cohort of pediatric and young adult females with TS. METHODS A retrospective chart review was used to obtain demographics, body composition, genetic reports, and lipid profiles in females with TS. RESULTS Lipid profiles were assessed in 158 females (mean age 13.6 years). Mean non-HDL-C was 118.9 mg/dL (±32.0); the prevalence of high non-HDL-C (≥144 mg/dL) was 17.7% (n = 28). In TS females aged 8-17 years (n = 46), the prevalence of high non-HDL-C was 23.9% (95% CI 11.1-36.7; n = 11) between 2011 and 2012, compared to 9.2% (95% CI 5.6-14.1) in females of the same age in the general population reported in the National Health and Nutrition Examination Survey (NHANES) dataset (p < 0.005). Body mass index (BMI) accounted for only 6% of variance in non-HDL-C values (β coefficient = 1.31, p < 0.05). CONCLUSIONS Children and adolescents aged 8-17 years with TS appear to have a greater prevalence of adverse non-HDL-C levels compared to the general adolescent population. The prevalence of high non-HDL-C was not fully explained by BMI.
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Affiliation(s)
- Jennifer C Kelley
- Department of Pediatrics, Monroe Carell Jr. Children's Hospital at Vanderbilt, Nashville, Tennessee, USA
| | - Iris Gutmark-Little
- Department of Pediatrics, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA
| | - Philippe Backeljauw
- Department of Pediatrics, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA
| | - Vaneeta Bamba
- Division of Endocrinology, Department of Pediatrics, Children's Hospital of Philadelphia, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania, USA
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Morales-Demori R. Congenital heart disease and cardiac procedural outcomes in patients with trisomy 21 and Turner syndrome. CONGENIT HEART DIS 2017; 12:820-827. [DOI: 10.1111/chd.12521] [Citation(s) in RCA: 30] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/20/2017] [Accepted: 07/09/2017] [Indexed: 01/15/2023]
Affiliation(s)
- Raysa Morales-Demori
- Department of Pediatrics, Division of Pediatric Cardiology; Baylor College of Medicine, Texas Children's Hospital; Houston Texas, USA
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DNA Genotyping of Suspected Partial Hydatidiform Moles Detects Clinically Significant Aneuploidy. Int J Gynecol Pathol 2017; 36:217-221. [DOI: 10.1097/pgp.0000000000000322] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Sarangi SN, Acharya SS. Bleeding Disorders in Congenital Syndromes. Pediatrics 2017; 139:peds.2015-4360. [PMID: 28062601 DOI: 10.1542/peds.2015-4360] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 08/15/2016] [Indexed: 11/24/2022] Open
Abstract
Pediatricians provide a medical home for children with congenital syndromes who often need complex multidisciplinary care. There are some syndromes associated with thrombocytopenia, inherited platelet disorders, factor deficiencies, connective tissue disorders, and vascular abnormalities, which pose a real risk of bleeding in affected children associated with trauma or surgeries. The risk of bleeding is not often an obvious feature of the syndrome and not well documented in the literature. This makes it especially hard for pediatricians who may care for a handful of children with these rare congenital syndromes in their lifetime. This review provides an overview of the etiology of bleeding in the different congenital syndromes along with a concise review of the hematologic and nonhematologic clinical manifestations. It also highlights the need and timing of diagnostic evaluation to uncover the bleeding risk in these syndromes emphasizing a primary care approach.
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Affiliation(s)
- Susmita N Sarangi
- Bleeding Disorders and Thrombosis Program, Cohen Children's Medical Center of New York, New Hyde Park, New York
| | - Suchitra S Acharya
- Bleeding Disorders and Thrombosis Program, Cohen Children's Medical Center of New York, New Hyde Park, New York
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Akute Vorstellungsanlässe. PRAXISHANDBUCH DER PÄDIATRISCHEN GRUNDVERSORGUNG 2017. [PMCID: PMC7158195 DOI: 10.1016/b978-3-437-21281-9.00006-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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Abstract
Pediatric patients with chronic illnesses or diseases or who require long-term nutrition support are most vulnerable to nutrition-related issues. Malnutrition in a pediatric patient may negatively affect long-term growth and development. Children also become malnourished much more quickly than adults. A comprehensive nutrition assessment that includes food and nutrition-related history, anthropometric measurements, biochemical data, medical tests and procedures, nutrition-focused physical findings, and patient history should be completed on these patients as no one parameter is a comprehensive indicator of nutrition status. Anthropometric measurements provide important information on the growth and nutrition status of a child, yet many times it is difficult to get accurate and valid measurements due to physical limitations of the child or improper technique. Inaccurate measurements may result in a missed diagnosis of malnutrition or may lead to an incorrect diagnosis of a healthy child. Knowledge of appropriate anthropometric measurements and alternatives is crucial when assessing growth in all children and essential for those who are physically handicapped or critically ill. The purpose of this review is to present key components of a pediatric nutrition assessment so proper nutrition-related diagnosis, including malnutrition, can be accomplished, a nutrition care plan established, and expected outcomes documented.
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Affiliation(s)
- Kelly Green Corkins
- Nutrition Therapy Department, LeBonheur Children's Hospital, Memphis, Tennessee, USA
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Abstract
Turner syndrome, a genetic disorder that affects only females, can cause various physical, emotional, and educational disabilities. This disorder may go undiagnosed until school age or later. Short stature and lack of spontaneous puberty are common characteristics and can lead to teasing by peers. Some experience attention deficit and the inability to notice social cues that can be misinterpreted as behavioral issues. Others have visual-spatial deficits that can lead to math learning disabilities and difficulty driving. Because the child with Turner syndrome often has a higher verbal than nonverbal intelligence, learning disabilities may be difficult to identify and often are overlooked. The school nurse, through mandated screenings and routine student office visits, may be the first to recognize Turner syndrome. School nurses need to be aware of this disorder and related educational disabilities to provide early intervention to maximize student health and educational success.
