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Ciancia S, Klink D, Craen M, Cools M. Early puberty suppression and gender-affirming hormones do not alter final height in transgender adolescents. Eur J Endocrinol 2023; 189:396-401. [PMID: 37703317 DOI: 10.1093/ejendo/lvad125] [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] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/22/2023] [Revised: 08/07/2023] [Accepted: 08/14/2023] [Indexed: 09/15/2023]
Abstract
BACKGROUND Early puberty suppression (ePS; Tanner stages 2 and 3) through gonadotropin-releasing hormone agonists (GnRHas) and gender-affirming hormones (GAHs) interferes with growth and may impact final height (FH). AIM To investigate the impact of ePS and GAH on FH in trans boys and trans girls. METHODS Retrospective study, including 10 trans boys and 22 trans girls at FH. Bone age (BA) was determined at the start of ePS and at the start of GAH according to Greulich and Pyle; predicted adult height (PAH) was calculated according to Bayley and Pinneau's tables; target height (TH) was calculated as adjusted mean of maternal and paternal height. Target height, PAH, and BA were determined according to sex registered at birth (SRAB) and experienced gender (EG). RESULTS The age at the start of PS was 12.37 ± 0.74 years in trans boys and 13.10 ± 1.12 years in trans girls. Total height gain since the start of ePS in trans boys was 14.62 ± 4.08 cm, with 70% achieved before the start of GAH. In trans girls, it was 20.68 ± 7.66 cm, with 61% achieved before GAH. Target height for SRAB was the most accurate predictor for FH in both trans boys and girls: the difference with FH was 1.57 cm ± 3.1 (P = .168) and -0.98 cm ± 4.17 (P = .319), respectively. Also the difference between FH and PAH at the start of PS for SRAB was nonsignificant in both trans boys and girls (2.62 cm ± 3.79, P = .056 and -2.35 cm ± 5.2, P = .051, respectively). CONCLUSION Early puberty suppression and GAH do not impact FH, supporting the safety of the treatment; however, trans adolescents achieve a FH in line with SRAB, rather than EG.
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Affiliation(s)
- Silvia Ciancia
- Department of Internal Medicine and Pediatrics, Ghent University, 9000 Ghent, Belgium
| | - Daniel Klink
- Pediatric Endocrinology Service, Department of Pediatrics, Ghent University Hospital, 9000 Ghent, Belgium
| | - Margarita Craen
- Department of Internal Medicine and Pediatrics, Ghent University, 9000 Ghent, Belgium
- Pediatric Endocrinology Service, Department of Pediatrics, Ghent University Hospital, 9000 Ghent, Belgium
| | - Martine Cools
- Department of Internal Medicine and Pediatrics, Ghent University, 9000 Ghent, Belgium
- Pediatric Endocrinology Service, Department of Pediatrics, Ghent University Hospital, 9000 Ghent, Belgium
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Claahsen-van der Grinten HL, Hannema SE, Klink D, Roeffen J, Spath MA, Verhaak C, de Vries ALC. [Children and adolescents with gender questions: dilemmas in the hormonal treatment by multidisciplinary teams]. Ned Tijdschr Geneeskd 2023; 167:D7548. [PMID: 37493291] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Subscribe] [Scholar Register] [Indexed: 07/27/2023]
Abstract
In the Netherlands but also in many other countries, there is an increasing social discussion about gender identity and gender diversity, and an increasing number of children and adolescents are seeking medical help because of questions about their gender identity. The cause of this increase is still unknown. Gender questions are diverse and require an individual approach by a multidisciplinary team. A number of adolescents have additional problems such as mood problems, autistiform symptoms and systemic problems. Diagnosis and treatment takes place in accordance with the quality standard for transgender care somatic and psychological. Hormonal treatment can help to reduce gender dysphoria and improve mental health.
