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El Haissoufi K, Lehn A, Chevalier I, Moog R, Becmeur F, Talon I. Surgical management of ovarian masses in children and adolescents: experience of an academic institution in France. Pediatr Surg Int 2024; 40:151. [PMID: 38842682 DOI: 10.1007/s00383-024-05734-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 05/27/2024] [Indexed: 06/07/2024]
Abstract
PURPOSE Surgical management of ovarian masses in girls still challenging. The aim of the study is to report an 8-year experience in managing children with ovarian masses, and to demonstrate the advantages and the limitations of laparoscopy for such lesions. METHODS Data of girls aged less than 18 years operated because of an ovarian mass between January 2015 and February 2023 were retrospectively reviewed. Patients were divided into two groups: group A including children operated by laparoscopy, and Group B of patients who underwent open surgery. RESULTS Eighty-eight children were enrolled. Laparoscopy was performed in 56 patients (63.6%). Group A patients had smaller tumor size (53.6±38.5 vs. 122.2±75.4 mm, P<0.0001), shorter operative time (50.4±20.3 vs. 71.5±36.5 min, P = 0.004), reduced length of hospital stay (1.4±1.1 vs. 3±2.3 days, P<0.0001), and absence of postoperative complications. Only 3 cases (5.7%) of recurrence were seen exclusively within patients followed for benign tumors during a mean follow-up period of 4.6±3 years. CONCLUSION Laparoscopy should be done in benign ovarian lesions or/and if a torsion is seen. For tumors at high risk of malignancy, laparoscopy can be performed to establish a clear macroscopic diagnosis, for staging of the disease, and resection of small tumors. Conversion to open surgery is indicated in case of doubt.
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Affiliation(s)
- Kamal El Haissoufi
- Hôpitaux Universitaires de Strasbourg, Strasbourg, France.
- Faculty of Medicine, Mohammed 1st University, Oujda, Morocco.
| | - Anne Lehn
- Hôpitaux Universitaires de Strasbourg, Strasbourg, France
| | | | - Raphaël Moog
- Hôpitaux Universitaires de Strasbourg, Strasbourg, France
| | | | - Isabelle Talon
- Hôpitaux Universitaires de Strasbourg, Strasbourg, France
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Therapeutic Management and Prognostic Factors for Ovarian Malignant Tumours in Adolescents: A Comprehensive Review of Current Guidelines. Diagnostics (Basel) 2023; 13:diagnostics13061080. [PMID: 36980387 PMCID: PMC10047001 DOI: 10.3390/diagnostics13061080] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2022] [Revised: 02/27/2023] [Accepted: 03/03/2023] [Indexed: 03/14/2023] Open
Abstract
Background: Ovarian malignant tumours are rarely diagnosed in adolescents but may have a significant impact on their survival, future fertility and quality of life. The management of such cases is rather complex and requires expertise and careful planning according to scarce existing evidence and recommendations. Objective: The aim of this study was to review and compare recommendations from published guidelines regarding the diagnosis, prognosis and treatment of malignant ovarian tumours in adolescents. Evidence acquisition: A comparative descriptive/narrative review of guidelines issued by L’Observatoire des Tumeurs Malignes Rares Gynécologiques, the British Society for Paediatric & Adolescent Gynaecology, the European Society for Medical Oncology, the European Society of Gynecological Oncology-European Society for Paediatric Oncology and the European Cooperative Study Group for Pediatric Rare Tumors was conducted. Results: All guidelines recommend a thorough diagnostic work-up, consisting of both imaging tests and serum tumour marker measurement, as well as the use of immunohistochemical methods to confirm the diagnosis and complete surgical staging prior to constructing the treatment plan. There is a lack of recommendations regarding the assessment of prognostic factors, with only one guideline providing detailed information. Treatment strategies, as suggested by the majority of guidelines and with only a few discrepancies between them, should include both surgery and adjuvant therapies, mainly chemotherapy, with great emphasis on fertility preservation when it is considered oncologically safe and on the significance of regular and long-term follow-up. Conclusions: There is a significant degree of agreement among recommendations of existing guidelines. The reported differences, although limited, highlight the need for the adoption of an international consensus in order to further improve the management of adolescent ovarian cancer.