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Affiliation(s)
- Darlene A Ardary
- Clearfield County Career and Technology Center, Clearfield, PA, USA
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Identification of Y-Chromosome Sequences in Turner Syndrome. Indian J Pediatr 2016; 83:405-9. [PMID: 26634260 DOI: 10.1007/s12098-015-1929-6] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/08/2015] [Accepted: 10/15/2015] [Indexed: 10/22/2022]
Abstract
OBJECTIVES To investigate the presence of Y-chromosome sequences and determine their frequency in patients with Turner syndrome. METHODS The study included 23 patients with Turner syndrome from Brazil, who gave written informed consent for participating in the study. Cytogenetic analyses were performed in peripheral blood lymphocytes, with 100 metaphases per patient. Genomic DNA was also extracted from peripheral blood lymphocytes, and gene sequences DYZ1, DYZ3, ZFY and SRY were amplified by Polymerase Chain Reaction. RESULTS The cytogenetic analysis showed a 45,X karyotype in 9 patients (39.2 %) and a mosaic pattern in 14 (60.8 %). In 8.7 % (2 out of 23) of the patients, Y-chromosome sequences were found. This prevalence is very similar to those reported previously. The initial karyotype analysis of these patients did not reveal Y-chromosome material, but they were found positive for Y-specific sequences in the lymphocyte DNA analysis. CONCLUSION The PCR technique showed that 2 (8.7 %) of the patients with Turner syndrome had Y-chromosome sequences, both presenting marker chromosomes on cytogenetic analysis.
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Tremblay I, Van Vliet G, Gonthier M, Janvier A. Partnering with parents to disclose Klinefelter syndrome to their child. Acta Paediatr 2016; 105:456-61. [PMID: 26683842 DOI: 10.1111/apa.13301] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/22/2015] [Revised: 12/03/2015] [Accepted: 12/07/2015] [Indexed: 11/29/2022]
Abstract
UNLABELLED In paediatrics, a diagnosis of Klinefelter syndrome can occur after prenatal testing or because of symptoms such as learning difficulties or incomplete puberty. After the diagnosis, parents have to decide when and how to speak about this condition to their child. Parents and healthcare professionals (HCPs) may have different perceptions related to disclosure of this diagnosis. Due to the absence of clear guidelines, parents and HCPs may feel uncomfortable discussing the condition and may hide the truth in a prolonged fashion. CONCLUSION For patients with a prenatal diagnosis, we recommend a gradual and personalised disclosure process starting between the ages of 5 and 13 years. For older patients, a personalised approach should also be the goal. Various communication strategies and recommendations regarding disclosure of Klinefelter syndrome are proposed.
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Affiliation(s)
- Isabelle Tremblay
- Department of Psychology; Sainte-Justine Hospital; Quebec Canada
- Research Center; Sainte-Justine Hospital; Quebec Canada
| | - Guy Van Vliet
- Research Center; Sainte-Justine Hospital; Quebec Canada
- Endocrinology Service; Sainte-Justine Hospital; Quebec Canada
| | - Monique Gonthier
- Research Center; Sainte-Justine Hospital; Quebec Canada
- Department of Pediatrics; University of Montreal; Quebec Canada
| | - Annie Janvier
- Research Center; Sainte-Justine Hospital; Quebec Canada
- Department of Pediatrics; University of Montreal; Quebec Canada
- Bureau de l’Éthique Clinique; University of Montreal; Quebec Canada
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Periquito I, Carrusca C, Morgado J, Robalo B, Pereira C, de Lurdes Sampaio M. Familial Turner syndrome: the importance of information. J Pediatr Endocrinol Metab 2016; 29:617-20. [PMID: 26824976 DOI: 10.1515/jpem-2015-0277] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/15/2015] [Accepted: 12/14/2015] [Indexed: 11/15/2022]
Abstract
Turner syndrome is a common genetic disorder with an incidence of 1 in 2500 live births. Spontaneous fertility is rare in such patients and is most likely in women with mosaicism or very distal Xp deletions. The authors report an unusual case of familial Turner syndrome in a woman with mosaicism 45,X/46,Xdel(Xp) karyotype with three documented spontaneous pregnancies, which resulted in two daughters with 46,Xdel(X)(p11.4)mat karyotype and a healthy son. The mother was first diagnosed by the age of 11 and did not receive contraceptive medication, due to information that she would be infertile. Both daughters were referred to an endocrinology unit and are now under growth hormone treatment, and have been growing in the 3rd percentile. This family illustrates the complexity and difficulties in counseling, follow-up and treatment in Turner syndrome, namely referring to a tertiary center, fertility and treatment such as growth hormone and hormonal replacement, due to the heterogeneity of the clinical spectrum.
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Stakeholder Buy-In and Physician Education Improve Adherence to Guidelines for Down Syndrome. J Pediatr 2016; 171:262-8.e1-2. [PMID: 26831529 DOI: 10.1016/j.jpeds.2015.12.026] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/11/2015] [Revised: 10/13/2015] [Accepted: 12/04/2015] [Indexed: 01/08/2023]
Abstract
OBJECTIVES To assess adherence to the 2011 American Academy of Pediatrics (AAP) health supervision guidelines for Down syndrome, to determine whether pediatrician education improves adherence, and to evaluate stakeholder attitudes toward these guidelines. STUDY DESIGN Twenty-two pediatric care sites participated in chart review of adherence to the components of the AAP guidelines for Down syndrome in this longitudinal cohort study. We analyzed universal recommendations which apply to all children with Down syndrome. Thirteen pediatric practices caring for 82 patients with Down syndrome received educational information. Frequency calculations with Bonferroni adjustment of the P value threshold (P = .05/9 = .0056) were performed. Adherence rates were compared between cohorts and within the individual before and after intervention using 2 × 2 contingency tables and goodness-of-fit tests. Pediatricians and parents of children with Down syndrome completed an anonymous survey regarding their attitudes toward the guidelines. RESULTS Statistically significant increases in adherence were seen in 5 of the 8 universal recommendations following pediatrician education (P ≤ .002), including cardiology and genetics visits, rates of echocardiography, annual audiology testing, and sleep studies by age 4 years. Both physicians and parents reported generally positive views of the guidelines, yet baseline adherence rates were suboptimal. Pediatrician education preferences include directly integrating the guidelines into an electronic medical record system. CONCLUSION Stakeholder attitudes reflect a willingness to follow the AAP guidelines for Down syndrome. Providing rapid access to simple, clear reminders of recommended assessments successfully improved adherence to the AAP guidelines for Down syndrome.