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Affiliation(s)
| | - Sabine E Hannema
- Amsterdam UMC, locatie VUmc, Kennis- en Zorgcentrum voor Genderdysforie, Amsterdam
| | - Daniel Klink
- Amsterdam UMC, locatie VUmc, Kennis- en Zorgcentrum voor Genderdysforie, Amsterdam
| | - Joep Roeffen
- Amsterdam UMC, locatie VUmc, Kennis- en Zorgcentrum voor Genderdysforie, Amsterdam
| | - Marian A Spath
- Radboudumc, Expertisecentrum Geslacht & Gender, Nijmegen
| | - Chris Verhaak
- Radboudumc, Expertisecentrum Geslacht & Gender, Nijmegen
| | - Annelou L C de Vries
- Amsterdam UMC, locatie VUmc, Kennis- en Zorgcentrum voor Genderdysforie, Amsterdam
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Ryckx S, De Schepper J, Giron P, Maes K, Vaeyens F, Wilgenhof K, Lefesvre P, Ernst C, Vanderlinden K, Klink D, Hes F, Vanbesien J, Gies I, Staels W. Peripheral precocious puberty in Li-Fraumeni syndrome: a case report and literature review of pure androgen-secreting adrenocortical tumors. J Med Case Rep 2023; 17:195. [PMID: 37179382 PMCID: PMC10183130 DOI: 10.1186/s13256-023-03889-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] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2022] [Accepted: 03/14/2023] [Indexed: 05/15/2023] Open
Abstract
INTRODUCTION Pure androgen-secreting adrenocortical tumors are a rare but important cause of peripheral precocious puberty. CASE PRESENTATION Here, we report a pure androgen-secreting adrenocortical tumor in a 2.5-year-old boy presenting with penile enlargement, pubic hair, frequent erections, and rapid linear growth. We confirmed the diagnosis through laboratory tests, medical imaging, and histology. Furthermore, genetic testing detected a pathogenic germline variant in the TP53 gene, molecularly confirming underlying Li-Fraumeni syndrome. DISCUSSION Only 15 well-documented cases of pure androgen-secreting adrenocortical tumors have been reported so far. No clinical or imaging signs were identified to differentiate adenomas from carcinomas, and no other cases of Li-Fraumeni syndrome were diagnosed in the four patients that underwent genetic testing. However, diagnosing Li-Fraumeni syndrome is important as it implies a need for intensive tumor surveillance and avoidance of ionizing radiation. CONCLUSION In this article, we emphasize the need to screen for TP53 gene variants in children with androgen-producing adrenal adenomas and report an association with arterial hypertension.
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Affiliation(s)
- Sofie Ryckx
- Division of Pediatric Endocrinology and Diabetology, Department of Pediatrics, ZNA Queen Paola Child Hospital, Lindendreef 1, 2020, Antwerp, Belgium.
- Division of Pediatric Endocrinology, Department of Pediatrics, Vrije Universiteit Brussel (VUB), Universitair Ziekenhuis Brussel (UZ Brussel), Laarbeeklaan 101, 1090, Brussels, Belgium.
