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Gravholt CH, Andersen NH, Christin-Maitre S, Davis SM, Duijnhouwer A, Gawlik A, Maciel-Guerra AT, Gutmark-Little I, Fleischer K, Hong D, Klein KO, Prakash SK, Shankar RK, Sandberg DE, Sas TCJ, Skakkebæk A, Stochholm K, van der Velden JA, Backeljauw PF. Clinical practice guidelines for the care of girls and women with Turner syndrome. Eur J Endocrinol 2024; 190:G53-G151. [PMID: 38748847 DOI: 10.1093/ejendo/lvae050] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/28/2024] [Accepted: 04/19/2024] [Indexed: 06/16/2024]
Abstract
Turner syndrome (TS) affects 50 per 100 000 females. TS affects multiple organs through all stages of life, necessitating multidisciplinary care. This guideline extends previous ones and includes important new advances, within diagnostics and genetics, estrogen treatment, fertility, co-morbidities, and neurocognition and neuropsychology. Exploratory meetings were held in 2021 in Europe and United States culminating with a consensus meeting in Aarhus, Denmark in June 2023. Prior to this, eight groups addressed important areas in TS care: (1) diagnosis and genetics, (2) growth, (3) puberty and estrogen treatment, (4) cardiovascular health, (5) transition, (6) fertility assessment, monitoring, and counselling, (7) health surveillance for comorbidities throughout the lifespan, and (8) neurocognition and its implications for mental health and well-being. Each group produced proposals for the present guidelines, which were meticulously discussed by the entire group. Four pertinent questions were submitted for formal GRADE (Grading of Recommendations, Assessment, Development and Evaluation) evaluation with systematic review of the literature. The guidelines project was initiated by the European Society for Endocrinology and the Pediatric Endocrine Society, in collaboration with members from the European Society for Pediatric Endocrinology, the European Society of Human Reproduction and Embryology, the European Reference Network on Rare Endocrine Conditions, the Society for Endocrinology, and the European Society of Cardiology, Japanese Society for Pediatric Endocrinology, Australia and New Zealand Society for Pediatric Endocrinology and Diabetes, Latin American Society for Pediatric Endocrinology, Arab Society for Pediatric Endocrinology and Diabetes, and the Asia Pacific Pediatric Endocrine Society. Advocacy groups appointed representatives for pre-meeting discussions and the consensus meeting.
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Affiliation(s)
- Claus H Gravholt
- Department of Endocrinology, Aarhus University Hospital, 8200 Aarhus N, Denmark
- Department of Molecular Medicine, Aarhus University Hospital, 8200 Aarhus N, Denmark
- Department of Clinical Medicine, Aarhus University, 8200 Aarhus N, Denmark
| | - Niels H Andersen
- Department of Cardiology, Aalborg University Hospital, 9000 Aalborg, Denmark
| | - Sophie Christin-Maitre
- Endocrine and Reproductive Medicine Unit, Center of Rare Endocrine Diseases of Growth and Development (CMERCD), FIRENDO, Endo ERN Hôpital Saint-Antoine, Sorbonne University, Assistance Publique-Hôpitaux de Paris, 75012 Paris, France
| | - Shanlee M Davis
- Department of Pediatrics, University of Colorado School of Medicine, Aurora, CO 80045, United States
- eXtraOrdinarY Kids Clinic, Children's Hospital Colorado, Aurora, CO 80045, United States
| | - Anthonie Duijnhouwer
- Department of Cardiology, Radboud University Medical Center, Nijmegen 6500 HB, The Netherlands
| | - Aneta Gawlik
- Departments of Pediatrics and Pediatric Endocrinology, Faculty of Medical Sciences in Katowice, Medical University of Silesia, 40-752 Katowice, Poland
| | - Andrea T Maciel-Guerra
- Area of Medical Genetics, Department of Translational Medicine, School of Medical Sciences, State University of Campinas, 13083-888 São Paulo, Brazil
| | - Iris Gutmark-Little
- Cincinnati Children's Hospital Medical Center, University of Cincinnati, Cincinnati, Ohio 45229, United States
| | - Kathrin Fleischer
- Department of Reproductive Medicine, Nij Geertgen Center for Fertility, Ripseweg 9, 5424 SM Elsendorp, The Netherlands
| | - David Hong
- Division of Interdisciplinary Brain Sciences, Stanford University School of Medicine, Stanford, CA 94304, United States
- Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine, Stanford, CA 94304, United States
| | - Karen O Klein
- Rady Children's Hospital, University of California, San Diego, CA 92123, United States
| | - Siddharth K Prakash
- Department of Internal Medicine, University of Texas Health Science Center at Houston, Houston, TX 77030, United States
| | - Roopa Kanakatti Shankar
- Division of Endocrinology, Children's National Hospital, The George Washington University School of Medicine, Washington, DC 20010, United States
| | - David E Sandberg
- Susan B. Meister Child Health Evaluation and Research Center, Department of Pediatrics, University of Michigan, Ann Arbor, MI 48109-2800, United States
- Division of Pediatric Psychology, Department of Pediatrics, University of Michigan, Ann Arbor, MI 48109-2800, United States
| | - Theo C J Sas
- Department the Pediatric Endocrinology, Sophia Children's Hospital, Rotterdam 3015 CN, The Netherlands
- Department of Pediatrics, Centre for Pediatric and Adult Diabetes Care and Research, Rotterdam 3015 CN, The Netherlands
| | - Anne Skakkebæk
- Department of Molecular Medicine, Aarhus University Hospital, 8200 Aarhus N, Denmark