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Rinke ML, Driscoll A, Mikat-Stevens N, Healy J, Colantuoni E, Elias AF, Pletcher BA, Gubernick RS, Larson I, Chung WK, Tarini BA. A Quality Improvement Collaborative to Improve Pediatric Primary Care Genetic Services. Pediatrics 2016; 137:e20143874. [PMID: 26823539 DOI: 10.1542/peds.2014-3874] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 08/17/2015] [Indexed: 11/24/2022] Open
Abstract
OBJECTIVE To investigate if a national pediatric primary care quality improvement collaborative (QIC) could improve and sustain adherence with process measures related to diagnosis and management of children with genetic disorders. METHODS Thirteen practices in 11 states from the American Academy of Pediatrics' Quality Improvement Innovation Networks participated in a 6-month QIC that included regular educational opportunities, access to genetic professionals, and performance feedback. The QIC identified 11 aims related to improving diagnosis and management of children with genetic disorders. The practices evaluated adherence by reviewing patient records at baseline, monthly for 6 months (active improvement period), and then once 6 months after the QIC's conclusion to check for sustainability. Random intercept binomial regression models with practice level random intercepts were used to compare adherence over time for each aim. RESULTS During the active improvement period, statistically significant improvements in adherence were observed for 4 of the 7 aims achieving minimal data submission levels. For example, adherence improved for family histories created/maintained at health supervision visits documenting all components of the family history (6% vs 60%, P < .001), and for patients with specific genetic disorders who received recommended care (58% vs 85%, P < .001). All 4 of these aims also demonstrated statistically significant improvements during the sustainability period. CONCLUSIONS A national QIC reveals promise in improving and sustaining adherence with process measures related to the diagnosis and management of genetic disorders. Future research should focus on patient outcome measures and the optimal number of aims to pursue in QICs.
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Affiliation(s)
- Michael L Rinke
- Department of Pediatrics, Children's Hospital at Montefiore, Bronx, New York;
| | - Amy Driscoll
- Peakview Pediatrics, University of Colorado Health, Greely, Colorado
| | | | - Jill Healy
- American Academy of Pediatrics, Elk Grove Village, Illinois
| | - Elizabeth Colantuoni
- Department of Biostatistics, Johns Hopkins University Bloomberg School of Public Health, Baltimore, Maryland
| | - Abdallah F Elias
- Department of Medical Genetics, Shodair Children's Hospital, Helena, Montana
| | | | | | - Ingrid Larson
- Department of General Academic Pediatrics, Children's Mercy Hospital, Kansas City, Missouri
| | - Wendy K Chung
- Department of Pediatrics, New York Presbyterian Hospital, Columbia University, New York, New York; and
| | - Beth A Tarini
- Department of Pediatrics and Communicable Diseases, University of Michigan, Ann Arbor, Michigan
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Abstract
CHD is frequently associated with a genetic syndrome. These syndromes often present specific cardiovascular and non-cardiovascular co-morbidities that confer significant peri-operative risks affecting multiple organ systems. Although surgical outcomes have improved over time, these co-morbidities continue to contribute substantially to poor peri-operative mortality and morbidity outcomes. Peri-operative morbidity may have long-standing ramifications on neurodevelopment and overall health. Recognising the cardiovascular and non-cardiovascular risks associated with specific syndromic diagnoses will facilitate expectant management, early detection of clinical problems, and improved outcomes--for example, the development of syndrome-based protocols for peri-operative evaluation and prophylactic actions may improve outcomes for the more frequently encountered syndromes such as 22q11 deletion syndrome.
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Bispo AVS, Burégio-Frota P, Oliveira dos Santos L, Leal GF, Duarte AR, Araújo J, Cavalcante da Silva V, Muniz MTC, Liehr T, Santos N. Y chromosome in Turner syndrome: detection of hidden mosaicism and the report of a rare X;Y translocation case. Reprod Fertil Dev 2015; 26:1176-82. [PMID: 25294360 DOI: 10.1071/rd13207] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2013] [Accepted: 09/13/2013] [Indexed: 12/15/2022] Open
Abstract
Turner syndrome (TS) is a common genetic disorder in females associated with the absence of complete or parts of a second sex chromosome. In 5-12% of patients, mosaicism for a cell line with a normal or structurally abnormal Y chromosome is identified. The presence of Y-chromosome material is of medical importance because it results in an increased risk of developing gonadal tumours and virilisation. Molecular study and fluorescence in situ hybridisation approaches were used to study 74 Brazilian TS patients in order to determine the frequency of hidden Y-chromosome mosaicism, and to infer the potential risk of developing malignancies. Additionally, we describe one TS girl with a very uncommon karyotype 46,X,der(X)t(X;Y)(p22.3?2;q11.23) comprising a partial monosomy of Xp22.3?2 together with a partial monosomy of Yq11.23. The presence of cryptic Y-chromosome-specific sequences was detected in 2.7% of the cases. All patients with Y-chromosome-positive sequences showed normal female genitalia with no signs of virilisation. Indeed, the clinical data from Y-chromosome-positive patients was very similar to those with Y-negative results. Therefore, we recommend that the search for hidden Y-chromosome mosaicism should be carried out in all TS cases and not be limited to virilised patients or carriers of a specific karyotype.