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The Surgical Procedure in the Case of Ovarian Lesion in Neonate. J Pediatr Hematol Oncol 2023; 45:e126-e127. [PMID: 35398866 DOI: 10.1097/mph.0000000000002464] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/28/2021] [Accepted: 03/04/2022] [Indexed: 02/03/2023]
Abstract
BACKGROUND In newborns and infants, ovarian lesions can be detected during ultrasound examination before or after birth. Malignant ovarian lesions account for <1% of malignancies in newborns. However, in case of doubt about the nature of the lesion, surgery with tissue collection for histopathologic evaluation should be considered with the absolute condition of fertility preservation. OBSERVATIONS The aim of this publication was to describe a case report of a 3-day-old infant who presented an ovarian lesion on postnatal ultrasound, with features suggesting a malignant nature of the ovary. In the described case, laparoscopy and mini-laparotomy were performed, torsion was excluded. The ovary was preserved, and histopathologic examination excluded the malignant nature of the lesion. CONCLUSION A detailed analysis of the clinical status, laboratory tests, and imaging studies is necessary before making a final decision on further therapeutic, especially surgical management of a newborn with an ovarian lesion.
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Ibrahimkhil AS, Malakzai HA, Haidary AM, Hussaini N, Abdul-Ghafar J. Pathological Features of Ovarian Tumors, Diagnosed at a Tertiary Care Hospital in Afghanistan: A Cross-sectional Study. Cancer Manag Res 2022; 14:3325-3333. [DOI: 10.2147/cmar.s384969] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2022] [Accepted: 11/17/2022] [Indexed: 11/29/2022] Open
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Tarca E, Trandafir LM, Cojocaru E, Costea CF, Rosu ST, Butnariu LI, Iordache AC, Munteanu V, Luca AC. Diagnosis Difficulties and Minimally Invasive Treatment for Ovarian Masses in Adolescents. Int J Womens Health 2022; 14:1047-1057. [PMID: 35971543 PMCID: PMC9375555 DOI: 10.2147/ijwh.s374444] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2022] [Accepted: 08/03/2022] [Indexed: 11/23/2022] Open
Abstract
About 1% of childhood tumors can be malignant ovarian tumors and differential diagnosis with benign ones is sometimes difficult before surgery. Concerning the management of such tumors in adolescents for which future fertility is a concern, there is specific interest in their malignant potential and the possible use of ovarian-sparing operative techniques, as well the suitability of chemotherapy. To exemplify the difficulties of preoperative differential diagnosis, personalized approach and the difficulties of deciding to preserve the affected ovary, we report a rare case of a 14-year-old female adolescent with a growing abdominal painless mass and without any other chronic diseases. After physical examination and imaging investigations, laparoscopic surgical procedure is performed, the peritoneal cavity is explored and the well-delimited gigantic tumor is removed. Considering the normally looking pelvis and absence of adenopathy, as well as the patient's age and wish to have children, both ovaries are preserved. Laparoscopy has become the gold standard in the management of this condition, although there are few studies that report this approach in children; the differential diagnosis between a benign and a malignant tumor cannot be established exactly until after the histological examination, which revealed in our case a cystic teratoma with mature tissues. A better understanding of clinical features and evolution of giant ovarian masses in adolescents could help clinicians better diagnose and treat such lesions.