| | - Jean De Schepper
- Division of Pediatric Endocrinology, Department of Pediatrics, Vrije Universiteit Brussel (VUB), Universitair Ziekenhuis Brussel (UZ Brussel), Laarbeeklaan 101, 1090, Brussels, Belgium
| | - Philippe Giron
- Centre for Medical Genetics, Vrije Universiteit Brussel (VUB), Universitair Ziekenhuis Brussel (UZ Brussel), Brussels, Belgium
| | - Ken Maes
- Centre for Medical Genetics, Vrije Universiteit Brussel (VUB), Universitair Ziekenhuis Brussel (UZ Brussel), Brussels, Belgium
| | - Freya Vaeyens
- Centre for Medical Genetics, Vrije Universiteit Brussel (VUB), Universitair Ziekenhuis Brussel (UZ Brussel), Brussels, Belgium
| | - Kaat Wilgenhof
- Department of Pathology, Vrije Universiteit Brussel (VUB), Universitair Ziekenhuis Brussel (UZ Brussel), Brussels, Belgium
| | - Pierre Lefesvre
- Department of Pathology, Vrije Universiteit Brussel (VUB), Universitair Ziekenhuis Brussel (UZ Brussel), Brussels, Belgium
| | - Caroline Ernst
- Department of Radiology, Vrije Universiteit Brussel (VUB), Universitair Ziekenhuis Brussel (UZ Brussel), Brussels, Belgium
| | - Kim Vanderlinden
- Division of Pediatric Surgery, Department of Surgery, Vrije Universiteit Brussel (VUB), Universitair Ziekenhuis Brussel (UZ Brussel), Brussels, Belgium
| | - Daniel Klink
- Division of Pediatric Endocrinology and Diabetology, Department of Pediatrics, ZNA Queen Paola Child Hospital, Lindendreef 1, 2020, Antwerp, Belgium
| | - Frederik Hes
- Centre for Medical Genetics, Vrije Universiteit Brussel (VUB), Universitair Ziekenhuis Brussel (UZ Brussel), Brussels, Belgium
| | - Jesse Vanbesien
- Division of Pediatric Endocrinology, Department of Pediatrics, Vrije Universiteit Brussel (VUB), Universitair Ziekenhuis Brussel (UZ Brussel), Laarbeeklaan 101, 1090, Brussels, Belgium
| | - Inge Gies
- Division of Pediatric Endocrinology, Department of Pediatrics, Vrije Universiteit Brussel (VUB), Universitair Ziekenhuis Brussel (UZ Brussel), Laarbeeklaan 101, 1090, Brussels, Belgium
| | - Willem Staels
- Division of Pediatric Endocrinology, Department of Pediatrics, Vrije Universiteit Brussel (VUB), Universitair Ziekenhuis Brussel (UZ Brussel), Laarbeeklaan 101, 1090, Brussels, Belgium
- Beta Cell Neogenesis (BENE) Research Group, Vrije Universiteit Brussel (VUB), Brussels, Belgium
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Claahsen - van der Grinten H, Verhaak C, Steensma T, Middelberg T, Roeffen J, Klink D. Gender incongruence and gender dysphoria in childhood and adolescence-current insights in diagnostics, management, and follow-up. Eur J Pediatr 2021; 180:1349-1357. [PMID: 33337526 PMCID: PMC8032627 DOI: 10.1007/s00431-020-03906-y] [Citation(s) in RCA: 30] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/05/2020] [Revised: 12/04/2020] [Accepted: 12/10/2020] [Indexed: 12/03/2022]
Abstract
Gender incongruence (GI) is defined as a condition in which the gender identity of a person does not align with the gender assigned at birth. Awareness and more social acceptance have paved the way for early medical intervention about two decades ago and are now part of good clinical practice although much robust data is lacking. Medical and mental treatment in adolescents with GI is complex and is recommended to take place within a team of mental health professionals, psychiatrists, endocrinologists, and other healthcare providers. The somatic treatment generally consists of the use of GnRH analogues to prevent the progression of biological puberty and subsequently gender-affirming hormonal treatment to develop sex characteristics of the self-identified gender and surgical procedures. However to optimize treatment regimens, long-term follow-up and additional studies are still needed. What is known • The prevalence of gender dysphoria increased significantly in the past years and can lead to significant complaints and burdens especially during puberty. • Pubertal suppression and gender-affirmed treatment can be effectively used in adolescence with gender dysphoria. What is new • Transgender mental and medical healthcare is a long-lasting process during which not only the child/adolescent with GI but also their parents/family have to be counseled in making choices about their social, medical, and legal transitions. • There are an increasing number of transgender persons defining as nonbinary. Therefore, an individualized approach by an experienced team is necessary.