- Department of Clinical Medicine, Aarhus University, 8200 Aarhus N, Denmark
- Department of Clinical Genetics, Aarhus University Hospital, 8200 Aarhus N, Denmark
| | - Kirstine Stochholm
- Department of Endocrinology, Aarhus University Hospital, 8200 Aarhus N, Denmark
- Center for Rare Diseases, Department of Pediatrics, Aarhus University Hospital, 8200 Aarhus N, Denmark
| | - Janielle A van der Velden
- Department of Pediatric Endocrinology, Radboud University Medical Center, Amalia Children's Hospital, Nijmegen 6500 HB, The Netherlands
| | - Philippe F Backeljauw
- Cincinnati Children's Hospital Medical Center, University of Cincinnati, Cincinnati, Ohio 45229, United States
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Tallón-Walton V, Sánchez-Molins M, Hu W, Martínez-Abadías N, Casado A, Manzanares-Céspedes MC. Comprehensive Oral Diagnosis and Management for Women with Turner Syndrome. Diagnostics (Basel) 2024; 14:769. [PMID: 38611682 PMCID: PMC11011770 DOI: 10.3390/diagnostics14070769] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2024] [Revised: 04/02/2024] [Accepted: 04/04/2024] [Indexed: 04/14/2024] Open
Abstract
Turner Syndrome (TS) is a rare genetic disorder that affects females when one of the X chromosomes is partially or completely missing. Due to high genetic and phenotypic variability, TS diagnosis is challenging and is often delayed until adolescence, resulting in poor clinical management. Numerous oral, dental and craniofacial anomalies have been associated with TS, yet a comprehensive description is still lacking. This study addresses this gap through a detailed analysis of oral health and craniofacial characteristics in a cohort of 15 females with TS and their first-degree relatives. Subjects with TS ranged from 3 to 48 years old, none showed evidence of periodontal disease and only the youngest was in mixed dentition. Using the Multifunction System, we identified an aggregation of multiple signs and symptoms in each TS subject, including tooth anomalies (supernumerary molars, agenesis, microdontia, enamel defects, alterations in eruption patterns -advanced and delayed for chronological age-, crowding, rotations and transpositions), malocclusion (class II/1 and II/2) and Class II facial profile, while relatives exhibited fewer manifestations. The early detection of these signs and symptoms is crucial for appropriate referral and the optimal clinical management of TS, especially during the critical period of 9 to 10 years when congenital dental anomalies appear. The use of an established taxonomy to describe these phenotypic features is essential for early detection. Multidisciplinary teams are required to ensure holistic care management in rare diseases like TS.
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Affiliation(s)
- Victoria Tallón-Walton
- Human Anatomy and Embryology Unit, Experimental Pathology and Therapeutics Department, University of Barcelona, 08907 Barcelona, Spain; (V.T.-W.); (W.H.)
| | | | - Wenwen Hu
- Human Anatomy and Embryology Unit, Experimental Pathology and Therapeutics Department, University of Barcelona, 08907 Barcelona, Spain; (V.T.-W.); (W.H.)
| | - Neus Martínez-Abadías
- Evolutionary Biology, Ecology and Environmental Sciences Department, University of Barcelona, 08007 Barcelona, Spain;
| | - Aroa Casado
- Evolutionary Biology, Ecology and Environmental Sciences Department, University of Barcelona, 08007 Barcelona, Spain;
| | - María Cristina Manzanares-Céspedes
- Human Anatomy and Embryology Unit, Experimental Pathology and Therapeutics Department, University of Barcelona, 08907 Barcelona, Spain; (V.T.-W.); (W.H.)
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Dumančić J, Scott GR, Savić Pavičin I, Anić-Milošević S, Medančić N, Brkić H. Canine Crown Sexual Dimorphism in a Sample of the Modern Croatian Population. Dent J (Basel) 2023; 11:175. [PMID: 37504241 PMCID: PMC10377766 DOI: 10.3390/dj11070175] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2023] [Revised: 07/06/2023] [Accepted: 07/14/2023] [Indexed: 07/29/2023] Open
Abstract
Sex assessment is a key part of forensic analysis to establish the identity of unknown deceased individuals. Previous studies have shown that canines are the most dimorphic teeth, but population-specific data are necessary for forensic methods. This study explores sex dimorphism in canine crown dimensions and morphology in a contemporary Croatian population. The material consisted of 302 dental casts (147 females, 155 males) of orthodontic patients and dental students (11-25 years). The distal accessory ridge (DAR) of the upper and lower canines was evaluated using the Arizona State University Dental Anthropology System. Mesiodistal (MD) and buccolingual (BL) crown dimensions were measured on 120 casts. Sex differences in MD and BL dimensions were significant (p < 0.05) for all the canines (upper and lower, left and right), while in DAR only for lower canines (p < 0.000001). When all variables were put into the model, backward stepwise discriminant function analysis isolated lower canine DAR and lower left canine MD as the two independent variables differentiating sex. Using these two variables, a discriminant function formula allowed for sex determination with an accuracy of 73.5%. This study shows that both canine crown morphology and dimensions are useful for sex determination, especially for lower canines. These methods can be applied to children, as lower canines erupt at about 9 years of age.