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Affiliation(s)
- Elena Tarca
- Department of Surgery II-Pediatric Surgery, "Grigore T. Popa" University of Medicine and Pharmacy, Iaşi, 700115, Romania
| | - Laura Mihaela Trandafir
- Department of Mother and Child Medicine-Pediatrics, "Grigore T. Popa" University of Medicine and Pharmacy, Iaşi, 700115, Romania
| | - Elena Cojocaru
- Department of Morphofunctional Sciences I-Pathology, "Grigore T. Popa" University of Medicine and Pharmacy, Iaşi, 700115, Romania
| | - Claudia Florida Costea
- Department of Surgery II-Ophthalmology, "Grigore T. Popa" University of Medicine and Pharmacy, Iaşi, 700115, Romania
| | - Solange Tamara Rosu
- Department of Nursing, "Grigore T. Popa" University of Medicine and Pharmacy, Iaşi, 700115, Romania
| | - Lacramioara Ionela Butnariu
- Department of Mother and Child Medicine-Genetics, "Grigore T. Popa" University of Medicine and Pharmacy, Iaşi, 700115, Romania
| | - Alin Constantin Iordache
- Department of Surgery II-Neurosurgery, "Grigore T. Popa" University of Medicine and Pharmacy, Iaşi, 700115, Romania
| | - Valentin Munteanu
- Department of Biomedical Sciences, "Grigore T. Popa" University of Medicine and Pharmacy, Iaşi, 700115, Romania
| | - Alina Costina Luca
- Department of Mother and Child Medicine-Pediatrics, "Grigore T. Popa" University of Medicine and Pharmacy, Iaşi, 700115, Romania
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Stefanopol IA, Baroiu L, Chirila S, Miulescu M, Anghel L, Nechita L, Dinu CA, Stefanescu V, Bobeica C, Nechifor A, Tatu AL. The Influence of Living in Rural Areas on the Evolution and Management of Pediatric Ovarian Cystic Lesions: A Retrospective Study on a Cohort from South Eastern Romania. Int J Gen Med 2022; 15:5273-5284. [PMID: 35655655 PMCID: PMC9153997 DOI: 10.2147/ijgm.s368202] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2022] [Accepted: 05/10/2022] [Indexed: 11/23/2022] Open
Affiliation(s)
- Ioana Anca Stefanopol
- Department of Morphological and Functional Sciences, Faculty of Medicine and Pharmacy, “Dunărea de Jos” University, Galati, Romania
- Department of Pediatric Surgery and Orthopedy, “Sf Ioan” Clinical Emergency Hospital for Children, Galati, Romania
| | - Liliana Baroiu
- Clinical Medical Department, Faculty of Medicine and Pharmacy, “Dunărea de Jos” University, Galati, Romania
- Infectious Diseases Department, “Sf. Cuvioasa Parascheva” Clinical Hospital of Infectious Diseases, Galati, Romania
- Correspondence: Liliana Baroiu, Clinical Medical Department, Faculty of Medicine and Pharmacy, “Dunărea de Jos” University, 47 Domnească Street, Galati, 800010, Romania, Tel +40723201241, Email
| | - Sergiu Chirila
- Medical Informatics and Biostatistics, Faculty of Medicine, Ovidius University, Constanta, Romania
- Sergiu Chirila, Medical Informatics and Biostatistics, Faculty of Medicine, Ovidius University, 1 University Alee, Campus B, Constanta, 900470, Romania, Tel +407213320668, Email
| | - Magdalena Miulescu
- Research Center in the Functional Cardiorespiratory and Neuromotor Exploration, Faculty of Medicine and Pharmacy, “Dunărea de Jos” University, Galați, Romania
| | - Lucreţia Anghel
- Clinical Medical Department, Faculty of Medicine and Pharmacy, “Dunărea de Jos” University, Galati, Romania
- Internal Medicine Department, “sf Andrew the Apostle” County Emergency Clinical Hospital, Galati, Romania
| | - Luiza Nechita