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Affiliation(s)
| | - Chris Verhaak
- Department of Medical Psychology, Amalia Children’s Hospital, Radboud University Medical Center, Nijmegen, Netherlands
| | - Thomas Steensma
- Center of Expertise on Gender Dysphoria and Department of Medical Psychology, Amsterdam UMC, location VUmc, Amsterdam, Netherlands
| | - Tim Middelberg
- Department of plastic surgery, University Medical Centre Groningen, University of Groningen, Groningen, Netherlands
| | - Joep Roeffen
- Genderteam South Netherlands, Mutsaersstichting, Venlo/Eindhoven, Netherlands
| | - Daniel Klink
- Division of Pediatric Endocrinology and Diabetes, ZNA Queen Paola Children’s Hospital, Antwerp, Belgium and Division of Pediatric Endocrinology, Department of Internal Medicine and Pediatrics, Ghent University Hospital and Ghent University, Ghent, Belgium
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Van Gampelaere C, Luyckx K, van der Straaten S, Laridaen J, Goethals ER, Casteels K, Vanbesien J, den Brinker M, Depoorter S, Klink D, Cools M, Goubert L. Families with pediatric type 1 diabetes: A comparison with the general population on child well-being, parental distress, and parenting behavior. Pediatr Diabetes 2020; 21:395-408. [PMID: 31697435 DOI: 10.1111/pedi.12942] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [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: 03/27/2019] [Revised: 10/18/2019] [Accepted: 10/28/2019] [Indexed: 12/14/2022] Open
Abstract
AIMS The aim of this study was to compare families with a child (2-12 years) with type 1 diabetes (T1D) to families which are not confronted with chronic illness, with regard to children's well-being, parental distress, and parenting behavior. In addition, differences were explored between families whose child has optimal vs suboptimal glycemic control. METHODS Mothers, fathers, and children of 105 families with pediatric T1D completed questionnaires assessing child well-being, parental distress, and parenting. The control group consisted of 414 families without chronic illness. RESULTS With regard to child well-being, children with T1D had more adjustment difficulties (as reported by mothers) and lower quality of life (QoL) (as reported by mothers and fathers), whereas children themselves (8-12 years) reported higher QoL compared to controls. In terms of parental distress, mothers, but not fathers, of children with T1D reported more stress, anxiety symptoms, and depressive symptoms than controls. With regard to parenting behavior, parent reports revealed less protectiveness in fathers and less autonomy support and responsiveness in both parents as compared to controls. No differences were found in parent-reported psychological control between parents of children with and without T1D, but children with T1D perceived lowered parental psychological control. Lastly, secondary analyses indicated that especially families with suboptimal child glycemic control showed more maternal distress and worse child well-being (according to parents). CONCLUSIONS Families confronted with pediatric T1D differ from families without chronic illness: childhood T1D impacts parental perceptions of child well-being and differentially affects mothers' and fathers' distress levels and behaviors.
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Affiliation(s)
- Cynthia Van Gampelaere
- Department of Experimental, Clinical and Health Psychology, Ghent University, Ghent, Belgium
| | - Koen Luyckx
- Department of School Psychology and Development in Context, University of Leuven, Leuven, Belgium.,UNIBS, University of the Free State, Bloemfontein, South Africa
| | - Saskia van der Straaten
- Department of Pediatrics, Division of Pediatric Endocrinology, Ghent University Hospital, Ghent, Belgium
| | - Jolien Laridaen
- Department of Medical Child and Adolescent Psychology, Ghent University Hospital, Ghent, Belgium
| | - Eveline R Goethals
- Department of School Psychology and Development in Context, University of Leuven, Leuven, Belgium.,Department of Pediatric Diabetes, University Hospital Leuven, Leuven, Belgium.,Joslin Diabetes Center, Harvard Medical School, Boston, Massachusetts
