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Kırkgöz T, Gürsoy S, Acar S, Köprülü Ö, Özkaya B, Arslan G, Nalbantoğlu Ö, Hazan F, Özkan B. Identification of a novel homozygous NR5A1 variant in a patient with a 46,XY disorders of sex development. J Pediatr Endocrinol Metab 2024; 0:jpem-2023-0551. [PMID: 38650427 DOI: 10.1515/jpem-2023-0551] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/14/2023] [Accepted: 03/29/2024] [Indexed: 04/25/2024]
Abstract
OBJECTIVES Nuclear receptor subfamily 5 group A member 1 (NR5A1) is a transcription factor critical for the development of various organs. Pathogenic variants in NR5A1 are associated with a spectrum of disorders of sex development (DSD). CASE REPORT A 15-month-old baby, raised as a girl, was referred for genital swelling and ambiguous genitalia. Born to healthy consanguineous parents, the baby had a phallus, perineal hypospadias, labial fusion, and a hypoplastic scrotum. Hormonal evaluation showed normal levels, and ultrasonography revealed small gonads and absence of Müllerian derivatives. Post-human chorionic gonadotropin (hCG) testing indicated an adequate testosterone response. The karyotype was 46,XY, and in it was found a homozygous NR5A1 variant (c.307 C>T, p.Arg103Trp) in a custom 46 XY DSD gene panel. Notably, the patient exhibited complete sex reversal, hyposplenia, and no adrenal insufficiency. CONCLUSIONS Previously, NR5A1 pathogenic variants were considered to be dominantly inherited, and homozygous cases were thought to be associated with adrenal insufficiency. Despite the homozygous pathogenic variant, our patient showed hyposplenism with normal adrenal function; this highlights the complexity of NR5A1 genotype-phenotype correlations. These patients should be monitored for adrenal insufficiency and DSD as well as splenic function.
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Affiliation(s)
- Tarık Kırkgöz
- Division of Paediatric Endocrinology, Behçet Uz Children's Education and Research Hospital, Izmir, Türkiye
| | - Semra Gürsoy
- Deparment of Paediatric Genetics, Behçet Uz Children's Education and Research Hospital, Izmir, Türkiye
| | - Sezer Acar
- Division of Paediatric Endocrinology, Behçet Uz Children's Education and Research Hospital, Izmir, Türkiye
| | - Özge Köprülü
- Division of Paediatric Endocrinology, Behçet Uz Children's Education and Research Hospital, Izmir, Türkiye
| | - Beyhan Özkaya
- Division of Paediatric Endocrinology, Behçet Uz Children's Education and Research Hospital, Izmir, Türkiye
| | - Gülçin Arslan
- Division of Paediatric Endocrinology, Behçet Uz Children's Education and Research Hospital, Izmir, Türkiye
| | - Özlem Nalbantoğlu
- Division of Paediatric Endocrinology, Behçet Uz Children's Education and Research Hospital, Izmir, Türkiye
| | - Filiz Hazan
- Department of Medical Genetics, Behçet Uz Children's Education and Research Hospital, Izmir, Türkiye
| | - Behzat Özkan
- Division of Paediatric Endocrinology, Behçet Uz Children's Education and Research Hospital, Izmir, Türkiye
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Kırkgöz T, Acar S, Küme T, Kırkgöz HH, Tabanlı G, Nalbantoğlu Ö, Yılmaz Ü, Ünalp A, Özkan B. Evaluation of Serum Advanced Glycation End Product Levels and Microvascular Complications in Children and Adolescents with Type 1 Diabetes Mellitus. Turk Arch Pediatr 2024; 59:31-37. [PMID: 38454257 PMCID: PMC10837560 DOI: 10.5152/turkarchpediatr.2024.23147] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2023] [Accepted: 09/05/2023] [Indexed: 03/09/2024]
Abstract
OBJECTIVE Advanced glycation end products (AGEs) are irreversible macromolecules formed by nonenzymatic reactions due to chronic hyperglycemia. The aim of this study was to assess the relationship between AGEs and the microvascular complications of children and adolescents with type 1 diabetes mellitus (T1DM). MATERIALS AND METHODS Twenty-six T1DM patients with microvascular complications and 58 complication-naive patients who were similar regarding age, sex, and pubertal status enrolled in the study. Anthropometric, biochemical, ophthalmologic, and neurologic variables were compared with serum AGEs levels by the fluorescence method. RESULTS There was no significant difference observed between the patients with complications and those without complications in terms of serum levels of AGEs and other biochemical parameters. However, the duration of T1DM and urine microalbumin-creatinine ratio (uACR) were significantly higher in the complication-positive group (P < .001). Serum levels of AGEs were found to be similar when retinopathy, peripheral, and optic neuropathy were separately compared with the complication-naive group (P > .05). However, patients with nephropathy had significantly higher serum levels of AGEs than patients without complications (P = .023). In addition, there was a significant positive correlation between serum AGEs levels and uACR (P = .042) but not other parameters (P > .05). CONCLUSION This study is the first to evaluate the association between serum AGEs levels and microvascular complications in children and adolescents with T1DM. Our study highlights that serum AGEs levels are significantly correlated with nephropathy but not with retinopathy and neuropathy. Further long-term studies with a larger sample size are required to establish a better relationship between diabetic complications and AGEs. Cite this article as: Kırkgöz T, Acar S, Küme T, et al. Evaluation of serum advanced glycation end product levels and microvascular complications in children and adolescents with type 1 diabetes mellitus. Turk Arch Pediatr. 2024;59(1):31-37.
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Affiliation(s)
- Tarık Kırkgöz
- Department of Pediatric Endocrinology, Dr. Behçet Uz Children’s Education and Research Hospital, İzmir, Turkey
| | - Sezer Acar
- Department of Pediatric Endocrinology, Dr. Behçet Uz Children’s Education and Research Hospital, İzmir, Turkey
| | - Tuncay Küme
- Department of Medical Biochemistry, Dokuz Eylül University Faculty of Medicine, İzmir, Turkey
| | - Hatice Hilal Kırkgöz
- Department of Pediatric Neurology, Dr. Behçet Uz Children’s Education and Research Hospital, İzmir, Turkey
| | - Gülin Tabanlı
- Department of Pediatric Endocrinology, Dr. Behçet Uz Children’s Education and Research Hospital, İzmir, Turkey
| | - Özlem Nalbantoğlu
- Department of Pediatric Endocrinology, Dr. Behçet Uz Children’s Education and Research Hospital, İzmir, Turkey
| | - Ünsal Yılmaz
- Department of Pediatric Neurology, Dr. Behçet Uz Children’s Education and Research Hospital, İzmir, Turkey
| | - Aycan Ünalp
- Department of Pediatric Neurology, Dr. Behçet Uz Children’s Education and Research Hospital, İzmir, Turkey
| | - Behzat Özkan
- Department of Pediatric Endocrinology, Dr. Behçet Uz Children’s Education and Research Hospital, İzmir, Turkey
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Kırkgöz T, Gürsoy S, Acar S, Nalbantoğlu Ö, Özkaya B, Anıl Korkmaz H, Hazan F, Özkan B. Genetic diagnosis of congenital hypopituitarism in Turkish patients by a target gene panel: novel pathogenic variants in GHRHR, GLI2, LHX4 and POU1F1 genes. Arch Endocrinol Metab 2023; 68:e220254. [PMID: 37948564 PMCID: PMC10916835 DOI: 10.20945/2359-4292-2022-0254] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/04/2022] [Accepted: 05/02/2023] [Indexed: 11/12/2023]
Abstract
Objective Congenital hypopituitarism (CH) is a rare disease characterized by one or more hormone deficiencies of the pituitary gland. To date, many genes have been associated with CH. In this study, we identified the allelic variant spectrum of 11 causative genes in Turkish patients with CH. Materials and methods This study included 47 patients [21 girls (44.6%) and 26 boys (55.4%)] from 45 families. To identify the genetic etiology, we screened 11 candidate genes associated with CH using next-generation sequencing. To confirm and detect the status of the specific familial variant in relatives, Sanger sequencing was also performed. Results We identified 12 possible pathogenic variants in GHRHR, GH1, GLI2, PROP-1, POU1F1, and LHX4 in 11 patients (23.4%), of which six were novel variants: two in GHRHR, two in POU1F1, one in GLI2, and one in LHX4. In all patients, these variants were most frequently found in GLI2, followed by PROP-1 and GHRHR. Conclusion Genetic causes were determined in only 23.4% of all patients with CH and 63% of molecularly diagnosed patients (7/11) from consanguineous families. Despite advances in genetics, we were unable to identify the genetic etiology of most patients with CH, suggesting the effect of unknown genes or environmental factors. More genetic studies are necessary to understand the etiology of CH.
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Affiliation(s)
- Tarık Kırkgöz
- Division of Pediatric Endocrinology, Dr. Behçet Uz Children's Education and Research Hospital, Izmir, Turkey,
| | - Semra Gürsoy
- Division of Pediatric Genetics, Dr. Behçet Uz Children's Education and Research Hospital, Izmir, Turkey
| | - Sezer Acar
- Division of Pediatric Endocrinology, Dr. Behçet Uz Children's Education and Research Hospital, Izmir, Turkey
| | - Özlem Nalbantoğlu
- Division of Pediatric Endocrinology, Dr. Behçet Uz Children's Education and Research Hospital, Izmir, Turkey
| | - Beyhan Özkaya
- Division of Pediatric Endocrinology, Dr. Behçet Uz Children's Education and Research Hospital, Izmir, Turkey
| | - Hüseyin Anıl Korkmaz
- Division of Pediatric Endocrinology, Dr. Behçet Uz Children's Education and Research Hospital, Izmir, Turkey
| | - Filiz Hazan
- Department of Medical Genetics, Dr. Behçet Uz Children's Education and Research Hospital, Izmir, Turkey
| | - Behzat Özkan
- Division of Pediatric Endocrinology, Dr. Behçet Uz Children's Education and Research Hospital, Izmir, Turkey
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Köprülü Ö, Acar S, Erdoğan KM, Nalbantoğlu Ö, Kırkgöz T, Arslan G, Özkaya B, Kutbay YB, Özkan B. Distinctively Different Phenotypes of Two Cases with a Rare Karyotype of 45,X/47,XYY Mosaicism: Case Report and Literature Review. jpr 2022. [DOI: 10.4274/jpr.galenos.2022.36539] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
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Nalbantoğlu Ö, Hazan F, Acar S, Gürsoy S, Özkan B. Screening of non-syndromic early-onset child and adolescent obese patients in terms of LEP, LEPR, MC4R and POMC gene variants by next-generation sequencing. J Pediatr Endocrinol Metab 2022; 35:1041-1050. [PMID: 35801948 DOI: 10.1515/jpem-2022-0027] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/15/2022] [Accepted: 06/16/2022] [Indexed: 11/15/2022]
Abstract
OBJECTIVES Non-syndromic monogenic obesity is a rare cause of early-onset severe obesity in the childhood period. The aim of this study was to screen four obesity related genes (LEP, LEPR, MC4R and POMC) in children and adolescents who had severe, non-syndromic early onset obesity. METHODS Next-generation sequencing of all exons in LEP, LEPR, MC4R and POMC was performed in 154 children and adolescents with early onset severe obesity obesity. RESULTS Fifteen different variants in nineteen patients were identified with a variant detection rate of 12.3%. While six different heterozygous variants were observed in MC4R gene (10/154 patients; 6.5%), five different variants in POMC gene (four of them were heterozygous and one of them was homozygous) (6/154 patients; 3.9%) and four different homozygous variants in LEPR gene (3/154 patients; 1.9%) were described. However, no variants were detected in the LEP gene. The most common pathogenic variant was c.496G>A in MC4R gene, which was detected in four unrelated patients. Six novel variants (6/15 variants; 40%) were described in seven patients. Four of them including c.233C>A and c.752T>C in MC4R gene and c.761dup and c.1221dup in LEPR gene were evaluated as pathogenic or likely pathogenic. CONCLUSIONS In conclusion, MC4R variants are the most common genetic cause of monogenic early-onset obesity, consistent with the literature. The c.496G>A variant in MC4R gene is highly prevalent in early-onset obese patients.