- Clinical Medical Department, Faculty of Medicine and Pharmacy, “Dunărea de Jos” University, Galati, Romania
| | - Ciprian Adrian Dinu
- Dental Department, Faculty of Medicine and Pharmacy, “Dunărea de Jos” University, Galati, Romania
| | - Victorita Stefanescu
- Clinical Medical Department, Faculty of Medicine and Pharmacy, “Dunărea de Jos” University, Galati, Romania
| | - Carmen Bobeica
- Department of Morphological and Functional Sciences, Faculty of Medicine and Pharmacy, “Dunărea de Jos” University, Galati, Romania
| | - Alexandru Nechifor
- Clinical Medical Department, Faculty of Medicine and Pharmacy, “Dunărea de Jos” University, Galati, Romania
| | - Alin Laurenţiu Tatu
- Clinical Medical Department, Faculty of Medicine and Pharmacy, “Dunărea de Jos” University, Galati, Romania
- Research Center in the Field of Medical and Pharmaceutical Sciences, Reform-UDJ, Galati, Romania
- Dermatology Department, “Sf. Cuvioasa Parascheva” Clinical Hospital of Infectious Diseases, Galati, Romania
- Multidisciplinary Integrated Center of Dermatological Interface Research MIC DIR, Galati, Romania
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Childress KJ, Patil NM, Muscal JA, Dietrich JE, Venkatramani R. Borderline Ovarian Tumor in the Pediatric and Adolescent Population: A Case Series and Literature Review. J Pediatr Adolesc Gynecol 2018; 31:48-54. [PMID: 28899828 DOI: 10.1016/j.jpag.2017.09.001] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/16/2017] [Accepted: 09/01/2017] [Indexed: 12/21/2022]
Abstract
STUDY OBJECTIVE To determine the diagnosis, management, and outcome for children and adolescents with borderline ovarian tumor (BOT), and to provide a review of the literature on BOT in children and adolescents. DESIGN A retrospective cohort study of female adolescents younger than age 21 years diagnosed with BOT between January 2001 and May 2016. SETTING Texas Children's Hospital, Houston, Texas. PARTICIPANTS Fourteen patients (ages 12 to 18 years) diagnosed with BOT. MAIN OUTCOME MEASURES Clinical presentation, preoperative characteristics, surgical technique, cancer stage, histology, treatment, and recurrence. RESULTS Median age at diagnosis was 15.5 years, with most postmenarchal. Abdominal mass/pain were the most common presenting symptoms. Median tumor size was 16.6 cm (range, 4-32 cm). Preoperative cancer antigen 125 (CA 125) was elevated in 54% (7/13) of cases. All patients had fertility-preserving surgery, either cystectomy (CY) or unilateral salpingo-oophorectomy (USO): 5 via laparoscopy (LSC) and 9 via laparotomy. Most were stage I with 5 serous and 9 mucinous BOT histology. No one received adjuvant chemotherapy. Two patients had recurrence. One had ipsilateral recurrence 2 months after LSC CY for FIGO stage IC1 mucinous BOT. The second had contralateral recurrence 15 months after laparotomy, right USO for FIGO stage IIIC serous BOT treated with LSC CY, then a second recurrence treated with USO after oocyte cryopreservation for fertility preservation. All patients were alive at last follow-up, 1 with disease. CONCLUSIONS BOT in children and adolescents can be treated conservatively with fertility-preserving techniques and surveillance with good outcome. The role of adjuvant therapy is not known.
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Affiliation(s)
- Krista J Childress
- Division of Pediatric and Adolescent Gynecology, Department of Obstetrics and Gynecology, Baylor College of Medicine, Houston, Texas.