| | - Kristina Casteels
- Department of Pediatric Diabetes, University Hospital Leuven, Leuven, Belgium.,Department of Development and Regeneration, University of Leuven, Leuven, Belgium
| | - Jesse Vanbesien
- Department of Pediatrics, University Hospital Brussels, Brussel, Belgium
| | - Marieke den Brinker
- Department of Pediatrics Division of Pediatric Endocrinology and Diabetology, University Hospital Antwerp, Edegem, Belgium
| | - Sylvia Depoorter
- Department of Child Endocrinology, General Hospital Sint-Jan Bruges-Ostend, Bruges, Belgium
| | - Daniel Klink
- Department of Child Endocrinology, Queen Paola Children's Hospital, Antwerp, Belgium
| | - Martine Cools
- Department of Pediatrics, Division of Pediatric Endocrinology, Ghent University Hospital, Ghent, Belgium.,Department of Internal Medicine and Pediatrics, Ghent University, Ghent, Belgium
| | - Liesbet Goubert
- Department of Experimental, Clinical and Health Psychology, Ghent University, Ghent, Belgium
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Krainev AA, Mathavan VK, Klink D, Fuentes RC, Birhiray R. Resection of a mature cystic teratoma of the liver harboring a carcinoid tumor. J Surg Case Rep 2018; 2018:rjy279. [PMID: 30397434 PMCID: PMC6207844 DOI: 10.1093/jscr/rjy279] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [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: 08/13/2018] [Revised: 09/23/2018] [Accepted: 10/17/2018] [Indexed: 12/15/2022] Open
Abstract
Cystic teratomas are rare pluripotent embryonic tumors which most commonly originate in gonadal organs. Extra-gonadal cystic teratomas are exceedingly uncommon, accounting for only 1% of all cystic teratomas, and have been reported in unusual locations including the kidney, mediastinum and liver. These extra-ovarian cystic teratomas have also been known to harbor other neoplasms including carcinoid tumors. In this report, we describe a unique case of a hepatic cystic teratoma occurring as a combined tumor with a carcinoid in a young female. The patient underwent elective laparoscopic resection of her tumor after extensive radiographic and endoscopic work-up for chronic, non-localizable abdominal pain. We believe the carcinoid tumor arose de novofrom committed differentiation of a cell line within the teratoma, and not metastatic spread.
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Affiliation(s)
- Alexei A Krainev
- General Surgery Residency Program, St. Vincent Hospital Indianapolis, St. Vincent Ortho Center 2001 West 86th Street, Indianapolis, Indiana, USA
| | - Viney K Mathavan
- St. Vincent Hospital Indianapolis/North Indy Surgical Group, Indianapolis, IN, USA
| | - Daniel Klink
- St. Vincent Hospital Indianapolis, Department of Pathology/AmeriPath Anatomic Pathology Services, Indianapolis, IN, USA
| | - Rocio C Fuentes
- General Surgery Residency Program, St. Vincent Hospital Indianapolis, Indianapolis, IN, USA
| | - Ruemu Birhiray
- St. Vincent Hospital Indianapolis, Department of Hematology/Oncology, Indianapolis, IN, USA
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de Vries ALC, Klink D, Cohen-Kettenis PT. What the Primary Care Pediatrician Needs to Know About Gender Incongruence and Gender Dysphoria in Children and Adolescents. Pediatr Clin North Am 2016; 63:1121-1135. [PMID: 27865337 DOI: 10.1016/j.pcl.2016.07.011] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.1] [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] [Indexed: 10/20/2022]
Abstract
The recognition and acknowledgment that gender identity and birth-assigned sex may be incongruent in children and adolescents have evolved in recent decades. Transgender care for children and adolescents has developed and is now more widely available. Controversies exist, however, around clinical management of gender dysphoria and gender incongruence in children and adolescents. Clinical guidelines are consensus based and research evidence is limited. Puberty suppression as part of clinical management has become a valuable element of adolescent transgender care, but long-term evidence of success is limited. These uncertainties should be weighed against the risk of harming a transgender adolescent when medical intervention is denied.