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Affiliation(s)
- Özlem Nalbantoğlu
- Clinic of Pediatric Endocrinology, University of Health Sciences Turkey, Dr. BehçetUz Child Disease and Pediatric Surgery Training and Research Hospital, İzmir, Turkey
| | - Filiz Hazan
- Clinic of Medical Genetics, University of Health Sciences Turkey, Dr. BehçetUz Child Disease and Pediatric Surgery Training and Research Hospital, İzmir, Turkey
| | - Sezer Acar
- Clinic of Pediatric Endocrinology, University of Health Sciences Turkey, Dr. BehçetUz Child Disease and Pediatric Surgery Training and Research Hospital, İzmir, Turkey
| | - Semra Gürsoy
- Clinic of Pediatric Genetics, University of Health Sciences Turkey, Dr. BehçetUz Child Disease and Pediatric Surgery Training and Research Hospital, İzmir, Turkey
| | - Behzat Özkan
- Clinic of Pediatric Endocrinology, University of Health Sciences Turkey, Dr. BehçetUz Child Disease and Pediatric Surgery Training and Research Hospital, İzmir, Turkey
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Kırkgöz T, Özkan B, Hazan F, Acar S, Nalbantoğlu Ö, Özkaya B, Kulalı MA, Gürsoy S, Ikegawa S, Guo L. A Null Mutation of TNFRSF11A Causes Dysosteosclerosis, Not Osteopetrosis. Front Genet 2022; 13:938814. [PMID: 35812760 PMCID: PMC9263543 DOI: 10.3389/fgene.2022.938814] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2022] [Accepted: 06/06/2022] [Indexed: 11/15/2022] Open
Abstract
Dysosteosclerosis (DOS) is a rare sclerosing bone dysplasia characterized by unique osteosclerosis of the long tubular bones and platyspondyly. DOS is inherited in an autosomal recessive manner and is genetically and clinically heterogeneous. To date, four individuals with DOS who have five different TNFRSF11A mutations have been reported. Based on their data, it is hypothesized that mutations producing aberrant mutant RANK proteins (missense or truncated or elongated) cause DOS, while null mutations lead to osteopetrosis, autosomal recessive 7 (OPTB7). Herein, we present the fifth case of TNFRSF11A-associated DOS with a novel homozygous frame-shift mutation (c.19_31del; p.[Arg7CysfsTer172]). The mutation is predicted to cause nonsense mutation-mediated mRNA decay (NMD) in all RANK isoform transcripts, resulting in totally null allele. Our findings suggest genotype-phenotype relationship in TNFRSF11A-associated OPTB7 and DOS remains unclear, and that the deficiency of TNFRSF11A functions might cause DOS, rather than osteopetrosis. More data are necessary to understand the phenotypic spectrum caused by TNFRSF11A mutations.
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Affiliation(s)
- Tarık Kırkgöz
- Division of Pediatric Endocrinology, Dr. Behçet Uz Children’s Education and Research Hospital, Izmir, Turkey
| | - Behzat Özkan
- Division of Pediatric Endocrinology, Dr. Behçet Uz Children’s Education and Research Hospital, Izmir, Turkey
| | - Filiz Hazan
- Department of Medical Genetics, Dr. Behçet Uz Children’s Education and Research Hospital, Izmir, Turkey
| | - Sezer Acar
- Division of Pediatric Endocrinology, Dr. Behçet Uz Children’s Education and Research Hospital, Izmir, Turkey
- *Correspondence: Sezer Acar, ; Long Guo,
| | - Özlem Nalbantoğlu
- Division of Pediatric Endocrinology, Dr. Behçet Uz Children’s Education and Research Hospital, Izmir, Turkey
| | - Beyhan Özkaya
- Division of Pediatric Endocrinology, Dr. Behçet Uz Children’s Education and Research Hospital, Izmir, Turkey
| | - Melike Ataseven Kulalı
- Division of Pediatric Genetics, School of Medicine, Afyon Kocatepe University, Afyonkarahisar, Turkey
| | - Semra Gürsoy
- Division of Pediatric Genetics, Dr. Behçet Uz Children’s Education and Research Hospital, Izmir, Turkey
| | - Shiro Ikegawa
- Laboratory for Bone and Joint Diseases, RIKEN Center for Integrative Medical Sciences, Tokyo, Japan
| | - Long Guo
- Laboratory for Bone and Joint Diseases, RIKEN Center for Integrative Medical Sciences, Tokyo, Japan
- *Correspondence: Sezer Acar, ; Long Guo,
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Beyazgül G, Bağ Ö, Yurtseven İ, Coşkunol F, Başer S, Çiçek D, Kanberoğlu Gİ, Çelik F, Nalbantoğlu Ö, Özkan B. How Vitamin D Levels of Children Changed During COVID-19 Pandemic: A Comparison of Pre-pandemic and Pandemic Periods. J Clin Res Pediatr Endocrinol 2022; 14:188-195. [PMID: 35135185 PMCID: PMC9176086 DOI: 10.4274/jcrpe.galenos.2022.2021-10-6] [Citation(s) in RCA: 13] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/01/2022] Open
Abstract
OBJECTIVE The synthesis of vitamin D is related to sun exposure, thus the restrictions during the Coronavirus disease-2019 (COVID-19) pandemic may have affected the levels of vitamin D in all age groups. The aim of this study was to evaluate vitamin D levels of healthy children and adolescents during the first year of the pandemic. METHODS The study group included healthy children and adolescents who were admitted for general check-ups and evaluated with 25(OH)D levels. Then, it was divided into two groups: Group 1 “pre-pandemic”, and Group 2 “pandemic”. Vitamin D levels were recorded from the hospital database and were compared according to age groups, gender, and the season, retrospectively. RESULTS The study group [mean age=90.29±59.45 median age=79 interquartile range (IQR): 102 months, male/female: 1409/1624] included 3033 children and adolescents (Group 1/Group 2 n=1864/1169). Although the mean 25(OH)D levels among preschool children did not differ between groups, the vitamin D levels of school-aged children and adolescents were significantly lower in the pandemic period than in the pre-pandemic period [Group 1 median=16.50 (IQR: 10.5) vs Group 2 median=15.9 (IQR: 11.3) in 6-12 age group (p=0.026); Group 1 median=13.30 (IQR: 10.2) vs Group 2 median=11.20 (IQR: 9.7) in 12-18 age group (p=0.003)]. Moreover, the 25(OH)D levels of adolescents showed seasonal variance with lower levels in winter, and unexpectedly, in summer. CONCLUSION Pandemic-related restrictions have caused significant decreases in vitamin D levels of school-aged children and adolescents. We suggest that children and adolescents should be given vitamin D supplementation in order to maintain sufficient levels of vitamin D during the pandemic.
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Affiliation(s)
- Güler Beyazgül
- University of Health Sciences Turkey, Dr. Behçet Uz Pediatric Diseases and Surgery Training and Research Hospital, Clinic of General Pediatrics, İzmir, Turkey,* Address for Correspondence: University of Health Sciences Turkey, Dr. Behçet Uz Pediatric Diseases and Surgery Training and Research Hospital, Clinic of General Pediatrics, İzmir, Turkey Phone: +90 232 464 61 67 E-mail:
| | - Özlem Bağ
- University of Health Sciences Turkey, Dr. Behçet Uz Pediatric Diseases and Surgery Training and Research Hospital, Clinic of General Pediatrics, İzmir, Turkey
| | - İlkay Yurtseven
- University of Health Sciences Turkey, Dr. Behçet Uz Pediatric Diseases and Surgery Training and Research Hospital, Clinic of General Pediatrics, İzmir, Turkey
| | - Fulya Coşkunol
- University of Health Sciences Turkey, Dr. Behçet Uz Pediatric Diseases and Surgery Training and Research Hospital, Clinic of General Pediatrics, İzmir, Turkey
| | - Saynur Başer
- University of Health Sciences Turkey, Dr. Behçet Uz Pediatric Diseases and Surgery Training and Research Hospital, Clinic of General Pediatrics, İzmir, Turkey
| | - Duygu Çiçek
- University of Health Sciences Turkey, Dr. Behçet Uz Pediatric Diseases and Surgery Training and Research Hospital, Clinic of General Pediatrics, İzmir, Turkey
| | - Gül İrem Kanberoğlu
- University of Health Sciences Turkey, Dr. Behçet Uz Pediatric Diseases and Surgery Training and Research Hospital, Clinic of General Pediatrics, İzmir, Turkey
| | - Filiz Çelik
- University of Health Sciences Turkey, Dr. Behçet Uz Pediatric Diseases and Surgery Training and Research Hospital, Clinic of General Pediatrics, İzmir, Turkey
| | - Özlem Nalbantoğlu
- University of Health Sciences Turkey, Dr. Behçet Uz Pediatric Diseases and Surgery Training and Research Hospital, Clinic of Pediatric Endocrinology, İzmir, Turkey
| | - Behzat Özkan
- University of Health Sciences Turkey, Dr. Behçet Uz Pediatric Diseases and Surgery Training and Research Hospital, Clinic of Pediatric Endocrinology, İzmir, Turkey
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Acar S, Gürsoy S, Arslan G, Nalbantoğlu Ö, Hazan F, Köprülü Ö, Özkaya B, Özkan B. Screening of 23 candidate genes by next-generation sequencing of patients with permanent congenital hypothyroidism: novel variants in TG, TSHR, DUOX2, FOXE1, and SLC26A7. J Endocrinol Invest 2022; 45:773-786. [PMID: 34780050 DOI: 10.1007/s40618-021-01706-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/28/2021] [Accepted: 11/07/2021] [Indexed: 12/11/2022]
Abstract
PURPOSE To date, many genes have been associated with congenital hypothyroidism (CH). Our aim was to identify the mutational spectrum of 23 causative genes in Turkish patients with permanent CH, including thyroid dysgenesis (TD) and dyshormonogenesis (TDH) cases. METHODS A total of 134 patients with permanent CH (130 primary, 4 central) were included. To identify the genetic etiology, we screened 23 candidate genes associated with CH by next-generation sequencing. For confirmation and to detect the status of the specific familial variant in relatives, Sanger sequencing was also performed. RESULTS Possible pathogenic variants were found in 5.2% of patients with TD and in 64.0% of the patients with normal-sized thyroid or goiter. In all patients, variants were most frequently found in TSHR, followed by TPO and TG. The same homozygous TSHB variant (c.162 + 5G > A) was identified in four patients with central CH. In addition, we detected novel variants in the TSHR, TG, SLC26A7, FOXE1, and DUOX2. CONCLUSION Genetic causes were determined in the majority of CH patients with TDH, however, despite advances in genetics, we were unable to identify the genetic etiology of most CH patients with TD, suggesting the effect of unknown genes or environmental factors. The previous studies and our findings suggest that TSHR and TPO mutations is the main genetic defect of CH in the Turkish population.
