1
|
Hietamäki J, Kärkinen J, Iivonen AP, Vaaralahti K, Tarkkanen A, Almusa H, Huopio H, Hero M, Miettinen PJ, Raivio T. Presentation and diagnosis of childhood-onset combined pituitary hormone deficiency: A single center experience from over 30 years. EClinicalMedicine 2022; 51:101556. [PMID: 35875813 PMCID: PMC9304914 DOI: 10.1016/j.eclinm.2022.101556] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/10/2022] [Revised: 06/20/2022] [Accepted: 06/23/2022] [Indexed: 12/20/2022] Open
Abstract
BACKGROUND Childhood-onset combined pituitary hormone deficiency (CPHD) has a wide spectrum of etiologies and genetic causes for congenital disease. We aimed to describe the clinical spectrum and genetic etiologies of CPHD in a single tertiary center and estimate the population-level incidence of congenital CPHD. METHODS The retrospective clinical cohort comprised 124 CPHD patients (48 with congenital CPHD) treated at the Helsinki University Hospital (HUH) Children's Hospital between 1985 and 2018. Clinical data were collected from the patient charts. Whole exome sequencing was performed in 21 patients with congenital CPHD of unknown etiology. FINDINGS The majority (61%;76/124) of the patients had acquired CPHD, most frequently due to craniopharyngiomas and gliomas. The estimated incidence of congenital CPHD was 1/16 000 (95%CI, 1/11 000-1/24 000). The clinical presentation of congenital CPHD in infancy included prolonged/severe neonatal hypoglycaemia, prolonged jaundice, and/or micropenis/bilateral cryptorchidism in 23 (66%) patients; despite these clinical cues, only 76% of them were referred to endocrine investigations during the first year of life. The median delay between the first violation of the growth screening rules and the initiation of GH Rx treatment among all congenital CPHD patients was 2·2 years, interquartile range 1·2-3·7 years. Seven patients harbored pathogenic variants in PROP1, SOX3, TBC1D32, OTX2, and SOX2, and one patient carried a likely pathogenic variant in SHH (c.676G>A, p.(Ala226Thr)). INTERPRETATION Our study suggests that congenital CPHD can occur in 1/16 000 children, and that patients frequently exhibit neonatal cues of hypopituitarism and early height growth deflection. These results need to be corroborated in future studies and might inform clinical practice. FUNDING Päivikki and Sakari Sohlberg Foundation, Biomedicum Helsinki Foundation, and Emil Aaltonen Foundation research grants.
Collapse
Affiliation(s)
- Johanna Hietamäki
- Helsinki University Hospital, New Children's Hospital, Pediatric Research Center, Helsinki 00014, Finland
| | - Juho Kärkinen
- Helsinki University Hospital, New Children's Hospital, Pediatric Research Center, Helsinki 00014, Finland
| | - Anna-Pauliina Iivonen
- Department of Physiology, Medicum Unit, Faculty of Medicine, and Stem Cells and Metabolism Research Program, Research Programs Unit, University of Helsinki, Helsinki 00014, Finland
| | - Kirsi Vaaralahti
- Department of Physiology, Medicum Unit, Faculty of Medicine, and Stem Cells and Metabolism Research Program, Research Programs Unit, University of Helsinki, Helsinki 00014, Finland
| | - Annika Tarkkanen
- Helsinki University Hospital, New Children's Hospital, Pediatric Research Center, Helsinki 00014, Finland
- Department of Physiology, Medicum Unit, Faculty of Medicine, and Stem Cells and Metabolism Research Program, Research Programs Unit, University of Helsinki, Helsinki 00014, Finland
| | - Henrikki Almusa
- Institute for Molecular Medicine Finland, FIMM, University of Helsinki, Helsinki, Finland
| | - Hanna Huopio
- Kuopio University Hospital, University of Eastern Finland, Kuopio, Finland
| | - Matti Hero
- Helsinki University Hospital, New Children's Hospital, Pediatric Research Center, Helsinki 00014, Finland
| | - Päivi J. Miettinen
- Helsinki University Hospital, New Children's Hospital, Pediatric Research Center, Helsinki 00014, Finland
| | - Taneli Raivio
- Helsinki University Hospital, New Children's Hospital, Pediatric Research Center, Helsinki 00014, Finland
- Department of Physiology, Medicum Unit, Faculty of Medicine, and Stem Cells and Metabolism Research Program, Research Programs Unit, University of Helsinki, Helsinki 00014, Finland
- Corresponding author at: Faculty of Medicine University of Helsinki, Medicum/Physiology, P.O. Box 63 (Haartmaninkatu 8), FI-00014 Helsinki, Finland.
| |
Collapse
|
2
|
Galal MS, Musa SA, Babiker OO, Hamdan HZ, Abdullah MA. Clinical profile and aetiologies of delayed puberty: a 15 years' experience from a tertiary centre in Sudan. J Pediatr Endocrinol Metab 2022; 35:938-945. [PMID: 35671155 DOI: 10.1515/jpem-2022-0243] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/08/2022] [Accepted: 05/17/2022] [Indexed: 11/15/2022]
Abstract
OBJECTIVES Delayed puberty is a common presentation to endocrine clinics, with adult height, sexual capability and fertility being the main concerns for the child and his/her family. Presentation is variable including short stature and/or absence of secondary sexual characteristics. The aetiology can either be constitutional, functional or permanent hypogonadotropic hypogonadism, permanent hypergonadotropic hypogonadism or unclassified. Despite the importance of this subject, there are no publications from Sudan. METHODS A retrospective hospital-based study. Records of all patients who were seen in the endocrinology unit at Gaffar Ibn Auf Children's Hospital and were diagnosed as having delayed puberty were reviewed and demographic, clinical, and investigations data were obtained. RESULTS A total of 136 patients were included in this study. Presentation includes short stature in 52.2%, both short stature and delayed puberty in 27.2%, and delayed puberty in 20.6%. The most common aetiologies were permanent hypogonadotropic hypogonadism and functional hypogonadotropic hypogonadism presented in 37.5% and 36% respectively, while constitutional delay of growth and puberty was found in only 14.7%. Type 1 diabetes mellitus (T1DM) was the most frequent chronic illness followed by coeliac disease. Hypergonadotropic hypogonadism was diagnosed in 11.7%, the majority of which were females. CONCLUSIONS The aetiological pattern reported in this series highlights the role of nutrition and general well-being in pubertal development, as well as the major impact of genetics and consanguinity on disease patterns. Data from African countries are limited and this is the first reported cohort on delayed puberty from Sudan.
Collapse
Affiliation(s)
- Marwa S Galal
- Department of Paediatrics and Child Health, Faculty of Medicine, Al-Neelain University, Khartoum, Sudan
| | - Salwa A Musa
- Department of Paediatrics and Child Health, Faculty of Medicine, Al-Neelain University, Khartoum, Sudan.,Paediatric Endocrinology Unit, Gaafar Ibn Auf Children's Hospital, Khartoum, Sudan
| | | | - Hamdan Z Hamdan
- Al-Neelain University, Faculty of Medicine, Khartoum, Sudan.,Department of Basic Medical Sciences, Unaizah College of Medicine and Medical Sciences, Qassim University, Unaizah, Kingdom of Saudi Arabia
| | - Mohamed A Abdullah
- Paediatric Endocrinology Unit, Gaafar Ibn Auf Children's Hospital, Khartoum, Sudan.,Department of Paediatrics and Child Health, Faculty of Medicine, University of Khartoum, Khartoum, Sudan
| |
Collapse
|