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Affiliation(s)
- Adriana Valéria Sales Bispo
- Departamento de Genética, Universidade Federal de Pernambuco. Av. da Engenharia, s/n, Cidade Universitária, 50740-600, Recife, PE, Brasil
| | - Pollyanna Burégio-Frota
- Laboratório de Pesquisa Translacional Prof. C. Anthony Hart, Instituto de Medicina Integral Prof. Fernando Figueira (IMIP), Rua dos Coelhos 300, Boa Vista, 50070-050, Recife, PE, Brasil
| | - Luana Oliveira dos Santos
- Departamento de Genética, Universidade Federal de Pernambuco. Av. da Engenharia, s/n, Cidade Universitária, 50740-600, Recife, PE, Brasil
| | - Gabriela Ferraz Leal
- Unidade de Genética Pediátrica, Instituto de Medicina Integral Prof. Fernando Figueira (IMIP), Rua dos Coelhos 300 Boa Vista. 50070-050, Recife, PE, Brasil
| | - Andrea Rezende Duarte
- Unidade de Genética Pediátrica, Instituto de Medicina Integral Prof. Fernando Figueira (IMIP), Rua dos Coelhos 300 Boa Vista. 50070-050, Recife, PE, Brasil
| | - Jacqueline Araújo
- Unidade de Endocrinologia Pediátrica, Hospital das Clínicas HC/UFPE, Av. da Engenharia, s/n, Cidade Universitária, 50740-600, Recife, PE, Brasil
| | - Vanessa Cavalcante da Silva
- Laboratório de Erros Inatos do Metabolismo-EIM, Universidade Federal de São Paulo-UNIFESP, Rua Sena Madureira 1500, Vila Mariana, 04021-001, São Paulo, SP, Brasil
| | | | - Thomas Liehr
- Jena University Hospital, Friedrich Schiller University, Institute of Human Genetics, Kollegiengasse 10, D-07743 Jena, Germany
| | - Neide Santos
- Departamento de Genética, Universidade Federal de Pernambuco. Av. da Engenharia, s/n, Cidade Universitária, 50740-600, Recife, PE, Brasil
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Rogol AD, Hayden GF. Etiologies and early diagnosis of short stature and growth failure in children and adolescents. J Pediatr 2014; 164:S1-14.e6. [PMID: 24731744 DOI: 10.1016/j.jpeds.2014.02.027] [Citation(s) in RCA: 90] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
Accurate measurement of height and weight using standardized techniques is a fundamental component of pediatric medical visits. Calculation of height velocity over time enables comparison with standardized growth charts to identify potential deviations from normal. Growth deviations may be expressed as SD from the normal population mean for children of comparable age and sex; children with heights >2 SD below the mean are generally classified as short stature. In a child with suspected impaired growth, a detailed evaluation should be conducted to identify the cause. Such an evaluation may include a combination of personal, family, and social history; physical examination; general and perhaps specialized laboratory evaluations; radiologic examinations; genetic testing; and consultation with a pediatric subspecialist, such as a pediatric endocrinologist. Variants of normal growth include familial short stature, constitutional delay of growth and puberty, and small for gestational age with catch-up growth. Pathological causes of abnormal growth include many systemic diseases and their treatments, growth hormone deficiency, and a series of genetic syndromes, including Noonan syndrome and Turner syndrome. Children with short stature in whom no specific cause is identified may be diagnosed with idiopathic short stature. Early identification of abnormal growth patterns and prompt referral to specialist care offer children with growth failure and/or short stature the greatest chance for appropriate diagnosis, treatment, and improved clinical outcomes.
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Affiliation(s)
- Alan D Rogol
- Division of Pediatric Diabetes and Endocrinology, University of Virginia Medical School, Charlottesville, VA.
| | - Gregory F Hayden
- Division of General Pediatrics, University of Virginia Medical School, Charlottesville, VA
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Alves C, Oliveira CS. Hearing loss among patients with Turner's syndrome: literature review1. Braz J Otorhinolaryngol 2014; 80:257-63. [PMID: 25153112 PMCID: PMC9535484 DOI: 10.1016/j.bjorl.2013.08.002] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2012] [Accepted: 08/23/2013] [Indexed: 11/26/2022] Open
Abstract
Introduction Turner's syndrome (TS) is caused by a partial or total deletion of an X chromosome, occurring in 1:2,000 to 1:5,000 live born females. Hearing loss is one of its major clinical manifestations. However, there are few studies investigating this problem. Objectives To review the current knowledge regarding the epidemiology, etiology, clinical manifestations and diagnosis of hearing impairment in patients with TS. Methods A bibliographic search was performed in the Medline and Lilacs databanks (1980-2012) to identify the main papers associating Turner's syndrome, hearing impairment and its clinical outcomes. Conclusions Recurrent otitis media, dysfunction of the Eustachian tube, conductive hearing loss during infancy and sensorineural hearing loss in adolescence are the audiologic disorders more common in ST. The karyotype appears to be important in the hearing loss, with studies demonstrating an increased prevalence in patients with monosomy 45,X or isochromosome 46,i(Xq). Morphologic studies of the cochlea are necessary to help out in the clarifying the etiology of the sensorineural hearing loss.
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Lopez-Rangel E, Mickelson ECR, Suzanne Lewis ME. The Value of a Genetic Diagnosis for Individuals with Intellectual Disabilities: Optimising Healthcare and Function Across the Lifespan. ACTA ACUST UNITED AC 2013. [DOI: 10.1179/096979508799103215] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022]
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Kota SK, Gayatri K, Pani JP, Kota SK, Meher LK, Modi KD. Dysgerminoma in a female with turner syndrome and Y chromosome material: A case-based review of literature. Indian J Endocrinol Metab 2012; 16:436-440. [PMID: 22629515 PMCID: PMC3354856 DOI: 10.4103/2230-8210.95706] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/17/2023] Open
Abstract
We report a 17-year-old girl evaluated for primary amenorrhea. Cytogenetic analysis of the peripheral blood lymphocytes revealed normal autosomes with 46X inv (Y) confirming the diagnosis of Turner's syndrome with Y cell line. Treatment was initiated with conjugated estrogen while recommending bilateral prophylactic oophorectomy to the patient. One year later the patient presented with abdominal mass, biopsy of the specimen following resection confirmed dysgerminoma originating from right ovary with no invasion or metastasis. The literature is reviewed with regard to the various pathogenetic mechanisms proposed for the development of germ cell tumors in ovary, the cytogenetic findings and recommendations to handle such scenario.