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Affiliation(s)
- S Acar
- Division of Pediatric Endocrinology, Dr. Behçet Uz Children's Education and Research Hospital, İsmet Kaptan Mh, Sezer Doğan Sokağı No:11, 35210, Konak/Izmir, Turkey.
| | - S Gürsoy
- Division of Pediatric Genetics, Dr. Behçet Uz Children's Education and Research Hospital, Izmir, Turkey
| | - G Arslan
- Division of Pediatric Endocrinology, Dr. Behçet Uz Children's Education and Research Hospital, İsmet Kaptan Mh, Sezer Doğan Sokağı No:11, 35210, Konak/Izmir, Turkey
| | - Ö Nalbantoğlu
- Division of Pediatric Endocrinology, Dr. Behçet Uz Children's Education and Research Hospital, İsmet Kaptan Mh, Sezer Doğan Sokağı No:11, 35210, Konak/Izmir, Turkey
| | - F Hazan
- Department of Medical Genetics, Dr. Behçet Uz Children's Education and Research Hospital, Izmir, Turkey
| | - Ö Köprülü
- Division of Pediatric Endocrinology, Dr. Behçet Uz Children's Education and Research Hospital, İsmet Kaptan Mh, Sezer Doğan Sokağı No:11, 35210, Konak/Izmir, Turkey
| | - B Özkaya
- Division of Pediatric Endocrinology, Dr. Behçet Uz Children's Education and Research Hospital, İsmet Kaptan Mh, Sezer Doğan Sokağı No:11, 35210, Konak/Izmir, Turkey
| | - B Özkan
- Division of Pediatric Endocrinology, Dr. Behçet Uz Children's Education and Research Hospital, İsmet Kaptan Mh, Sezer Doğan Sokağı No:11, 35210, Konak/Izmir, Turkey
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Dündar İ, Akıncı A, Camtosun E, Çiftçi N, Kayas L, Nalbantoğlu Ö. Trend in initial presenting features of type 1 diabetes mellitus over a 24 year period in turkey: a retrospective analysis of 814 cases. Turk J Pediatr 2022; 64:40-48. [DOI: 10.24953/turkjped.2020.3580] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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Gökşen D, Yeşilkaya E, Özen S, Kor Y, Eren E, Korkmaz Ö, Berberoğlu M, Karagüzel G, Er E, Abacı A, Evliyaoğlu O, Akbaş ED, Ünal E, Bolu S, Nalbantoğlu Ö, Anık A, Tayfun M, Büyükinan M, Abalı S, Can Yılmaz G, Kör D, Söbü E, Şıklar Z, Polat R, Darcan Ş. Molecular Diagnosis of Monogenic Diabetes and Their Clinical/Laboratory Features in Turkish Children. J Clin Res Pediatr Endocrinol 2021; 13:433-438. [PMID: 34250910 PMCID: PMC8638634 DOI: 10.4274/jcrpe.galenos.2021.2021.0056] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/01/2022] Open
Abstract
OBJECTIVE Monogenic diabetes is a heterogeneous disease that causes functional problems in pancreatic beta cells and hyperglycemia. The aim of this study was to determine the clinical and laboratory features, the admission characteristics and distribution of monogenic form of diabetes in childhood in Turkey. METHODS Patients aged 0-18 years, who were molecularly diagnosed with monogenic diabetes, and consented to participate, were included in the study. RESULTS Seventy-seven (45.6%) female and 92 male cases with a mean age of 8.18±5.05 years at diagnosis were included. 52.7% of the cases were diagnosed with monogenic diabetes by random blood glucose measurement. The reason for genetic analysis in 95 (56.2%) of cases was having a family member diagnosed with diabetes under the age of 25. At the time of diagnosis, ketone was detected in urine in 16.6% of the cases. Mean hemoglobin A1c on admission, fasting blood glucose, fasting insulin, and c-peptide values were 7.3±2.1%, 184.9±128.9 mg/dL, 9.4±22.9 IU/L, 1.36±1.1 and ng/L respectively. GCK-MODY was found in 100 (59.2%), HNF1A-MODY in 31 (18.3%), and variants in ABCC8 in 6 (3.6%), KCNJ11 in 5 (3%), HNF4A in 2 (1.2%), and HNF1B in 2 (1.2%). CONCLUSION Recent studies have indicated HNF1A-MODY is the most frequent of all the MODY-monogenic diabetes cases in the literature (50%), while GCK-MODY is the second most frequent (32%). In contrast to these reports, in our study, the most common form was GCK-MODY while less than 20% of cases were diagnosed with HNF1A-MODY.
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Affiliation(s)
- Damla Gökşen
- Ege University Faculty of Medicine, Department of Pediatric Endocrinology, İzmir, Turkey,* Address for Correspondence: Ege University Faculty of Medicine, Department of Pediatric Endocrinology, İzmir, Turkey Phone: +90 232 390 12 30 E-mail:
| | - Ediz Yeşilkaya
- 19 Mayıs Hospital, Clinic of Pediatric Endocrinology, Ankara, Turkey
| | - Samim Özen
- Ege University Faculty of Medicine, Department of Pediatric Endocrinology, İzmir, Turkey
| | - Yılmaz Kor
- Adana City Training and Research Hospital, Clinic of Pediatric Endocrinology, Adana, Turkey
| | - Erdal Eren
- Bursa Uludağ University Faculty of Medicine, Department of Pediatric Endocrinology, Bursa, Turkey
| | - Özlem Korkmaz
- Başkent University Faculty of Medicine, Department of Pediatric Endocrinology, Ankara, Turkey
| | - Merih Berberoğlu
- Ankara University Faculty of Medicine, Department of Pediatric Endocrinology, Ankara, Turkey
| | - Gülay Karagüzel
- Karadeniz Technical University Faculty of Medicine, Department of Pediatric Endocrinology, Trabzon, Turkey
| | - Eren Er
- Ege University Faculty of Medicine, Department of Pediatric Endocrinology, İzmir, Turkey
| | - Ayhan Abacı
- Dokuz Eylül University Faculty of Medicine, Department of Pediatric Endocrinology, İzmir, Turkey
| | - Olcay Evliyaoğlu
- İstanbul University, İstanbul Faculty of Medicine, Department of Pediatric Endocrinology, İstanbul, Turkey
| | - Emine Demet Akbaş
- Adana City Training and Research Hospital, Clinic of Pediatric Endocrinology, Adana, Turkey
| | - Edip Ünal
- Dicle University Faculty of Medicine, Department of Pediatric Endocrinology, Diyarbakır, Turkey
| | - Semih Bolu
- Adıyaman University Training and Research Hospital, Clinic of Pediatric Endocrinology, Adıyaman, Turkey
| | - Özlem Nalbantoğlu
- University of Health Sciences Turkey, Dr. Behçet Uz Children’s Diseases and Surgery Training and Research Hospital, Clinic of Pediatric Endocrinology, İzmir, Turkey
| | - Ahmet Anık
- Aydın Adnan Menderes University Faculty of Medicine, Department of Pediatric Endocrinology, Aydın, Turkey
| | - Meltem Tayfun
- Lokman Hekim University Faculty of Medicine, Department of Pediatric Endocrinology, Ankara, Turkey
| | - Muammer Büyükinan
- Konya Training and Research Hospital, Clinic of Pediatric Endocrinology, Konya, Turkey
| | - Saygın Abalı
- Acıbadem University Faculty of Medicine, Department of Pediatric Endocrinology, İstanbul, Turkey
| | - Gülay Can Yılmaz
- Mardin Public Hospital, Clinic of Pediatric Endocrinology, Mardin, Turkey
| | - Deniz Kör
- Çukurova University Faculty of Medicine, Department of Pediatrics Nutrition and Metabolic Diseases, Adana, Turkey
| | - Elif Söbü
- İstanbul Kartal Dr. Lütfi Kırdar City Hospital, Clinic of Pediatric Endocrinology, İstanbul, Turkey
| | - Zeynep Şıklar
- Ankara University Faculty of Medicine, Department of Pediatric Endocrinology, Ankara, Turkey
| | - Recep Polat
- Sakarya Training and Research Hospital, Clinic of Pediatric Endocrinology, Sakarya, Turkey
| | - Şükran Darcan
- Ege University Faculty of Medicine, Department of Pediatric Endocrinology, İzmir, Turkey
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Nalbantoğlu Ö, Acar S, Arslan G, Köprülü Ö, Özkan B. Investigating the Efficiency of Vitamin D Administration with Buccal Spray in the Treatment of Vitamin D Deficiency in Children and Adolescents. J Clin Res Pediatr Endocrinol 2021; 13:426-432. [PMID: 34109778 PMCID: PMC8638631 DOI: 10.4274/jcrpe.galenos.2021.2021.0047] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/01/2022] Open
Abstract
OBJECTIVE The aim of this study was to evaluate the efficiency of a buccal spray form of vitamin D compared to single oral dose (stoss therapy) and oral drops therapy in the treatment of vitamin D deficiency. METHODS Ninety healthy children and adolescents (3-18 years) with vitamin D deficiency [serum level of 25-hydroxyvitamin D (25(OH) D) <12 ng/mL] were randomized to receive vitamin D3 buccal spray (2000 U, n=30, group 1) for six weeks, oral drops (2000 U, n=30, group 2) for six weeks and a single oral dose (300 000 U) vitamin D3 (n=30, group 3). Serum calcium, phosphorus, alkaline phosphatase, parathyroid hormone and 25(OH)D levels of the patients were measured at baseline and after the treatment on the 42nd day. RESULTS All three groups had a significant increase in serum 25(OH)D concentrations (p<0.001). In group 1, baseline mean 25(OH)D was 8.0±0.41 ng/mL, which rose to 22.1 (17.8-28.2) ng/mL after treatment with a mean increase of 15.6±1.3 ng/mL. Similarly in group 2, baseline, post-treatment and mean increase in 25(OH)D concentrations were 7.9±0.45 ng/mL, 24.4 (20.6-29.6) ng/mL and 17.3±1.1 ng/mL while for group 3 these values were 7.6±0.47 ng/mL, 40.3 (29.4-58.4) ng/mL and 34.3±3.2 ng/mL, respectively. CONCLUSION We conclude that vitamin D3 supplementation with buccal spray and oral drops is equally effective in terms of raising vitamin D concentrations in short-term treatment of vitamin D deficiency.