| | - Ninad Mohan Patil
- Departments of Pathology and Immunology, and Obstetrics and Gynecology, Baylor College of Medicine, Houston, Texas
| | - Jodi A Muscal
- Division of Hematology-Oncology, Department of Pediatrics, Baylor College of Medicine, Houston, Texas
| | - Jennifer E Dietrich
- Division of Pediatric and Adolescent Gynecology, Department of Obstetrics and Gynecology, Baylor College of Medicine, Houston, Texas
| | - Rajkumar Venkatramani
- Division of Hematology-Oncology, Department of Pediatrics, Baylor College of Medicine, Houston, Texas
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Iltar E, Ureyen I, Toptas T, Savas M, Çekiç S, Uysal A. A Rare Case: Struma Ovarii in a 14-Year-Old Girl. J Adolesc Young Adult Oncol 2017; 7:134-136. [PMID: 28759301 DOI: 10.1089/jayao.2017.0033] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022] Open
Abstract
Ovarian tumors presented with ovarian mass in childhood and adolescence are uncommon but an important part of gynecological cases. Struma ovarii is one of the rare cystic benign ovarian tumors that is observed predominantly in women who are between the ages of 40 and 60 years old. It is extremely rare in adolescents. Herein, we present a 14-year-old adolescent girl with struma ovarii who presented to the emergency room with abdominal pain.
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Affiliation(s)
- Elif Iltar
- 1 Department of Gynecology and Obstetrics, Antalya Training and Research Hospital, Sağlık Bilimleri University , Antalya, Turkey
| | - Isin Ureyen
- 2 Division of Gynecological Oncology, Department of Gynecology and Obstetrics, Antalya Teaching and Research Hospital, Sağlık Bilimleri University , Antalya, Turkey
| | - Tayfun Toptas
- 2 Division of Gynecological Oncology, Department of Gynecology and Obstetrics, Antalya Teaching and Research Hospital, Sağlık Bilimleri University , Antalya, Turkey
| | - Melike Savas
- 1 Department of Gynecology and Obstetrics, Antalya Training and Research Hospital, Sağlık Bilimleri University , Antalya, Turkey
| | - Sema Çekiç
- 3 Department of Pathology, Antalya Teaching and Research Hospital, Sağlık Bilimleri University , Antalya, Turkey
| | - Aysel Uysal
- 1 Department of Gynecology and Obstetrics, Antalya Training and Research Hospital, Sağlık Bilimleri University , Antalya, Turkey
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Aydin BK, Saka N, Bas F, Yilmaz Y, Haliloglu B, Guran T, Turan S, Bereket A, Yesiltepe Mutlu G, Cizmecioglu F, Hatun S, Bezen D, Tutunculer F, Cebeci N, Isguven P, Memioglu N, Ercan O, Poyrazoglu S, Bundak R, Darendeliler F. Evaluation and Treatment Results of Ovarian Cysts in Childhood and Adolescence: A Multicenter, Retrospective Study of 100 Patients. J Pediatr Adolesc Gynecol 2017; 30:449-455. [PMID: 28167139 DOI: 10.1016/j.jpag.2017.01.011] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/18/2016] [Revised: 01/22/2017] [Accepted: 01/27/2017] [Indexed: 10/20/2022]
Abstract
STUDY OBJECTIVE To investigate the characteristics of children with ovarian cysts and evaluate treatment strategies. DESIGN Retrospective study. SETTING Eight pediatric endocrinology clinics, Turkey. PARTICIPANTS A total of 100 children and adolescents with ovarian cysts. INTERVENTIONS Patient data collected via retrospective chart review. Patients were stratified according to age into 4 groups (newborns, 1-12 months, 1-8 years, and 8-18 years). MAIN OUTCOME MEASURES Special emphasis was given to torsion and tumor cases, concomitant diseases, treatment modalities, and problems during follow-up. RESULTS Most newborns and infants were asymptomatic with the cysts being discovered incidentally; in girls ages 1-8, symptoms were common, including breast budding (47.1%, 16 of 34) and vaginal bleeding (29.4%, 10 of 34). Girls older than 8 years mostly presented with abdominal pain (31.6%, 12 of 38) and menstrual irregularity (21.1%, 8 of 38). Most of our patients were diagnosed with a simple ovarian cyst, but 9 patients were found to have ovarian tumors. Ovarian torsion was detected in 7 patients; 5 with large and 2 with small cysts (<20 mm). Two patients had central precocious puberty (CPP) at presentation and 5 patients developed CPP during follow-up. The surgical intervention rate was high (38%, 38 of 100), but was associated with earlier treatment year, and this association remained significant after adjusting for confounders (P = .035). CONCLUSION Most girls have simple cysts, which have a favorable prognosis without intervention; however, there might be coexisting pathologies or complications such as tumors, torsion, and CPP; hence these patients should be evaluated accordingly and treated with a multidisciplinary approach.