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Affiliation(s)
- Sunil Kumar Kota
- Department of Endocrinology, Medwin Hospital, Hyderabad, Andhra Pradesh, India
| | - Kotni Gayatri
- Department of Obstetrics and Gynecology, Riyadh Care Hospital, Saudi Arabia
| | - Jaya Prakash Pani
- Department of Obstetrics and Gynecology, Apollo Hospitals, Bhubaneswar, Orissa, India
| | - Siva Krishna Kota
- Department of Anesthesia, Central Security hospital, Riyadh, Saudi Arabia
| | - Lalit Kumar Meher
- Department of Medicine, MKCG Medical College, Berhampur, Orissa, India
| | - Kirtikumar D. Modi
- Department of Endocrinology, Medwin Hospital, Hyderabad, Andhra Pradesh, India
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Abstract
Puberty is a complex process of developmental change regulated by multiple genetic and endocrine controls. Abnormal pubertal development (both precocious and delayed puberty) can cause significant distress to the patient and may in some instances be a sign of life-threatening pathology. Delayed puberty is often due to constitutional delay of growth and puberty, but will also occur in cases of primary gonadal failure and in patients with disorders leading to diminished gonadotropin levels (ie, central nervous system [CNS] tumors). Precocious puberty may occur due to CNS disorders, certain genetic disorders, ectopic gonadotropin secretion or autonomous sex steroid secretion. Treatment is directed toward the underlying pathology, and may include agents to either stimulate or block pubertal development. Health care providers require knowledge of the normal onset of timing and rate of progression of puberty, and must be able to identify patients with abnormal pubertal development, as well as initiate the appropriate laboratory workup.
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Affiliation(s)
- Lindsey A Loomba-Albrecht
- Department of Pediatrics, Sectionof Endocrinology, University of Califor nia Davis Medical Center, Sacramento, CA, USA.
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Maureira JP, Vanhuyse F, Lekehal M, Hubert T, Vigouroux C, Mattei MF, Grandmougin D, Villemot JP. Failure of Marfan anatomic criteria to predict risk of aortic dissection in Turner syndrome: necessity of specific adjusted risk thresholds. Interact Cardiovasc Thorac Surg 2012; 14:610-4. [PMID: 22286600 DOI: 10.1093/icvts/ivr172] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023] Open
Abstract
Patients with Turner syndrome are prompt to develop spontaneous acute aortic dissection following insidious aortic dilatation, with abnormal cardiovascular anatomy and consequently require specific guidelines for regular surveillance since they represent a subset of high-risk young patients. We report a rare and uncommon case of spontaneous acute aortic dissection in a 48-year old female patient with Turner syndrome who was not apparently eligible for a prophylactic surgery. A CT scan showed a Stanford type A aortic dissection and was urgently referred for surgical management. We operated on the patient under deep hypothermia (18°C) and circulatory arrest with a retrograde cerebroplegia as the primary entry tear was located in the arch. The postoperative course was uneventful and the patient was discharged at the eighth postoperative day. Following description of this case, special attention was paid to determine predisposing risk factors for aortic dissection to be specifically adjusted to TS patients.
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Affiliation(s)
- Juan-Pablo Maureira
- Department of Cardiovascular Surgery and Heart Transplantations, ILCV CHU-Nancy, Vandoeuvre-lès-Nancy, France
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Williams CH, Frush DP. Compendium of national guidelines for imaging of the pediatric patient. Pediatr Radiol 2012; 42:82-94. [PMID: 21826467 DOI: 10.1007/s00247-011-2211-3] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/13/2011] [Accepted: 06/21/2011] [Indexed: 12/24/2022]
Abstract
BACKGROUND Diagnostic imaging plays an integral role in diagnosing and managing many pediatric disorders, but there is growing concern in both the medical community and the general public about the long-term health effects of ionizing radiation in children, as well as utilization of imaging evaluation. These concerns, coupled with increasing pressure to reduce national health care spending, underscore the need for an assessment of readily available guidelines, especially evidence-based guidelines, for imaging in children. OBJECTIVE To generate a list of national medical organization-endorsed guidelines with provisions for imaging the pediatric patient. MATERIALS AND METHODS Several resources, including the National Guideline Clearinghouse (NGC) and the Web sites of major medical organizations, were searched for documents that contained specific recommendations for imaging in the pediatric population. RESULTS A total of 155 guidelines from 40 medical organizations met inclusion criteria and are represented in our compendium. CONCLUSIONS The compendium generated in this study can be used to direct clinical care, inform policy development and improve education of health care personnel. Additionally, the compendium can be used to identify areas of redundancy or deficiency, which may stimulate the reassessment of existing recommendations as well as the creation of new guidelines.
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Fonteles AVR, Dondoni RS, Boguszewski MCDS, Nesi-França S, Marques-Pereira R, Sandrini Neto R, Lacerda Filho LD. [Final height (FH) in Turner syndrome (TS): experience of 76 cases followed at the Pediatric Endocrinology Unit, Hospital de Clinicas, Federal University of Paraná]. ACTA ACUST UNITED AC 2011; 55:318-25. [PMID: 21881814 DOI: 10.1590/s0004-27302011000500004] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2010] [Accepted: 04/06/2011] [Indexed: 11/22/2022]
Abstract
OBJECTIVE To report the final height (FH) of 76 patients with Turner syndrome (TS). MATERIALS AND METHODS Review of the files and calculation of z scores: of target height (TH), and FH according to NCHS/CDC/2000 and FH according to Lyon and cols. RESULTS Patients were classified in three groups: A (n = 16), treatment with estrogens and progestogens; B (n = 21), treatment with oxandrolone (OX); C (n = 39), growth hormone (GH) plus OX. The z score of TH was not different among the groups and z score of FH was not different between A e B. Z score of FH of group C was greater than the other groups, > 2SDS of Lyon's curve and fitted on the 3(rd) percentile of NCHS/CDC. Multiple regression analysis showed type of treatment (p < 0.001) and maternal height (p = 0.02) as most influencing factors on FH. CONCLUSION GH plus OX and maternal height contributed significantly to enhance FH of TS patients.
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Affiliation(s)
- Ana Vládia Ramos Fonteles
- Departamento de Pediatria, Hospital de Clínicas, Universidade Federal do Paraná, Curitiba, PR, Brasil.
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Dundar M, Uzak AS, Erdogan M, Akbarova Y. Prediction, prevention and personalisation of medication for the prenatal period: genetic prenatal tests for both rare and common diseases. EPMA J 2011. [PMID: 23199148 PMCID: PMC3405382 DOI: 10.1007/s13167-011-0080-3] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
Genetic testing usually helps physicians to determine possible genetic diseases in unborn babies, genetic disorders of patients and the carriers who might pass the mutant gene on to their children. They are performed on blood, tissues or other body fluids. In recent years, the screening tests and diagnostic tests have improved quickly and, as a result, the risks of pregnancy can be determined more commonly and physicians can diagnose several genetic disorders in the prenatal period. Detecting the abnormalities in utero enables correct management of the pregnancy, prenatal and postnatal medical care, and it is also important for making well informed decisions about continuing or terminating a pregnancy. Besides the improvements of conventional invasive diagnostic tests, the discovery of circulating cell-free foetal nucleic acids in maternal plasma has developed a new point of view for non-invasive prenatal diagnosis recently.