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Affiliation(s)
- Özlem Nalbantoğlu
- University of Health Sciences Turkey, Dr. Behçet Uz Child Diseases and Pediatric Surgery Training and Research Hospital, Clinic of Pediatric Endocrinology, İzmir, Turkey,* Address for Correspondence: University of Health Sciences Turkey, Dr. Behçet Uz Child Disease and Pediatric Surgery Training and Research Hospital, Clinic of Pediatric Endocrinology, İzmir, Turkey Phone: +90 506 594 40 40 E-mail:
| | - Sezer Acar
- University of Health Sciences Turkey, Dr. Behçet Uz Child Diseases and Pediatric Surgery Training and Research Hospital, Clinic of Pediatric Endocrinology, İzmir, Turkey
| | - Gülçin Arslan
- University of Health Sciences Turkey, Dr. Behçet Uz Child Diseases and Pediatric Surgery Training and Research Hospital, Clinic of Pediatric Endocrinology, İzmir, Turkey
| | - Özge Köprülü
- University of Health Sciences Turkey, Dr. Behçet Uz Child Diseases and Pediatric Surgery Training and Research Hospital, Clinic of Pediatric Endocrinology, İzmir, Turkey
| | - Behzat Özkan
- University of Health Sciences Turkey, Dr. Behçet Uz Child Diseases and Pediatric Surgery Training and Research Hospital, Clinic of Pediatric Endocrinology, İzmir, Turkey
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12
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Acar S, Schlingmann KP, Nalbantoğlu Ö, Köprülü Ö, Arslan G, Özkaya B, Özkan B. A novel synonymous homozygous variant [c.2538G>A (p.Thr846Thr)] in TRPM6 in a patient with hypomagnesemia with secondary hypocalcemia. J Pediatr Endocrinol Metab 2021; 34:1481-1486. [PMID: 34261199 DOI: 10.1515/jpem-2021-0165] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/09/2021] [Accepted: 06/20/2021] [Indexed: 11/15/2022]
Abstract
OBJECTIVES Hypomagnesemia 1, intestinal (HOMG1) is characterized by neurological symptoms that occur due to hypocalcemia and hypomagnesemia and caused by mutations in the TRPM6. Most of the identified variants in TRPM6 lead to premature termination: nonsense, frameshift, deletion, and splice site mutations. CASE PRESENTATION Herein, we report a 1.5 month-old case who presented with convulsion due to hypocalcemia and hypomagnesemia in the early infancy. Sequencing of TRPM6 revealed a novel homozygous synonymous variant [c.2538G > A (p.Thr846Thr)] in the last codon of exon 19, which is most likely to affect the splicing. We report a novel homozygous synonymous variant in the TRPM6 leading to HOMG1, expanding the mutational spectrum. CONCLUSIONS Synonymous mutations that were previously considered as harmless should be evaluated at the nucleotide level, keeping in mind that they may affect splicing and cause to the disease.
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Affiliation(s)
- Sezer Acar
- Division of Pediatric Endocrinology, Dr. Behçet Uz Children's Education and Research Hospital, Izmir, Turkey
| | | | - Özlem Nalbantoğlu
- Division of Pediatric Endocrinology, Dr. Behçet Uz Children's Education and Research Hospital, Izmir, Turkey
| | - Özge Köprülü
- Division of Pediatric Endocrinology, Dr. Behçet Uz Children's Education and Research Hospital, Izmir, Turkey
| | - Gülçin Arslan
- Division of Pediatric Endocrinology, Dr. Behçet Uz Children's Education and Research Hospital, Izmir, Turkey
| | - Beyhan Özkaya
- Division of Pediatric Endocrinology, Dr. Behçet Uz Children's Education and Research Hospital, Izmir, Turkey
| | - Behzat Özkan
- Division of Pediatric Endocrinology, Dr. Behçet Uz Children's Education and Research Hospital, Izmir, Turkey
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13
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Acar S, Nalbantoğlu Ö, Gürsoy S, Özkaya B, Köprülü Ö, Arslan G, Hazan F, Özkan B. Identification of two AMH gene variants in two unrelated patients with persistent Müllerian duct syndrome: one novel variant. Gynecol Endocrinol 2021; 37:476-479. [PMID: 33787423 DOI: 10.1080/09513590.2021.1908253] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/21/2022] Open
Abstract
INTRODUCTION Persistent müllerian duct syndrome (PMDS) is a rare form of 46, XY disorder of sex development characterized by the persistence of the müllerian structures (uterus, fallopian tubes, the upper part of the vagina) in phenotypically and genotypically normal males. This disease occurs as a result of impairment in the synthesis, release or effect of anti-Müllerian hormone (AMH) during the embryonic period. Approximately 85-88% of PMDS cases have been reported to have AMH or AMHRII mutation. CASE Herein, we report two PMDS cases from unrelated two families who presented with bilateral undescended testes, persistence of müllerian remnants, and low/undetectable serum AMH levels. Molecular genetic analysis revealed two homozygous variants in AMH. The first one is a novel missense variant (c.1315C > T), the latter is a frameshift variant caused by a deletion (c.343_344delCT), which is less frequently reported type in AMH. CONCLUSION The diagnosis of PMDS should be kept in mind in patients with externally normal males, bilateral cryptorchidism, and signs of müllerian remnants on laparoscopy.
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Affiliation(s)
- Sezer Acar
- Division of Pediatric Endocrinology, Dr. Behçet Uz Children's Education and Research Hospital, Izmir, Turkey
| | - Özlem Nalbantoğlu
- Division of Pediatric Endocrinology, Dr. Behçet Uz Children's Education and Research Hospital, Izmir, Turkey
| | - Semra Gürsoy
- Division of Pediatric Genetics, Dr. Behçet Uz Children's Education and Research Hospital, Izmir, Turkey
| | - Beyhan Özkaya
- Division of Pediatric Endocrinology, Dr. Behçet Uz Children's Education and Research Hospital, Izmir, Turkey
| | - Özge Köprülü
- Division of Pediatric Endocrinology, Dr. Behçet Uz Children's Education and Research Hospital, Izmir, Turkey
| | - Gülçin Arslan
- Division of Pediatric Endocrinology, Dr. Behçet Uz Children's Education and Research Hospital, Izmir, Turkey
| | - Filiz Hazan
- Department of Medical Genetics, Dr. Behçe Uz Children's Education and Research Hospital, Izmir, Turkey
| | - Behzat Özkan
- Division of Pediatric Endocrinology, Dr. Behçet Uz Children's Education and Research Hospital, Izmir, Turkey
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Yılmaz Ü, Nalbantoğlu Ö, Güzin Y, Edizer S, Akışin Z, Pekuz S, Kırkgöz HH, Yavuz M, Ünalp A, Özkan B. The effect of ketogenic diet on thyroid functions in children with drug-resistant epilepsy. Neurol Sci 2021; 42:5261-5269. [PMID: 33846882 DOI: 10.1007/s10072-021-05225-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2021] [Accepted: 03/24/2021] [Indexed: 11/28/2022]
Abstract
BACKGROUND Ketogenic diet (KD) remains a valuable treatment option for children with drug-resistant epilepsy. However, it may cause many well-known adverse effects such as dyslipidemia or kidney stones. But, its effects on thyroid functions are largely unknown. PURPOSE The aim of this study was to investigate the effects of the KD on thyroid functions in children with drug-resistant epilepsy. METHOD A total of 66 children (35 females) aged 3-193 months (median, 52 months) with drug-resistant epilepsy who received a KD for at least 12 months were enrolled in the study. All children were started on KD with 3:1 ratio which was then adjusted as clinically necessary. Serum free-thyroxine (FT4) and thyroid stimulating hormone (TSH) concentrations were measured before starting treatment and at the first, sixth and twelfth months of treatment. Changes in FT4 and TSH concentrations over 12 months were analyzed. RESULTS Median serum FT4 and TSH concentrations, and the frequencies of patients with low FT4 and high TSH concentrations did not change significantly in the study sample over the 12-month study period. Serum FT4 levels increased significantly and TSH concentrations decreased insignificantly in four patients receiving L-thyroxine replacement therapy. During the 12-month treatment period, BMI-SDS increased, and the number of antiepileptic drugs decreased significantly. CONCLUSION It appears that KD therapy does not impair thyroid functions in children with drug-resistant epilepsy. KD can be used safely along with L-thyroxine replacement even in children with pre-existing subclinical hypothyroidism.