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Affiliation(s)
- Jelena Dumančić
- Department of Dental Anthropology, School of Dental Medicine, University of Zagreb, 10000 Zagreb, Croatia
| | - G Richard Scott
- Department of Anthropology, University of Nevada, Reno, NV 89557, USA
| | - Ivana Savić Pavičin
- Department of Dental Anthropology, School of Dental Medicine, University of Zagreb, 10000 Zagreb, Croatia
| | - Sandra Anić-Milošević
- Department of Orthodontics, School of Dental Medicine, University of Zagreb, 10000 Zagreb, Croatia
| | | | - Hrvoje Brkić
- Department of Dental Anthropology, School of Dental Medicine, University of Zagreb, 10000 Zagreb, Croatia
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R B, P S, Muthu M, Nirmal L, Patil SS. Prevalence of the Cusp of Carabelli – A systematic review and meta-analysis. Ann Hum Biol 2022; 48:572-584. [DOI: 10.1080/03014460.2022.2032339] [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]
Affiliation(s)
- Bhavyaa R
- Centre for Early Childhood Caries Research (CECCRe), Department of Pediatric and Preventive Dentistry, Sri Ramachandra Faculty of Dental Sciences, Sri Ramachandra Institute of Higher Education and Research, 1, Ramachandra Nagar, Sri Ramachandra Nagar, Chennai, Tamil Nadu 600116, India
| | - Sujitha P
- Department of Pediatric and Preventive Dentistry, SRM Kattankulathur Dental College and Hospital, SRM Nagar, Kattankulathur, Kanchipuram District, Tamil Nadu-603203, India
| | - Murugan Muthu
- Centre for Early Childhood Caries Research (CECCRe), Department of Pediatric and Preventive Dentistry, Sri Ramachandra Faculty of Dental Sciences, Sri Ramachandra Institute of Higher Education and Research, 1, Ramachandra Nagar, Sri Ramachandra Nagar, Chennai, Tamil Nadu 600116, India
| | - Latha Nirmal
- Centre for Early Childhood Caries Research (CECCRe), Department of Pediatric and Preventive Dentistry, Sri Ramachandra Faculty of Dental Sciences, Sri Ramachandra Institute of Higher Education and Research, 1, Ramachandra Nagar, Sri Ramachandra Nagar, Chennai, Tamil Nadu 600116, India
| | - Sneha S Patil
- Centre for Early Childhood Caries Research (CECCRe), Department of Pediatric and Preventive Dentistry, Sri Ramachandra Faculty of Dental Sciences, Sri Ramachandra Institute of Higher Education and Research, 1, Ramachandra Nagar, Sri Ramachandra Nagar, Chennai, Tamil Nadu 600116, India
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Caries intensity and Streptococcus mutans in the saliva of patients with Turner syndrome. Saudi Dent J 2021; 33:448-452. [PMID: 34803285 PMCID: PMC8589624 DOI: 10.1016/j.sdentj.2020.12.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2020] [Revised: 11/05/2020] [Accepted: 12/06/2020] [Indexed: 11/21/2022] Open
Abstract
Aim The aim of this study was to evaluate the caries intensity and Streptococcus mutans (SM) counts in patients with Turner syndrome. Materials and methods Nineteen patients aged 20-40 years were clinically and cytogenetically diagnosed with Turner syndrome (45, X). The karyotype was determined by chromosome analysis of peripheral blood lymphocytes. The control group comprised 47 healthy women aged 21-40 years. Both groups included non-smokers with no specific diet, such as a vegetarian or vegan diet, who were generally healthy with good oral hygiene and periodontal condition. Patients treated with antibiotics or steroid preparations in the past 6 months or with diseases or conditions that might affect the oral mucosal environment, such as disorders of salivary secretion and diabetes, were excluded from the study. Decayed, missing, and filled teeth (DMFT) scores and SM counts in saliva were determined. Results No colony growth of SM was noticed in 53% of patients with Turner syndrome and 4.2% of controls (p < 0.001). Colony counts of SM ≥ 105 in saliva were observed in none of the patients with Turner syndrome but in 66% of controls (p < 0.001). The mean DMFT score was 1.63 ± 2.52 in patients with Turner syndrome and 14.49 ± 6.88 in controls. Statistically significant differences between the two groups were observed (p < 0.05). Conclusion Patients with genetic disorders may have different severities of caries and SM counts in saliva compared to those without genetic disorders. Further studies on saliva properties and genes located on the X chromosome could contribute to determining the effect of the X chromosome on the pathological processes in the oral cavity.
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