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Iyer NP, Tucker DF, Roberts SH, Moselhi M, Morgan M, Matthes JW. Outcome of fetuses with Turner syndrome: a 10-year congenital anomaly register based study. J Matern Fetal Neonatal Med 2011; 25:68-73. [DOI: 10.3109/14767058.2011.564688] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2023]
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Rivkees SA, Hager K, Hosono S, Wise A, Li P, Rinder HM, Gruen JR. A highly sensitive, high-throughput assay for the detection of Turner syndrome. J Clin Endocrinol Metab 2011; 96:699-705. [PMID: 21177792 PMCID: PMC3047225 DOI: 10.1210/jc.2010-1554] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
OBJECTIVE Turner syndrome (TS) occurs when an X-chromosome is completely or partially deleted or when X-chromosomal mosaicism is present. Girls with TS benefit from early diagnosis and treatment with GH; however, many girls with TS are not detected until after 10 yr of age, resulting in delayed evaluation and treatment. METHODS We developed a high-throughput test for TS, based on a quantitative method of genotyping to detect X-chromosome abnormalities. This test uses pyrosequencing to quantitate relative allele strength (RAS) from single-nucleotide polymorphisms using 18 informative single-nucleotide polymorphisms markers that span the X-chromosome and one marker for the detection of Y-chromosome material. RESULTS Cutoff ranges for heterozygous, homozygous, or out-of-range RAS values were established from a cohort of 496 males and females. Positive TS scoring criteria were defined as the presence of homozygosity for all 18 markers or the presence of at least one out-of-range RAS value. To determine the validity of this rapid test for TS detection, we undertook a large-scale study using DNA from 132 females without TS and 74 females with TS for whom karyotypes were available. TS was identified with 96.0% sensitivity and 97.0% specificity in this cohort. We also tested buccal swab DNA from a group of 19 females without TS and 69 females with TS. In this group, TS was identified with 97.1% sensitivity and 84.2% specificity. CONCLUSIONS These results demonstrate the validity of a high-throughput, pyrosequencing based test for the accurate detection of TS, providing a potential alternative to karyotype testing.
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Affiliation(s)
- Scott A Rivkees
- Yale Child Health Research Center, Yale University School of Medicine, 464 Congress Avenue, New Haven, Connecticut 06520, USA.
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Affiliation(s)
- Bradley S Miller
- Division of Endocrinology, Department of Pediatrics, University of Minnesota Amplatz Children's Hospital, MMC 8952D, East Building Room MB671, 2450 Riverside Avenue, Minneapolis, MN 55455, USA.
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Abstract
Turner syndrome is a genetic disorder characterized by an abnormal or missing X-chromosome. Rarely reported cutaneous manifestations in Turner syndrome include hemangiomas, angiokeratomas, hirsutism, and halo nevi. A recent study demonstrated an increased prevalence of halo nevi in Turner syndrome when compared to vitiligo. We present a case of halo nevi with multiple melanocytic nevi in an 11-year-old patient with Turner syndrome on growth hormone.
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Affiliation(s)
- Cristina E Bello-Quintero
- Jackson Memorial Hospital, Department of Dermatology, University of Miami, Miami, Florida 33136, USA.
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Neugeborener Junge mit Ullrich-Turner-Syndrom? Monatsschr Kinderheilkd 2010. [DOI: 10.1007/s00112-009-2153-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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Makishima T, King K, Brewer CC, Zalewski CK, Butman J, Bakalov VK, Bondy C, Griffith AJ. Otolaryngologic markers for the early diagnosis of Turner syndrome. Int J Pediatr Otorhinolaryngol 2009; 73:1564-7. [PMID: 19732968 PMCID: PMC2757481 DOI: 10.1016/j.ijporl.2009.08.005] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/11/2009] [Revised: 08/06/2009] [Accepted: 08/07/2009] [Indexed: 12/30/2022]
Abstract
OBJECTIVE To identify and characterize otolaryngologic markers for the early diagnosis of Turner syndrome (TS). STUDY DESIGN Prospective cohort survey. SETTING Clinical Center of the National Institutes of Health (NIH). PATIENTS Ninety-one females, 7-61 years old (average=28.7 y), enrolled in a multidisciplinary study of karyotype-phenotype correlations in TS. MAIN OUTCOME MEASURES Age at diagnosis, X chromosome karyotype, history of chronic or recurrent otitis media (OM), sensorineural hearing loss (SNHL), palate dysmorphism, pinna deformity, pterygium colli, low posterior hairline, low-set ears, and micrognathia. RESULTS Sixty-nine (76%) patients had a history of chronic or recurrent OM, 62 (68%) had a dysmorphic palate, 57 (63%) had SNHL, and 90 (99%) had one or more of these findings. 83 (91%; average age at diagnosis=9.4 y) had one or more external craniofacial signs: pinna abnormalities, pterygium colli, low-set ears, micrognathia or a low posterior hairline. Eight patients (average age at diagnosis=13.2 y) had no external craniofacial signs, although seven (88%) of these eight patients had a history of chronic or recurrent OM, dysmorphic palate or SNHL. The age at diagnosis was not significantly different between groups with or without external craniofacial signs (P=0.126). CONCLUSIONS PATIENTS with mild or incompletely penetrant TS phenotypes often present with otitis media, hearing loss, or both before the diagnosis of TS is established. Palatal dysmorphism, including ogival morphology, is another otolaryngologic marker for TS. Prompt recognition of these manifestations of TS could hasten its diagnosis and appropriate medical care.