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Affiliation(s)
- Ünsal Yılmaz
- Pediatric Neurology Department, Health Sciences University Dr. Behçet Uz Children's Education and Research Hospital, Alsancak, 35210, Izmir, Turkey.
| | - Özlem Nalbantoğlu
- Pediatric Endocrinology Department, Health Sciences University Dr. Behçet Uz Children's Education and Research Hospital, Izmir, Turkey
| | - Yiğithan Güzin
- Pediatric Neurology Department, Health Sciences University Dr. Behçet Uz Children's Education and Research Hospital, Alsancak, 35210, Izmir, Turkey
| | - Selvinaz Edizer
- Pediatric Neurology Department, Health Sciences University Dr. Behçet Uz Children's Education and Research Hospital, Alsancak, 35210, Izmir, Turkey
| | - Zeynep Akışin
- Nutrition and Dietetics Department, Health Sciences University Dr. Behçet Uz Children's Education and Research Hospital, Izmir, Turkey
| | - Serdar Pekuz
- Pediatric Neurology Department, Health Sciences University Dr. Behçet Uz Children's Education and Research Hospital, Alsancak, 35210, Izmir, Turkey
| | - Hatice Hilal Kırkgöz
- Pediatric Neurology Department, Health Sciences University Dr. Behçet Uz Children's Education and Research Hospital, Alsancak, 35210, Izmir, Turkey
| | - Merve Yavuz
- Pediatric Neurology Department, Health Sciences University Dr. Behçet Uz Children's Education and Research Hospital, Alsancak, 35210, Izmir, Turkey
| | - Aycan Ünalp
- Pediatric Neurology Department, Health Sciences University Dr. Behçet Uz Children's Education and Research Hospital, Alsancak, 35210, Izmir, Turkey
| | - Behzat Özkan
- Pediatric Endocrinology Department, Health Sciences University Dr. Behçet Uz Children's Education and Research Hospital, Izmir, Turkey
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Gürsoy S, Hazan F, Aykut A, Nalbantoğlu Ö, Korkmaz HA, Demir K, Özkan B, Çoğulu Ö. Detection of SHOX Gene Variations in Patients with Skeletal Abnormalities with or without Short Stature. J Clin Res Pediatr Endocrinol 2020; 12:358-365. [PMID: 32295321 PMCID: PMC7711637 DOI: 10.4274/jcrpe.galenos.2020.2019.0001] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/01/2022] Open
Abstract
OBJECTIVE SHOX gene mutations constitute one of the genetic causes of short stature. The clinical phenotype includes variable degrees of growth impairment, such as Langer mesomelic dysplasia (LMD), Léri-Weill dyschondrosteosis (LWD) or idiopathic short stature (ISS). The aim of this study was to describe the clinical features and molecular results of SHOX deficiency in a group of Turkish patients who had skeletal findings with and without short stature. METHODS Forty-six patients with ISS, disproportionate short stature or skeletal findings without short stature from 35 different families were included. SHOX gene analysis was performed using Sanger sequencing and multiplex ligation-dependent probe amplification analysis. RESULTS Three different point mutations (two nonsense, one frameshift) and one whole SHOX gene deletion were detected in 15 patients from four different families. While 4/15 patients had LMD, the remaining patients had clinical features compatible with LWD. Madelung’s deformity, cubitus valgus, muscular hypertrophy and short forearm were the most common phenotypic features, as well as short stature. Additionally, hearing loss was detected in two patients with LMD. CONCLUSION This study has presented the clinical spectrum and molecular findings of 15 patients with SHOX gene mutations or deletions. SHOX deficiency should be especially considered in patients who have disproportionate short stature or forearm anomalies with or without short stature. Although most of the patients had partial or whole gene deletions, SHOX gene sequencing should be performed in suspected cases. Furthermore, conductive hearing loss may rarely accompany these clinical manifestations.
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Affiliation(s)
- Semra Gürsoy
- University of Health Sciences Turkey, Dr. Behçet Uz Child Disease and Pediatric Surgery Training and Research Hospital, Clinic of Pediatric Genetics, İzmir, Turkey,* Address for Correspondence: University of Health Sciences Turkey, Dr. Behçet Uz Child Disease and Pediatric Surgery Training and Research Hospital, Clinic of Pediatric Genetics, İzmir, Turkey Phone: +90 232 411 36 19 E-mail:
| | - Filiz Hazan
- University of Health Sciences Turkey, Dr. Behçet Uz Child Disease and Pediatric Surgery Training and Research Hospital, Clinic of Medical Genetics, İzmir, Turkey
| | - Ayça Aykut
- Ege University Faculty of Medicine, Department of Medical Genetics, İzmir, Turkey
| | - Özlem Nalbantoğlu
- University of Health Sciences Turkey, Dr. Behçet Uz Child Disease and Pediatric Surgery Training and Research Hospital, Clinic of Pediatric Endocrinology, İzmir, Turkey
| | | | - Korcan Demir
- Dokuz Eylül University Faculty of Medicine, Department of Pediatric Endocrinology, İzmir, Turkey
| | - Behzat Özkan
- University of Health Sciences Turkey, Dr. Behçet Uz Child Disease and Pediatric Surgery Training and Research Hospital, Clinic of Pediatric Endocrinology, İzmir, Turkey
| | - Özgür Çoğulu
- Ege University Faculty of Medicine, Department of Pediatric Genetics, İzmir, Turkey
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16
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Nalbantoğlu Ö, Arslan G, Köprülü Ö, Hazan F, Gürsoy S, Özkan B. Three Siblings with Idiopathic Hypogonadotropic Hypogonadism in a Nonconsanguineous Family: A Novel KISS1R/GPR54 Loss-of-Function Mutation. J Clin Res Pediatr Endocrinol 2019; 11:444-448. [PMID: 30905142 PMCID: PMC6878343 DOI: 10.4274/jcrpe.galenos.2019.2018.0230] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/19/2022] Open
Abstract
Idiopathic hypogonadotropic hypogonadism (IHH) is a rare disease caused by defects in the secretion of gonadotropin releasing hormone (GnRH) or the action of GnRH on the pituitary gonadotrophes. KISS1R is one of the genes which, when mutated, cause IHH and mutations of this gene are responsible for about 2-5% of patients with normosmic IHH (NIHH). In this report, we present three siblings with NIHH due to a compound heterozygous KISS1R mutation. Genetic studies were carried out in the 14 year old index case with IHH and three siblings, two of whom were prepubertal. Genomic DNA was extracted from peripheral leukocytes and KISS1R gene was sequenced by using standard polymerase chain reaction amplification procedures. In molecular analysis of the index case, a compound heterozygous mutation was determined in KISS1R gene c.969C>A (p.Y323X) (known pathogenic) and c.170T>C (p.L57P) (novel). Mutation c.170T>C (p.L57P) was inherited from the mother while c.969C>A (p.Y323X) was inherited from the father. The same genotype was also found in two of the three siblings. A compound heterozygous mutation of the KISS1 gene, including one novel mutation, was found to cause NIHH and also incomplete puberty in a non-consanguineous family.
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Affiliation(s)
- Özlem Nalbantoğlu
- Dr. Behçet Uz Pediatric Diseases and Surgery Training and Research Hospital, Clinic of Pediatric Endocrinology, İzmir, Turkey
| | - Gülçin Arslan
- Dr. Behçet Uz Pediatric Diseases and Surgery Training and Research Hospital, Clinic of Pediatric Endocrinology, İzmir, Turkey,* Address for Correspondence: Dr. Behçet Uz Pediatric Diseases and Surgery Training and Research Hospital, Clinic of Pediatric Endocrinology, İzmir, Turkey Phone: +90 555 811 95 77 E-mail:
| | - Özge Köprülü
- Dr. Behçet Uz Pediatric Diseases and Surgery Training and Research Hospital, Clinic of Pediatric Endocrinology, İzmir, Turkey
| | - Filiz Hazan
- Dr. Behçet Uz Pediatric Diseases and Surgery Training and Research Hospital, Clinic of Pediatric Genetics, İzmir, Turkey
| | - Semra Gürsoy
- Dr. Behçet Uz Pediatric Diseases and Surgery Training and Research Hospital, Clinic of Pediatric Genetics, İzmir, Turkey
| | - Behzat Özkan
- Dr. Behçet Uz Pediatric Diseases and Surgery Training and Research Hospital, Clinic of Pediatric Endocrinology, İzmir, Turkey
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Hatun S, Yesiltepe Mutlu G, Cinaz P, Turan S, Ekberzade A, Bereket A, Erbas MY, Akcay T, Onal H, Bolu S, Arslanoglu I, Doger E, Yilmaz AA, Ucakturk A, Karabulut GS, Tuhan HÜ, Demir K, Erdeve SS, Aycan Z, Nalbantoğlu Ö, Kara C, Gungor N. Characteristics of Turkish children with Type 2 diabetes at onset: a multicentre, cross-sectional study. Diabet Med 2019; 36:1243-1250. [PMID: 31099079 DOI: 10.1111/dme.14038] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 05/15/2019] [Indexed: 12/30/2022]
Abstract
AIMS To describe the baseline clinical and laboratory findings and treatment modalities of 367 children and adolescents diagnosed with Type 2 diabetes in various paediatric endocrinology centres in Turkey. METHODS A standard questionnaire regarding clinical and laboratory characteristics at onset was uploaded to an online national database system. Data for 367 children (aged 6-18 years) newly diagnosed with Type 2 diabetes at 37 different paediatric endocrinology centres were analysed. RESULTS After exclusion of the children with a BMI Z-score < 1 SD, those with genetic syndromes associated with Type 2 diabetes, and those whose C-peptide and/or insulin levels were not available, 227 cases were included in the study. Mean age was 13.8 ± 2.2 (range 6.5-17.8) years, with female preponderance (68%). Family history of Type 2 diabetes was positive in 86% of the children. The mean BMI was 31.3 ± 6.5 kg/m2 (range 18.7-61) and BMI Z-score was 2.4 ± 0.8 (range 1-5). More than half (57%) of the children were identified by an opportunistic diabetes screening due to existing risk markers without typical symptoms of diabetes. Only 13% (n = 29) were treated solely by lifestyle modification, while 40.5% (n = 92) were treated with metformin, 13% (n = 30) were treated with insulin, and 33.5% (n = 76) were treated with a combination of insulin and metformin initially. Mean HbA1C levels of the insulin and combination of insulin and metformin groups were 98 (11.1%) and 102 mmol/mol (11.5%), respectively, and also were significantly higher than the lifestyle modification only and metformin groups mean HbA1C levels (70(8.6%) and 67 mmol/mol (8.3%), respectively). CONCLUSIONS An opportunistic screening of children who are at high risk of Type 2 diabetes is essential, as our data showed that > 50% of the children were asymptomatic at diagnosis. The other important result of our study was the high rate of exclusion from the initial registration (38%), suggesting that accurate diagnosis of Type 2 diabetes in youth is still problematic, even for paediatric endocrinologists.