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Affiliation(s)
- Banu Kucukemre Aydin
- Istanbul University, Istanbul Faculty of Medicine, Department of Pediatrics, Pediatric Endocrinology Unit, Istanbul, Turkey.
| | - Nurcin Saka
- Istanbul University, Istanbul Faculty of Medicine, Department of Pediatrics, Pediatric Endocrinology Unit, Istanbul, Turkey
| | - Firdevs Bas
- Istanbul University, Istanbul Faculty of Medicine, Department of Pediatrics, Pediatric Endocrinology Unit, Istanbul, Turkey
| | - Yasin Yilmaz
- Istanbul University, Istanbul Faculty of Medicine, Department of Pediatrics, Pediatric Endocrinology Unit, Istanbul, Turkey
| | - Belma Haliloglu
- Marmara University, Medical Faculty, Department of Pediatrics, Pediatric Endocrinology Unit, Istanbul, Turkey
| | - Tulay Guran
- Marmara University, Medical Faculty, Department of Pediatrics, Pediatric Endocrinology Unit, Istanbul, Turkey
| | - Serap Turan
- Marmara University, Medical Faculty, Department of Pediatrics, Pediatric Endocrinology Unit, Istanbul, Turkey
| | - Abdullah Bereket
- Marmara University, Medical Faculty, Department of Pediatrics, Pediatric Endocrinology Unit, Istanbul, Turkey
| | - Gul Yesiltepe Mutlu
- Kocaeli University, Medical Faculty, Department of Pediatrics, Pediatric Endocrinology Unit, Kocaeli, Turkey
| | - Filiz Cizmecioglu
- Kocaeli University, Medical Faculty, Department of Pediatrics, Pediatric Endocrinology Unit, Kocaeli, Turkey
| | - Sukru Hatun
- Kocaeli University, Medical Faculty, Department of Pediatrics, Pediatric Endocrinology Unit, Kocaeli, Turkey
| | - Digdem Bezen
- Trakya University, Medical Faculty, Department of Pediatrics, Pediatric Endocrinology Unit, Edirne, Turkey
| | - Filiz Tutunculer
- Trakya University, Medical Faculty, Department of Pediatrics, Pediatric Endocrinology Unit, Edirne, Turkey
| | - Nurcan Cebeci
- Derince Training and Research Hospital, Department of Pediatrics, Kocaeli, Turkey
| | - Pinar Isguven
- Sakarya University, Faculty of Medicine, Department of Pediatrics, Pediatric Endocrinology Unit, Sakarya, Turkey
| | - Nihal Memioglu
- American Hospital, Department of Pediatrics, Istanbul, Turkey
| | - Oya Ercan
- Istanbul University, Cerrahpasa Faculty of Medicine, Department of Pediatrics, Pediatric Endocrinology Unit, Istanbul, Turkey
| | - Sukran Poyrazoglu
- Istanbul University, Istanbul Faculty of Medicine, Department of Pediatrics, Pediatric Endocrinology Unit, Istanbul, Turkey
| | - Rüveyde Bundak
- Istanbul University, Istanbul Faculty of Medicine, Department of Pediatrics, Pediatric Endocrinology Unit, Istanbul, Turkey
| | - Feyza Darendeliler
- Istanbul University, Istanbul Faculty of Medicine, Department of Pediatrics, Pediatric Endocrinology Unit, Istanbul, Turkey
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