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Affiliation(s)
- Annelou L C de Vries
- Department of Child and Adolescent Psychiatry, VU University Medical Center, Room 1y130, PO Box 7057, 1007 MB Amsterdam, The Netherlands.
| | - Daniel Klink
- Division of Endocrinology, Department of Pediatrics, VU University Medical Center, PO Box 7057, 1007 MB Amsterdam, The Netherlands
| | - Peggy T Cohen-Kettenis
- Department of Medical Psychology, VU University Medical Center, PO Box 7057, 1007 MB Amsterdam, The Netherlands
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Abstract
Young people with gender dysphoria are increasingly seen by pediatric endocrinologists. Mental health child specialists assess the adolescent and give advice about psychological or medical treatment. Provided they fulfill eligibility and readiness criteria, adolescents may receive pubertal suspension, consisting of using gonadotrophin-releasing hormone analogs, later followed by cross-sex hormones (sex steroids of the experienced gender). If they fulfill additional criteria, they may have various types of gender affirming surgery. Current issues involve safety aspects. Although generally considered safe in the short-term, the long-term effects regarding bone health and cardiovascular risks are still unknown. Therefore, vigilance is warranted during and long after completion of the last gender affirming surgeries. The timing of the various treatment steps is also under debate: instead of fixed age limits, the cognitive and emotional maturation, along with the physical development, are now often considered as more relevant.
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Affiliation(s)
- Peggy T Cohen-Kettenis
- Department of Medical Psychology, VU University Medical Center, PO Box 7057, 1007 MB Amsterdam, The Netherlands.
| | - Daniel Klink
- Department of Pediatrics, VU University Medical Center, PO Box 7057, 1007 MB Amsterdam, The Netherlands
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Klink D, Caris M, Heijboer A, van Trotsenburg M, Rotteveel J. Bone mass in young adulthood following gonadotropin-releasing hormone analog treatment and cross-sex hormone treatment in adolescents with gender dysphoria. J Clin Endocrinol Metab 2015; 100:E270-5. [PMID: 25427144 DOI: 10.1210/jc.2014-2439] [Citation(s) in RCA: 136] [Impact Index Per Article: 15.1] [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] [Indexed: 02/04/2023]
Abstract
CONTEXT Sex steroids are important for bone mass accrual. Adolescents with gender dysphoria (GD) treated with gonadotropin-releasing hormone analog (GnRHa) therapy are temporarily sex-steroid deprived until the addition of cross-sex hormones (CSH). The effect of this treatment on bone mineral density (BMD) in later life is not known. OBJECTIVE This study aimed to assess BMD development during GnRHa therapy and at age 22 years in young adults with GD who started sex reassignment (SR) during adolescence. DESIGN AND SETTING This was a longitudinal observational study at a tertiary referral center. PATIENTS Young adults diagnosed with gender identity disorder of adolescence (DSM IV-TR) who started SR in puberty and had undergone gonadectomy between June 1998 and August 2012 were included. In 34 subjects BMD development until the age of 22 years was analyzed. INTERVENTION GnRHa monotherapy (median duration in natal boys with GD [transwomen] and natal girls with GD [transmen] 1.3 and 1.5 y, respectively) followed by CSH (median duration in transwomen and transmen, 5.8 and 5.4 y, respectively) with discontinuation of GnRHa after gonadectomy. MAJOR OUTCOME MEASURES How BMD develops during SR until the age of 22 years. RESULTS AND CONCLUSION Between the start of GnRHa and age 22 years the lumbar areal BMD z score (for natal sex) in transwomen decreased significantly from -0.8 to -1.4 and in transmen there was a trend for decrease from 0.2 to -0.3. This suggests that the BMD was below their pretreatment potential and either attainment of peak bone mass has been delayed or peak bone mass itself is attenuated.