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Affiliation(s)
- S Hatun
- Koç University School of Medicine, Division of Pediatric Endocrinology and Diabetes, Turkey
| | - G Yesiltepe Mutlu
- Koç University School of Medicine, Division of Pediatric Endocrinology and Diabetes, Turkey
| | - P Cinaz
- Gazi University, School of Medicine, Division of Pediatric Endocrinology and Diabetes, Turkey
| | - S Turan
- Marmara University, School of Medicine, Division of Pediatric Endocrinology and Diabetes, Turkey
| | - A Ekberzade
- Marmara University, School of Medicine, Division of Pediatric Endocrinology and Diabetes, Turkey
| | - A Bereket
- Marmara University, School of Medicine, Division of Pediatric Endocrinology and Diabetes, Turkey
| | - M Y Erbas
- Kanuni Sultan Suleyman Training and Research Hospital, Turkey
| | - T Akcay
- Kanuni Sultan Suleyman Training and Research Hospital, Turkey
- Istinye University, Medical Park Gaziosmanpasa Hospital, Pediatric Endocrinology Unit, Turkey
| | - H Onal
- Kanuni Sultan Suleyman Training and Research Hospital, Turkey
| | - S Bolu
- Düzce University, Faculty of Medicine, Division of Pediatric Endocrinology and Diabetes, Turkey
| | - I Arslanoglu
- Düzce University, Faculty of Medicine, Division of Pediatric Endocrinology and Diabetes, Turkey
| | - E Doger
- Gazi University, School of Medicine, Division of Pediatric Endocrinology and Diabetes, Turkey
| | - A A Yilmaz
- University of Health Sciences, Dr. Sami Ulus Obstetrics and Gynecology, Children's Health and Disease Training and Research Hospital, Clinic of Pediatric Endocrinology, Turkey
- University of Health Sciences, Ankara Child Health and Diseases Hematology Oncology Training and Research Hospital, Department of Pediatric Endocrinology, Turkey
| | - A Ucakturk
- University of Health Sciences, Ankara Child Health and Diseases Hematology Oncology Training and Research Hospital, Department of Pediatric Endocrinology, Turkey
| | - G S Karabulut
- Kocaeli University, Faculty of Medicine, Division of Pediatric Endocrinology and Diabetes, Turkey
| | - H Ü Tuhan
- Dokuz Eylül Faculty of Medicine, Division of Pediatric Endocrinology and Diabetes, Turkey
| | - K Demir
- Dokuz Eylül Faculty of Medicine, Division of Pediatric Endocrinology and Diabetes, Turkey
| | - S S Erdeve
- University of Health Sciences, Dr. Sami Ulus Obstetrics and Gynecology, Children's Health and Disease Training and Research Hospital, Clinic of Pediatric Endocrinology, Turkey
| | - Z Aycan
- University of Health Sciences, Dr. Sami Ulus Obstetrics and Gynecology, Children's Health and Disease Training and Research Hospital, Clinic of Pediatric Endocrinology, Turkey
| | - Ö Nalbantoğlu
- University of Health Sciences, Dr. Behçet Uz Children Diseases and Surgery Training and Research Hospital, Department of Pediatric Endocrinology, Turkey
| | - C Kara
- Ondokuz Mayıs University, Faculty of Medicine, Department of Pediatric Endocrinology and Diabetes, Turkey
| | - N Gungor
- Department of Pediatrics, Division of Endocrinology, Louisiana State University Health Sciences Center, Shreveport, LA, USA
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Abacı A, Çatlı G, Kırbıyık Ö, Şahin NM, Abalı ZY, Ünal E, Şıklar Z, Mengen E, Özen S, Güran T, Kara C, Yıldız M, Eren E, Nalbantoğlu Ö, Güven A, Çayır A, Akbaş ED, Kor Y, Çürek Y, Aycan Z, Baş F, Darcan Ş, Berberoğlu M. Genotype-phenotype correlation, gonadal malignancy risk, gender preference, and testosterone/dihydrotestosterone ratio in steroid 5-alpha-reductase type 2 deficiency: a multicenter study from Turkey. J Endocrinol Invest 2019; 42:453-470. [PMID: 30132287 DOI: 10.1007/s40618-018-0940-y] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/07/2018] [Accepted: 08/06/2018] [Indexed: 01/09/2023]
Abstract
BACKGROUND Studies regarding genetic and clinical characteristics, gender preference, and gonadal malignancy rates for steroid 5-alpha-reductase type 2 deficiency (5α-RD2) are limited and they were conducted on small number of patients. OBJECTIVE To present genotype-phenotype correlation, gonadal malignancy risk, gender preference, and diagnostic sensitivity of serum testosterone/dihydrotestosterone (T/DHT) ratio in patients with 5α-RD2. MATERIALS AND METHODS Patients with variations in the SRD5A2 gene were included in the study. Demographic characteristics, phenotype, gender assignment, hormonal tests, molecular genetic data, and presence of gonadal malignancy were evaluated. RESULTS A total of 85 patients were included in the study. Abnormality of the external genitalia was the most dominant phenotype (92.9%). Gender assignment was male in 58.8% and female in 29.4% of the patients, while it was uncertain for 11.8%. Fourteen patients underwent bilateral gonadectomy, and no gonadal malignancy was detected. The most frequent pathogenic variants were p.Ala65Pro (30.6%), p.Leu55Gln (16.5%), and p.Gly196Ser (15.3%). The p.Ala65Pro and p.Leu55Gln showed more undervirilization than the p.Gly196Ser. The diagnostic sensitivity of stimulated T/DHT ratio was higher than baseline serum T/DHT ratio, even in pubertal patients. The cut-off values yielding the best sensitivity for stimulated T/DHT ratio were ≥ 8.5 for minipuberty, ≥ 10 for prepuberty, and ≥ 17 for puberty. CONCLUSION There is no significant genotype-phenotype correlation in 5α-RD2. Gonadal malignancy risk seems to be low. If genetic analysis is not available at the time of diagnosis, stimulated T/DHT ratio can be useful, especially if different cut-off values are utilized in accordance with the pubertal status.
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Affiliation(s)
- A Abacı
- Department of Pediatric Endocrinology, Faculty of Medicine, Dokuz Eylül University, Balcova, 35340, Izmir, Turkey.
| | - G Çatlı
- Department of Pediatric Endocrinology, Faculty of Medicine, İzmir Katip Çelebi University, Izmir, Turkey
| | - Ö Kırbıyık
- Division of Genetics, Tepecik Training and Research Hospital, Sağlık Bilimleri University, Izmir, Turkey
| | - N M Şahin
- Department of Pediatric Endocrinology, Faculty of Medicine and Dr Sami Ulus Woman Health and Children Research Hospital, Yıldırım Beyazıt University, Ankara, Turkey
| | - Z Y Abalı
- Department of Pediatric Endocrinology, Faculty of Medicine, İstanbul University, İstanbul, Turkey
| | - E Ünal
- Department of Pediatric Endocrinology, Faculty of Medicine, Dicle University, Diyarbakır, Turkey
| | - Z Şıklar
- Department of Pediatric Endocrinology, Faculty of Medicine, Ankara University, Ankara, Turkey
| | - E Mengen
- Department of Pediatric Endocrinology, Faculty of Medicine, Çukurova University, Adana, Turkey
| | - S Özen
- Department of Pediatric Endocrinology, Faculty of Medicine, Ege University, Izmir, Turkey
| | - T Güran
- Department of Pediatric Endocrinology, Faculty of Medicine, Marmara University, İstanbul, Turkey
| | - C Kara
- Department of Pediatric Endocrinology, Faculty of Medicine, Ondokuz Mayıs University, Samsun, Turkey
| | - M Yıldız
- Division of Pediatric Endocrinology, Kanuni Sultan Süleyman Training and Research Hospital, İstanbul, Turkey
| | - E Eren
- Department of Pediatric Endocrinology, Faculty of Medicine, Uludağ University, Bursa, Turkey
| | - Ö Nalbantoğlu
- Division of Pediatric Endocrinology, Dr. Behcet Uz Children's Hospital, Izmir, Turkey
| | - A Güven
- Department of Pediatric Endocrinology, Göztepe Training and Research Hospital, İstanbul, Turkey
- Department of Pediatric Endocrinology, Faculty of Medicine, Amasya University, Amasya, Turkey
| | - A Çayır
- Division of Pediatric Endocrinology, Erzurum Training and Research Hospital, Erzurum, Turkey
| | - E D Akbaş
- Department of Pediatric Endocrinology, Faculty of Medicine, Gazi University, Ankara, Turkey
| | - Y Kor
- Department of Pediatric Endocrinology, Numune Training and Research Hospital, Sağlık Bilimleri University, Adana, Turkey
| | - Y Çürek
- Department of Pediatric Endocrinology, Sağlık Bilimleri University Antalya Training and Research Hospital, Antalya, Turkey
| | - Z Aycan
- Department of Pediatric Endocrinology, Faculty of Medicine and Dr Sami Ulus Woman Health and Children Research Hospital, Yıldırım Beyazıt University, Ankara, Turkey
| | - F Baş
- Department of Pediatric Endocrinology, Faculty of Medicine, İstanbul University, İstanbul, Turkey
| | - Ş Darcan
- Department of Pediatric Endocrinology, Faculty of Medicine, Ege University, Izmir, Turkey
| | - M Berberoğlu
- Department of Pediatric Endocrinology, Faculty of Medicine, Ankara University, Ankara, Turkey
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Abstract
Rabson-Mendenhall syndrome (RMS) is an autosomal recessive disorder due to mutations in the insulin receptor gene (INSR) which is mapped to 19p13.2. RMS is characterized by acanthosis nigricans, generalized lanugo, tooth and nail dysplasia, high nasal bridge, and growth retardation. A 5-year-old female patient was referred due to acanthosis nigricans and generalized lanugo. On her physical examination, severe acanthosis nigricans of the neck, axillae, the external genitalia and antecubital regions, generalized lanugo, mildly decreased subcutaneous fat, dysmorphic facial features, and polydactyly on her left hand were noted. Insulin resistance and impaired glucose tolerance were found. Sequence analysis of the INSR in the patient revealed c.3529+5G>A mutation in homozygous state. RMS should be suspected in a patient with characteristic physical features and insulin resistance.