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Affiliation(s)
- Tomoko Makishima
- Otolaryngology Branch, National Institute on Deafness and Other Communication Disorders, National Institutes of Health, Bethesda, MD 20850-3320, USA
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Oliveira RMRD, Verreschi ITDN, Lipay MVN, Eça LP, Guedes AD, Bianco B. Y chromosome in Turner syndrome: review of the literature. SAO PAULO MED J 2009; 127:373-8. [PMID: 20512293 PMCID: PMC11149669 DOI: 10.1590/s1516-31802009000600010] [Citation(s) in RCA: 61] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/06/2009] [Accepted: 12/08/2009] [Indexed: 02/20/2023] Open
Abstract
Turner syndrome (TS) is one of the most common types of aneuploidy among humans, and is present in 1:2000 newborns with female phenotype. Cytogenetically, the syndrome is characterized by sex chromosome monosomy (45,X), which is present in 50-60% of the cases. The other cases present mosaicism, with a 45,X cell line accompanied by one or more other cell lines with a complete or structurally abnormal X or Y chromosome. The presence of Y-chromosome material in patients with dysgenetic gonads increases the risk of gonadal tumors, especially gonadoblastoma. The greatest concern is the high risk of developing gonadoblastoma or other tumors and virilization during puberty if chromosome Y-specific sequences are present. The role of the Y chromosome in human oncogenesis is still controversial. Even though gonadoblastoma is a benign tumor, it can undergo transformation into invasive dysgerminoma in 60% of the cases, and also into other, malignant forms of germ cell tumors. Although some authors have questioned the high incidence of gonadoblastoma (around 30%), the risk of developing any kind of gonadal lesion, whether tumoral or not, justifies investigation of Y-chromosome sequences by means of the polymerase chain reaction (PCR), a highly sensitive, low-cost and easy-to-perform technique. In conclusion, mosaicism of both the X and the Y chromosome is a common finding in TS, and detection of Y-chromosome-specific sequences in patients, regardless of their karyotype, is necessary in order to prevent the development of gonadal lesions.
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Qureshi MA, Mouzaki M, Le T. Diagnosis of small bowel telangiectasia in Turner's syndrome using capsule endoscopy. J Pediatr Endocrinol Metab 2009; 22:759-62. [PMID: 19845127 DOI: 10.1515/jpem.2009.22.8.759] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/15/2023]
Affiliation(s)
- Muhammad Azim Qureshi
- Department of Pediatrics, Division of Gastroenterology and Nutrition, Penn State Children's Hospital, Hershey, PA 17033, USA.
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Carlson M, Silberbach M. Dissection of the aorta in Turner syndrome: two cases and review of 85 cases in the literature. BMJ Case Rep 2009; 2009:bcr0620091998. [PMID: 21731587 PMCID: PMC3027835 DOI: 10.1136/bcr.06.2009.1998] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2023] Open
Abstract
Patients with Turner syndrome (TS) are at risk for aortic dissection, but the clinical profile for those at risk is not well described. In addition to reporting two new cases, we performed an electronic search to identify all reported cases of aortic dissection associated with TS. In total, 85 cases of aortic dissection in TS were reported between 1961 and 2006. Dissection occurred at a young age, 30.7 (range 4-64) years, which is significantly earlier than its occurrence in the general female population (68 years). Importantly, in 11% of the cases, neither hypertension nor congenital heart disease were identified, suggesting that TS alone is an independent risk factor for aortic dissection; however, the cases where no risk factors were identified were very poorly documented. A TS aortic dissection registry has been established to determine the natural history and risk factors better (http://www.turnersyndrome.org/).
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Affiliation(s)
- M Carlson
- Division of Pediatric Cardiology, Doernbecher Children's Hospital, Oregon Health & Science University, Oregon, USA
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Wiktor AE, Bender G, Van Dyke DL. Identification of sex chromosome mosaicism: is analysis of 20 metaphase cells sufficient? Am J Med Genet A 2009; 149A:257-9. [PMID: 19161142 DOI: 10.1002/ajmg.a.32625] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Affiliation(s)
- Anne E Wiktor
- Cytogenetics Laboratory, Mayo Clinic, Rochester, MN 55905, USA
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Isojima T, Yokoya S, Ito J, Horikawa R, Tanaka T. Inconsistent determination of overweight by two anthropometric indices in girls with Turner syndrome. Acta Paediatr 2009; 98:513-8. [PMID: 19021594 DOI: 10.1111/j.1651-2227.2008.01132.x] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Abstract
AIM To evaluate the prevalence of overweight in girls with Turner syndrome (TS) as classified by the two major anthropometric indices, body mass index (BMI) and weight-for-height (WFH) and to make growth reference charts of them for comparison with those of the normal population. METHOD The samples for analysis were obtained from a retrospective cohort. In total, 1447 girls' cross-sectional data were analysed. Subjects were divided into four groups by ages: group A (0-5.99 years), B (6-10.99 years), C (11-15.99 years) and D (16-20.99 years). The cut-off values of overweight by BMI and WFH were those of the 90th percentile and 120 percent, respectively and the prevalence was calculated. For constructing growth reference charts, the LMS method was used. RESULTS The prevalence of overweight differed between the two indices. The proportions of the coincidental classification in all subjects, group A, B, C and D were 82.53%, 89.96%, 91.79%, 69.98% and 60.61%, respectively. These differences corresponded to the difference of age-dependent patterns of the two indices from those of the normal population, as judged from the growth charts constructed with all subjects. CONCLUSION A discrepancy in the prevalence of overweight as classified by BMI and WFH for girls with TS was detected.
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Affiliation(s)
- Tsuyoshi Isojima
- Clinical Research Center, National Center for Child Health and Development, Ohkura, Setagaya-ku, Tokyo, Japan.
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Isojima T, Yokoya S, Ito J, Horikawa R, Tanaka T. Trends in age and anthropometric data at start of growth hormone treatment for girls with Turner syndrome in Japan. Endocr J 2008; 55:1065-70. [PMID: 18753703 DOI: 10.1507/endocrj.k08e-144] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
The purpose of this study is to evaluate the trends in age and anthropometric data for girls with Turner syndrome (TS) at start of growth hormone (GH) treatment in Japan. The data for analysis were obtained from a retrospective cohort, the Foundation for Growth Science, Japan. We analyzed trends in starting age of GH treatment for girls with TS in Japan after dividing subjects (n=1,478) into three registration periods: 1991-1994, 1995-1999 and 2000-2004. We also assessed the ratio of the subpopulation of subjects under five years of age. As results, the mean age (standard deviation (SD)) at start of GH treatment was significantly different among the three groups (10.95 (3.63), 10.15 (3.39) and 8.78 (3.61), p<0.0001). The proportion of the subjects under five years of age increased significantly over time (5.11%, 7.11% and 16.85%, p<0.0001). Mean (SD) height SD scores were also significantly different (-3.41 (0.87), -3.26 (0.81) and -3.17 (0.79), p<0.0001). However, the proportions of the karyotype of 45,X were not significantly different among the three groups (p=0.25). We concluded that age and shortness at initiation of GH treatment had been improving over time. However, these favorable trends have not fully met the conditions recommended by international clinical guidelines for TS.