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Affiliation(s)
- Daniel Klink
- Center of Expertise on Gender Dysphoria (D.K., M.v.T., J.R.); Department of Pediatrics, Division of Endocrinology (D.K., M.C., J.R.); Department of Clinical Chemistry (A.H.); and Department of Obstetrics and Gynaecology (M.v.T.), VU University Medical Center, de Boelelaan 1118 1081 HZ Amsterdam, The Netherlands
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de Jong A, Bökenkamp A, Klink D. Arterial hypertension as a complication of prolonged therapy with GnRH-analogues in adolescent girls. Klin Padiatr 2011. [DOI: 10.1055/s-0031-1273887] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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Abstract
Thrombotic thrombocytopenic purpura (TTP), a well-recognized syndrome with typical diagnostic features, has been implicated in rare causes of sudden death. Involvement of TTP on the myocardium and cardiac conduction system has been characterized, but the consequences related to these effects are infrequently reported. The outcome is almost always death, thus underscoring the need for early detection and therapy. A case is reported of a 36-year-old man who suffered a fatal cardiac arrhythmia related to intramyocardial hemorrhage with a diagnosis of TTP established by postmortem examination.
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Affiliation(s)
- Paul O Arnold
- Department of Internal Medicine, Virginia Commonwealth University Health System, Richmond, Virginia 23298-0509, USA.
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Klink D, Schindelhauer D, Laner A, Tucker T, Bebok Z, Schwiebert EM, Boyd AC, Scholte BJ. Gene delivery systems—gene therapy vectors for cystic fibrosis. J Cyst Fibros 2004; 3 Suppl 2:203-12. [PMID: 15463959 DOI: 10.1016/j.jcf.2004.05.042] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
Gene delivery systems (GDS) play a central role in the development of gene therapy strategies for Cystic Fibrosis (CF). Further, these systems are important tools in studies with cultured cells and in animal models. In this review, we describe the properties of several viral and synthetic gene delivery systems, and evaluate their possible application in gene therapy of CF. While many gene delivery systems give satisfactory results in cultured or animal studies, none of these systems has been shown to fulfil all the requirements of safety and efficacy for use in CF patients. The intact airway epithelium, the most important target in CF gene therapy, proves to be well protected against invading vector systems.
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Affiliation(s)
- Daniel Klink
- Department of Cell Biology, Erasmus MC, Erasmus University, P.O. Box 1738, Rotterdam DR 3000, The Netherlands
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Klink D, Yu QC, Glick MC, Scanlin T. Lactosylated poly-L-lysine targets a potential lactose receptor in cystic fibrosis and non-cystic fibrosis airway epithelial cells. Mol Ther 2003; 7:73-80. [PMID: 12573620 DOI: 10.1016/s1525-0016(02)00016-3] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
Poly-L-lysine with 40% of the epsilon -amino groups substituted with lactosyl residues facilitated the internalization of lactosylated poly-L-lysine/cDNA complexes into cystic fibrosis (CF) and non-CF airway epithelial cells. It was previously shown that lactosylated poly-L-lysine enhanced the transfer of cDNA into the cell nucleus, resulting in transfection. The cell entry of lactosylated poly-L-lysine/cDNA complexes, however, has not been elucidated and we hypothesized that entry of the complex was by receptor-mediated endocytosis. It is shown here that binding of the vector/cDNA complexes to the cell membrane was inhibited by lactose but not N-acetyl glucosamine. Examination by electron microscopy revealed the complexes in clathrin-coated pits. Furthermore, the complexes colocalized with transferrin during cell entry and were shown in early endosomes. These results demonstrated that lactosylated poly-L-lysine/cDNA complexes enter airway epithelial cells via receptor-mediated endocytosis utilizing lactose-binding receptors, which employ the clathrin-coated pit for internalization. Taken together with the fact that nuclear translocation also is enhanced by lactose, these results demonstrate why lactosylated poly-L-lysine is an excellent vector for transfection of airway epithelial cells. Moreover, other carbohydrates covalently linked to poly-L-lysine for targeting other specific cell types, combined with lactosyl residues, can be designed for the development of other molecular conjugates for gene transfer.
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Affiliation(s)
- Daniel Klink
- The Cystic Fibrosis Center and Department of Pediatrics, University of Pennsylvania School of Medicine, The Children's Hospital of Philadelphia, Philadelphia, Pennsylvania 19104, USA
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