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Affiliation(s)
- Hale Tuhan
- Dokuz Eylül University Faculty of Medicine, Department of Pediatric Endocrinology, İzmir, Turkey
| | | | - Özlem Nalbantoğlu
- University of Health Sciences, Dr. Behçet Uz Children Diseases and Surgery Training and Research Hospital, Department of Pediatric Endocrinology, İzmir, Turkey
| | - Sezer Acar
- Dokuz Eylül University Faculty of Medicine, Department of Pediatric Endocrinology, İzmir, Turkey
| | - Ayhan Abacı
- Dokuz Eylül University Faculty of Medicine, Department of Pediatric Endocrinology, İzmir, Turkey
| | - Ece Böber
- Dokuz Eylül University Faculty of Medicine, Department of Pediatric Endocrinology, İzmir, Turkey
| | - Korcan Demir
- Dokuz Eylül University Faculty of Medicine, Department of Pediatric Endocrinology, İzmir, Turkey
,* Address for Correspondence: Dokuz Eylül University Faculty of Medicine, Department of Pediatric Endocrinology, İzmir, Turkey Phone: +90 232 412 60 77 E-mail:
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Tunç S, Demir K, Tükün FA, Topal C, Hazan F, Sağlam B, Nalbantoğlu Ö, Yıldız M, Özkan B. Melanocortin-4 Receptor Gene Mutations in a Group of Turkish Obese Children and Adolescents. J Clin Res Pediatr Endocrinol 2017; 9:216-221. [PMID: 28218067 PMCID: PMC5596802 DOI: 10.4274/jcrpe.4225] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
Abstract
OBJECTIVE Melanocortin-4 receptor (MC4R) mutations are the most common known cause of monogenic obesity. Data regarding MC4R mutations in Turkish subjects are limited. To determine the prevalence of MC4R mutations in a group of Turkish morbid obese children and adolescents. METHODS MC4R was sequenced in 47 consecutive morbidly obese children and adolescents (28 girls and 19 boys, aged 1-18 years) who presented during a one-year period. Inclusion criterion was a body mass index (BMI) ≥120% of the 95th percentile or ≥35 kg/m2. Patients with chronic diseases, Cushing syndrome, hypothyroidism, or suspected syndromes that could cause obesity were excluded. Onset of obesity was before age 10 years in all subjects. RESULTS Mean age was 13.2±4.1 years, age at onset of obesity 5.1±2.1 years, height standard deviation (SD) score 1.21±0.93, BMI 40.0±8.8 kg/m2, and BMI SD score was 2.72±0.37. One novel (c.870delG) and two previously reported (c.496 G>A, c.346_347delAG) mutations were found in four (8.5%) obese children and adolescents. The novel mutation (c.870delG) was predicted to be a disease-causing frame-shift mutation using in silico analyses. Fasting glucose and lipid levels of the patients with MC4R mutation were normal, but insulin resistance was present in two of the subjects. Six more individuals with MC4R mutation (1 child, 5 adults) were detected following analyses of the family members of affected children. CONCLUSION MC4R mutations are frequently found in morbid obese Turkish children and adolescents.
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Affiliation(s)
- Selma Tunç
- Dr. Behçet Uz Children’s Hospital, Clinic of Pediatric Endocrinology, İzmir, Turkey
| | - Korcan Demir
- Dokuz Eylül University Faculty of Medicine, Department of Pediatric Endocrinology, İzmir, Turkey
,* Address for Correspondence: Dokuz Eylül University Faculty of Medicine, Department of Pediatric Endocrinology, İzmir, Turkey E-mail:
| | - Fatma Ajlan Tükün
- Ankara University Faculty of Medicine, Department of Medical Genetics, Ankara, Turkey
| | - Cihan Topal
- Dr. Behçet Uz Children’s Hospital, Clinic of Pediatrics, İzmir, Turkey
| | - Filiz Hazan
- Dr. Behçet Uz Children’s Hospital, Clinic of Medical Genetics, İzmir, Turkey
| | - Burcu Sağlam
- Düzen Laboratory, Division of Genetic Diagnosis Center, Ankara, Turkey
| | - Özlem Nalbantoğlu
- Dr. Behçet Uz Children’s Hospital, Clinic of Pediatric Endocrinology, İzmir, Turkey
| | - Melek Yıldız
- Dr. Behçet Uz Children’s Hospital, Clinic of Pediatric Endocrinology, İzmir, Turkey
| | - Behzat Özkan
- Dr. Behçet Uz Children’s Hospital, Clinic of Pediatric Endocrinology, İzmir, Turkey
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Aral CA, Nalbantoğlu Ö, Nur BG, Altunsoy M, Aral K. Metabolic control and periodontal treatment decreases elevated oxidative stress in the early phases of type 1 diabetes onset. Arch Oral Biol 2017. [PMID: 28628802 DOI: 10.1016/j.archoralbio.2017.06.009] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
OBJECTIVE Recently, increasing concern has been focused on the contribution of oxidative stress in the pathology of periodontal disease and diabetes mellitus. Firstly, the present study aimed to analyze gingival crevicular fluid (GCF), salivary, and serum oxidative status in children with type 1 diabetes mellitus (T1DM) at diagnosis and systemically healthy children with and without gingivitis. Additionally, the diabetic patients were reevaluated after diabetes and periodontal treatment. DESIGN The study groups were composed of 32 T1DM patients at diagnosis, and age- and gender-matched thirty-six systemically healthy children with (G) and without (H) gingivitis. The diabetic patients who took insulin therapy (1.5 units/kg/day totally) and periodontal treatment (oral hygiene education with professional scaling) were reevaluated after 3 months. The levels of total antioxidant status (TAS), total oxidant status (TOS), and oxidative stress index (OSI) were recorded. RESULTS GCF, salivary, and serum OSI were elevated in group T1DM compared to the other groups at baseline (p<0.05), and decreased in group T1DM at reevaluation compared to baseline (p<0.05). GCF OSI was positively correlated with periodontal clinical parameters (p<0.05). Glycated hemoglobin was positively correlated with GCF TOS (r=0.302, p=0.007), GCF OSI (r=0.346, p=0.002), salivary TOS (r=0.326, p=0.046), and serum TOS (r=0.239, p=0.044). CONCLUSION The instability in the oxidative status that accompanies diabetes may be considered a significant pathogenic factor of diabetes-related periodontal inflammation.
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Affiliation(s)
- Cüneyt A Aral
- Division of Periodontology, Malatya Oral and Dental Health Hospital, The Turkish Ministry of Health, Malatya, Turkey.
| | - Özlem Nalbantoğlu
- Division of Pediatric Endocrinology, Dr. Behçet Uz Children's Hospital, İzmir, Turkey
| | - Bilge G Nur
- Division of Pediatric Dentistry, Private Practice, İzmir, Turkey
| | - Mustafa Altunsoy
- Division of Pediatric Dentistry, Private Practice, İzmir, Turkey
| | - Kübra Aral
- Division of Periodontology, Malatya Oral and Dental Health Hospital, The Turkish Ministry of Health, Malatya, Turkey
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Bağ Ö, Tunç S, Nalbantoğlu Ö, Ecevit Ç, Öztürk A, Özkan B, Demir K. Higher-Than-Conventional Subcutaneous Regular Insulin Doses Following Diabetic Ketoacidosis in Children and Adolescents. J Clin Res Pediatr Endocrinol 2017; 9:132-137. [PMID: 28044993 PMCID: PMC5463285 DOI: 10.4274/jcrpe.3925] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/01/2022] Open
Abstract
OBJECTIVE To evaluate the effect of initial insulin dosage on glycemic control in the first 48 hours of subcutaneous regular insulin therapy after resolution of diabetic ketoacidosis (DKA). METHODS Records of patients with DKA hospitalized in the past 3 years [n=76, median age=10.0 (6.0-12.0) years, Male/Female: 44/32] were reviewed. The patients were designated into two groups according to distribution of starting doses of subcutaneous insulin. Group 1 (n=28) received a median dose of 1.45 U/kg/day (1.41-1.5) and group 2 (n=48) a median dose of 0.96 U/kg/day (0.89-1). Clinical and laboratory data were analyzed. RESULTS Median, minimum, and maximum blood glucose levels of Group 1 in the first 48 hours of treatment were significantly lower than that of Group 2 [213 (171-242) vs. 255 (222-316), p=<0.001; 102 (85-151) vs. 129 (105-199), p=0.004; and 335 (290-365) vs. 375 (341-438), p=0.001, respectively]. The number of patients who experienced hypoglycemia (<70 mg/dL) were similar [Group 1, 5 (17.9%) vs. Group 2, 4 (8.3%), p=0.276] and none had severe hypoglycemia. In Group 1, the ratio of blood glucose levels within the target range (100-200 mg/dL) were higher (37.5% vs. 12.5%) and the number of results >200 mg/dL were lower (50% vs. 81.3%) compared to Group 2 (p=0.001 and p<0.001, respectively). CONCLUSION After resolution of DKA, a higher initial dose of 1.4-1.5 U/kg/day regular insulin is associated with better glycemic control in children and adolescents without an increase in risk of hypoglycemia.
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Affiliation(s)
- Özlem Bağ
- Dr. Behçet Uz Children's Hospital, Clinic of Pediatrics, İzmir, Turkey, Phone: +90 232 464 6167 E-mail:
| | - Selma Tunç
- Dr. Behçet Uz Children’s Hospital, Clinic of Pediatric Endocrinology, İzmir, Turkey
| | - Özlem Nalbantoğlu
- Dr. Behçet Uz Children’s Hospital, Clinic of Pediatric Endocrinology, İzmir, Turkey
| | - Çiğdem Ecevit
- Dr. Behçet Uz Children’s Hospital, Clinic of Pediatrics, İzmir, Turkey
| | - Aysel Öztürk
- Dr. Behçet Uz Children’s Hospital, Clinic of Pediatrics, İzmir, Turkey
| | - Behzat Özkan
- Dr. Behçet Uz Children’s Hospital, Clinic of Pediatric Endocrinology, İzmir, Turkey
| | - Korcan Demir
- Dokuz Eylül University Faculty of Medicine, Department of Pediatrics, Division of Pediatric Endocrinology, İzmir, Turkey
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Katipoğlu N, Karapinar TH, Demir K, Aydin Köker S, Nalbantoğlu Ö, Ay Y, Korkmaz HA, Oymak Y, Yıldız M, Tunç S, Hazan F, Vergin C, Ozkan B. Infantile-onset thiamine responsive megaloblastic anemia syndrome with SLC19A2 mutation: a case report. ARCH ARGENT PEDIATR 2017; 115:e153-e156. [PMID: 28504500 DOI: 10.5546/aap.2017.eng.e153] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2016] [Accepted: 12/05/2016] [Indexed: 11/12/2022]
Abstract
BACKGROUND Thiamine-responsive megaloblastic anemia syndrome (TRMA), also known as Rogers syndrome, is characterized by megaloblastic anemia, sensorineural hearing loss, and diabetes mellitus. Disturbances of the thiamine transport into the cells results from homozygous or compound heterozygous mutations in the SLC19A2 gene. CASE PRESENTATION We report a girl which presented with sensorineural deafness treated with a hearing prosthesis, insulin requiring diabetes, macrocytic anemia, treated with thiamine (100 mg/day). Hemoglobin level improved to 12.1 g/dl after dose of thiamine therapy increased up to 200 mg/day. CONCLUSION Patients with TRMA must be evaluated for megaloblastic anemia, sensorineural hearing loss, and diabetes mellitus. They must be followed for response of hematologic and diabetic after thiamine therapy. It should be kept in mind that dose of thiamine therapy may be increased according to the clinical response. Genetic counseling should be given.