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Affiliation(s)
- Tsuyoshi Isojima
- Clinical Research Center, National Center for Child Health and Development, Setagaya-ku, Tokyo, Japan
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Affiliation(s)
- Melissa L Loscalzo
- Department of Pediatrics, Division of Genetics, University of South Florida, St. Petersburg, Florida, USA
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Guedes AD, Bianco B, Callou EQ, Gomes AL, Lipay MVN, Verreschi ITN. O hormônio de crescimento na síndrome de Turner: dados e reflexões. ACTA ACUST UNITED AC 2008; 52:757-64. [DOI: 10.1590/s0004-27302008000500007] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2008] [Accepted: 06/10/2008] [Indexed: 01/15/2023]
Abstract
A baixa estatura é a principal característica na síndrome de Turner (ST). O agravo estatural na ST é precoce e torna-se mais evidente na puberdade. A haploinsuficiência do gene SHOX tem sido implicada como principal fator na definição da estatura de mulheres, no entanto, ainda que a maioria das pacientes não tenha deficiência do hormônio de crescimento, a terapia com GHr melhora a altura final. Recentemente, tem-se chamado a atenção para a associação entre GH e câncer. O risco de câncer nessas pacientes está associado à presença de fragmentos do cromossomo Y que pode levar ao desenvolvimento de gonadoblastoma. Dessa forma, a administração de GHr na ST deve ser feita com cautela. A investigação de seqüências do cromossomo Y deve ser realizada, bem como a gonadectomia profilática nos casos positivos, conferindo maior segurança ao tratamento.
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Cuturilo G, Skoric D, Grkovic SM, Bojic V, Rodic P, Stefanovic I. Aplastic anemia and Turner syndrome. ACTA ACUST UNITED AC 2008; 180:158-9. [PMID: 18206544 DOI: 10.1016/j.cancergencyto.2007.09.021] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2007] [Accepted: 09/26/2007] [Indexed: 11/19/2022]
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Carlson M, Silberbach M. Dissection of the aorta in Turner syndrome: two cases and review of 85 cases in the literature. J Med Genet 2007; 44:745-9. [PMID: 17873120 PMCID: PMC2652808 DOI: 10.1136/jmg.2007.052019] [Citation(s) in RCA: 143] [Impact Index Per Article: 8.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2007] [Revised: 08/14/2007] [Accepted: 08/16/2007] [Indexed: 12/23/2022]
Abstract
Girls and women with Turner syndrome are at risk for catastrophic aortic dissection and rupture, but the clinical profile for those at risk is not well described. In addition to reporting two new cases, we performed an electronic search to identify all reported cases of aortic dissection associated with Turner syndrome. Particular attention was paid to the reporting of systemic hypertension (HTN) and congenital heart disease (CHD) which are known risk factors for aortic disease in the general population. In total, 85 cases of aortic dissection in TS were reported between 1961 and 2006. Dissection occurred at a young age, 30.7 (range 4-64) years, which is significantly earlier than its occurrence in the general female population (68 years). Of the cases for which HTN and CHD were explicitly assessed, 15% had HTN alone, 30% had CHD alone and 34% had both. Importantly, in 11% of the cases, neither HTN nor CHD were identified, suggesting that TS alone is an independent risk factor for aortic dissection; however, the cases where no risk factors were identified were very poorly documented. Dissection in women with TS undergoing assisted reproductive techniques (ART) frequently resulted in death. The literature on aortic dissection in TS is sparse and most cases are poorly documented, making it difficult to establish firm guidelines regarding monitoring and treatment. A TS aortic dissection registry has been established to better determine the natural history and risk factors (http://www.tssus.org/readweb.asp?wid = 3092).
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Affiliation(s)
- M Carlson
- Division of Pediatric Cardiology, Doernbecher Children's Hospital, Oregon Health & Science University, Oregon 97239-3098, USA
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Coelho SCS, Ramos AD, Pinheiro VS, Solberg PFC, Faria JPD, Naliato ECO, Fernandes TJ, Guimarães MM. Nailfold video capillaroscopy in Turner syndrome: a descriptive study. J Vasc Bras 2007. [DOI: 10.1590/s1677-54492007000400005] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2023] Open
Abstract
BACKGROUND: An increased prevalence of impaired glucose homeostasis is reported in Turner syndrome. Endothelial changes are described in patients with insulin resistance, which may be present in patients with Turner syndrome. Video capillaroscopy is a noninvasive examination that allows assessment of vascular patency. OBJECTIVE: To describe the nailfold morphology of capillaries in Turner syndrome using video capillaroscopy. METHODS: Subjects were studied in a temperature-controlled room, 20 days after no nailfold manipulations. The capillaries were visualized by microscope connected to a television and computer and were studied and classified according to these patterns: loop distribution, papilla, avascular fields, edema, form, capillary limbs, flow and hemorrhagic extravasation. RESULTS: Fifty patients aged between 6-37 years with Turner syndrome were studied. Eighteen (36%) patients had normal capillaroscopy with hairpin pattern in loop distribution and no avascular fields. The papilla was ratified in 13 (26%) and enlarged in four (8%). Edema occurred in 22 (44%) cases. There were three (6%) macrocapillaries and three (6%) were branched. Tortuosity was present in five (10%) patients. Hemorrhagic extravasation occurred in one (2%) case. Flow was fast in seven (14%), granulous in five (10%) and slow in six (12%). CONCLUSION: There was a high prevalence of nailfold capillaroscopy changes in Turner syndrome and the most prevalent alterations found were edema and ratified papilla.
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