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Affiliation(s)
- Nagehan Katipoğlu
- Department of Pediatrics, Dr. Behcet Uz Children's Hospital, Izmir, Turkey
| | - Tuba H Karapinar
- Department of Pediatric Hematology and Oncology, Dr. Behcet Uz Children's Hospital, Izmir, Turkey
| | - Korean Demir
- Department of Pediatric Endocrinology, Dr. Behcet Uz Children's Hospital, Izmir, Turkey
| | - Sultan Aydin Köker
- Department of Pediatric Hematology and Oncology, Dr. Behcet Uz Children's Hospital, Izmir, Turkey.
| | - Özlem Nalbantoğlu
- Department of Pediatric Endocrinology, Dr. Behcet Uz Children's Hospital, Izmir, Turkey
| | - Yılmaz Ay
- Department of Pediatric Hematology and Oncology, Dr. Behcet Uz Children's Hospital, Izmir, Turkey
| | - Hüseyin A Korkmaz
- Department of Pediatric Endocrinology, Dr. Behcet Uz Children's Hospital, Izmir, Turkey
| | - Yeşim Oymak
- Department of Pediatric Hematology and Oncology, Dr. Behcet Uz Children's Hospital, Izmir, Turkey
| | - Melek Yıldız
- Department of Pediatric Endocrinology, Dr. Behcet Uz Children's Hospital, Izmir, Turkey
| | - Selma Tunç
- Department of Pediatric Endocrinology, Dr. Behcet Uz Children's Hospital, Izmir, Turkey
| | - Filiz Hazan
- Department of Medical Genetics, Dr. Behcet Uz Children's Hospital, Izmir, Turkey
| | - Canan Vergin
- Department of Pediatric Hematology and Oncology, Dr. Behcet Uz Children's Hospital, Izmir, Turkey
| | - Behzat Ozkan
- Department of Pediatric Endocrinology, Dr. Behcet Uz Children's Hospital, Izmir, Turkey
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Yıldız M, İşleten F, Demir K, Çelik N, Korkmaz HA, Tuğlu B, Nalbantoğlu Ö, Özkan B. Anti-cyclic citrullinated peptide antibodies are not frequently observed in children with type 1 diabetes mellitus: a single-center study. Turk J Pediatr 2016; 58:395-399. [PMID: 28276212 DOI: 10.24953/turkjped.2016.04.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Type 1 diabetes mellitus (DM) and rheumatoid arthritis (RA) have been reported to occur concurrently in some cases. This study aimed to evaluate the presence of anti-cyclic citrullinated peptide (CCP) antibodies, which have been reported to have diagnostic value for RA, in children with type 1 DM. The study included 90 children with type 1 DM (Group 1) and 76 control cases (Group 2). The rates of reported family histories of RA and rheumatoid factor positivity did not differ between groups. In group 1, one case (1.1%) was positive for anti-CCP antibodies, whereas none of the controls were positive. The anti-CCP positive patient had no relevant joint complaints. Anti-CCP antibodies were rarely found in cases of pediatric type 1 DM. Thus, relevant screening in the follow-up of pediatric patients does not appear to be rational in the absence of any signs or symptoms of arthritis. The single case exhibiting a high anti-CCP level needs to be followed up for RA, although this positive result might be nonspecific and transient.
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Affiliation(s)
- Melek Yıldız
- Divisions of Pediatric Endocrinology, Dr. Behçet Uz Children's Hospital, Izmir, Turkey
| | - Figen İşleten
- Divisions of Biochemistry, Dr. Behçet Uz Children's Hospital, Izmir, Turkey
| | - Korcan Demir
- Divisions of Pediatric Endocrinology, Dr. Behçet Uz Children's Hospital, Izmir, Turkey
| | - Nilüfer Çelik
- Divisions of Biochemistry, Dr. Behçet Uz Children's Hospital, Izmir, Turkey
| | - Hüseyin Anıl Korkmaz
- Divisions of Pediatric Endocrinology, Dr. Behçet Uz Children's Hospital, Izmir, Turkey
| | - Birsen Tuğlu
- Divisions of Biochemistry, Dr. Behçet Uz Children's Hospital, Izmir, Turkey
| | - Özlem Nalbantoğlu
- Divisions of Pediatric Endocrinology, Dr. Behçet Uz Children's Hospital, Izmir, Turkey
| | - Behzat Özkan
- Divisions of Pediatric Endocrinology, Dr. Behçet Uz Children's Hospital, Izmir, Turkey
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Demir K, Nalbantoğlu Ö, Karaer K, Korkmaz HA, Yıldız M, Tunç S, Özkan B. Genetic Diagnosis Using Whole Exome Analysis in Two Cases with Malignant Osteopetrosis of Infancy. J Clin Res Pediatr Endocrinol 2015; 7:356-7. [PMID: 26777052 PMCID: PMC4805220 DOI: 10.4274/jcrpe.2597] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/03/2022] Open
Affiliation(s)
- Korcan Demir
- Dr. Behçet Uz Children's Hospital, Clinic of Pediatric Endocrinology, İzmir, Turkey Phone: +90 232 412 60 77 E-mail: ,
| | - Özlem Nalbantoğlu
- Dr. Behçet Uz Children’s Hospital, Clinic of Pediatric Endocrinology, İzmir, Turkey
| | | | - Hüseyin Anıl Korkmaz
- Dr. Behçet Uz Children’s Hospital, Clinic of Pediatric Endocrinology, İzmir, Turkey
| | - Melek Yıldız
- Dr. Behçet Uz Children’s Hospital, Clinic of Pediatric Endocrinology, İzmir, Turkey
| | - Selma Tunç
- Dr. Behçet Uz Children’s Hospital, Clinic of Pediatric Endocrinology, İzmir, Turkey
| | - Behzat Özkan
- Dr. Behçet Uz Children’s Hospital, Clinic of Pediatric Endocrinology, İzmir, Turkey
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Nalbantoğlu Ö, Demir K, Korkmaz HA, Büyükinan M, Yıldız M, Tunç S, Özkan B. A novel mutation of AMH in three siblings with persistent Mullerian duct syndrome. J Pediatr Endocrinol Metab 2015; 28:1379-82. [PMID: 26181047 DOI: 10.1515/jpem-2014-0501] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/05/2014] [Accepted: 05/14/2015] [Indexed: 11/15/2022]
Abstract
BACKGROUND Persistent Mullerian duct syndrome (PMDS) is a rare form of male 46,XY disorder of sex development characterized by the presence of Mullerian duct derivatives in otherwise phenotypically normal males. AIM To report a novel mutation of the anti-Mullerian hormone (AMH) gene in two of three siblings with PMDS. CASES A 2-year-old male presented with recurrent left-sided inguinal hernia and absence of right testis. Laparoscopic surgery disclosed Mullerian duct derivates and transverse testicular ectopia. AMH level was found to be low [1.6 ng/mL (normal range 7.4-373.1), 11.42 pmol/L (normal range 52.8-2663.9)]. His 15-year-old and 7-year-old elder brothers were invited, and bilateral undescended testes were noted upon examination. Female reproductive structures were identified during surgery but no transverse testicular ectopia. All cases had 46,XY karyotype. Genetic analyses could be done in two of them and a unique homozygous T to C base substitution was found at position 1591 in the AMH gene. CONCLUSION This is the first report of the AMH gene mutation which is referred as p.Y531H (c.1591T>C), which resulted in different phenotypes of PMDS in three siblings.
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Demir K, Kattan WE, Zou M, Durmaz E, BinEssa H, Nalbantoğlu Ö, Al-Rijjal RA, Meyer B, Özkan B, Shi Y. Novel CYP27B1 Gene Mutations in Patients with Vitamin D-Dependent Rickets Type 1A. PLoS One 2015; 10:e0131376. [PMID: 26132292 PMCID: PMC4489500 DOI: 10.1371/journal.pone.0131376] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2015] [Accepted: 05/31/2015] [Indexed: 12/30/2022] Open
Abstract
The CYP27B1 gene encodes 25-hydroxyvitamin D-1α-hydroxylase. Mutations of this gene cause vitamin D-dependent rickets type 1A (VDDR-IA, OMIM 264700), which is a rare autosomal recessive disorder. To investigate CYP27B1 mutations, we studied 8 patients from 7 unrelated families. All coding exons and intron-exon boundaries of CYP27B1 gene were amplified by PCR from peripheral leukocyte DNA and subsequently sequenced. Homozygous mutations in the CYP27B1 gene were found in all the patients and heterozygous mutations were present in their normal parents. One novel single nucleotide variation (SNV, c.1215 T>C, p.R379R in the last nucleotide of exon 7) and three novel mutations were identified:, a splice donor site mutation (c.1215+2T>A) in intron 7, a 16-bp deletion in exon 6 (c.1022-1037del16), and a 2-bp deletion in exon 5 (c.934_935delAC). Both c.1215 T>C and c.1215+2T>A were present together in homozygous form in two unrelated patients, and caused exon 7 skipping. However, c.1215 T>C alone has no effect on pre-mRNA splicing. The skipping of exon 7 resulted in a shift of downstream reading frame and a premature stop codon 57 amino acids from L380 (p.L380Afs*57). The intra-exon deletions of c.1022-1037del16 and c.934_935delAC also resulted in a frameshift and the creation of premature stop codons at p.T341Rfs*5, and p.T312Rfs*19, respectively, leading to the functional inactivation of the CYP27B1 gene. Clinically, all the patients required continued calcitriol treatment and the clinical presentations were consistent with the complete loss of vitamin D1α-hydroxylase activity. In conclusion, three novel mutations have been identified. All of them caused frameshift and truncated proteins. The silent c.1215 T>C SNV has no effect on pre-mRNA splicing and it is likely a novel SNP. The current study further expands the CYP27B1 mutation spectrum.
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Affiliation(s)
- Korcan Demir
- Division of Pediatric Endocrinology, Dr. Behçet Uz Children's Hospital, İzmir, Turkey
| | - Walaa E Kattan
- College of Science and General Studies, Alfaisal University, Riyadh, Saudi Arabia; Department of Genetics, King Faisal Specialist Hospital & Research Centre, Riyadh, Saudi Arabia
| | - Minjing Zou
- Department of Genetics, King Faisal Specialist Hospital & Research Centre, Riyadh, Saudi Arabia
| | - Erdem Durmaz
- Department of Pediatric Endocrinology, Sifa University, Bornova Health Application and Research Center, İzmir, Turkey
| | - Huda BinEssa
- Department of Genetics, King Faisal Specialist Hospital & Research Centre, Riyadh, Saudi Arabia
| | - Özlem Nalbantoğlu
- Division of Pediatric Endocrinology, Dr. Behçet Uz Children's Hospital, İzmir, Turkey
| | - Roua A Al-Rijjal
- Department of Genetics, King Faisal Specialist Hospital & Research Centre, Riyadh, Saudi Arabia
| | - Brian Meyer
- Department of Genetics, King Faisal Specialist Hospital & Research Centre, Riyadh, Saudi Arabia
| | - Behzat Özkan
- Division of Pediatric Endocrinology, Dr. Behçet Uz Children's Hospital, İzmir, Turkey
| | - Yufei Shi
- Department of Genetics, King Faisal Specialist Hospital & Research Centre, Riyadh, Saudi Arabia
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