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Wessels M, Velthuis A, van Lochem E, Duijndam E, Hoorweg-Nijman G, de Kruijff I, Wolters V, Berghout E, Meijer J, Bokma JA, Mul D, van der Velden J, Roovers L, Mearin ML, van Setten P. Corrigendum to Raising the Cut-Off Level of Anti-Tissue Transglutaminase Antibodies to Detect Celiac Disease Reduces the Number of Small Bowel Biopsies in Children with Type 1 Diabetes: A Retrospective Study. The Journal of Pediatrics Volume 223, August 2020, Pages 87-92.e1. J Pediatr 2022; 246:293. [PMID: 35606196 DOI: 10.1016/j.jpeds.2022.04.033] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Affiliation(s)
- Margreet Wessels
- Department of Pediatrics, Rijnstate Hospital, Arnhem, The Netherlands.
| | - Anouk Velthuis
- Department of Pediatrics, Leiden University Medical Center, Leiden, The Netherlands
| | - Ellen van Lochem
- Department of Medical Microbiology and Immunology, Rijnstate Hospital, Arnhem, The Netherlands
| | - Eline Duijndam
- Department of Pediatrics, Leiden University Medical Center, Leiden, The Netherlands
| | | | - Ineke de Kruijff
- Department of Pediatrics, St Antonius Hospital, Utrecht, The Netherlands
| | - Victorien Wolters
- Department of Pediatric Gastroenterology, University Medical Center Utrecht-Wilhelmina Children's Hospital, Utrecht, The Netherlands
| | - Eveline Berghout
- Department of Pediatrics, Deventer Hospital, Deventer, The Netherlands
| | - Jos Meijer
- Department of Pathology, Rijnstate Hospital, Arnhem, The Netherlands
| | - Jan Alle Bokma
- Department of Pediatrics, Spaarne Hospital, Hoofddorp, The Netherlands
| | - Dick Mul
- Department of Pediatrics, Haga Hospital (Juliana Children's Hospital), The Hague, The Netherlands
| | - Janielle van der Velden
- Department of Pediatrics, Radboud University Nijmegen Medical Center, Nijmegen, The Netherlands
| | - Lian Roovers
- Clinical Research Department, Rijnstate Hospital, Arnhem, The Netherlands
| | - M Luisa Mearin
- Department of Pediatrics, Leiden University Medical Center, Leiden, The Netherlands
| | - Petra van Setten
- Department of Pediatrics, Rijnstate Hospital, Arnhem, The Netherlands
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Wessels M, Velthuis A, van Lochem E, Duijndam E, Hoorweg-Nijman G, de Kruijff I, Wolters V, Berghout E, Meijer J, Bokma JA, Mul D, van der Velden J, Roovers L, Mearin ML, van Setten P. Raising the Cut-Off Level of Anti-Tissue Transglutaminase Antibodies to Detect Celiac Disease Reduces the Number of Small Bowel Biopsies in Children with Type 1 Diabetes: A Retrospective Study. J Pediatr 2020; 223:87-92.e1. [PMID: 32381465 DOI: 10.1016/j.jpeds.2020.02.086] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/20/2019] [Revised: 01/30/2020] [Accepted: 02/28/2020] [Indexed: 01/03/2023]
Abstract
OBJECTIVE To study the optimal cut-off value for anti-tissue transglutaminase type 2 IgA antibodies (TG2A) in serum to select for diagnostic small bowel biopsies for celiac disease in children with type 1 diabetes mellitus. STUDY DESIGN Children with type 1 diabetes mellitus with elevated TG2A titers and duodenal biopsies performed during the course of their diabetes treatment were included. Anti-endomysial antibodies were recorded if present. The optimal TG2A cut-off value, expressed as the ratio between obtained value and upper limit of normal (ULN), was determined using receiver operating characteristic curve analysis and compared with the cut-off value used in the European Society for Pediatric Gastroenterology, Hepatology and Nutrition guidelines in terms of sensitivity, specificity, positive and negative predictive value. RESULTS We included 63 children. The optimal cut-off value for performing biopsies is demonstrated to be 11 times the ULN. Raising the cut-off value from 3 times the ULN to 11 times the ULN changed sensitivity from 96% to 87% and increased specificity from 36% to 73%, increased the positive predictive value from 88% to 94% and lowered negative predictive value from 67% to 53%. The percentage of normal histology was decreased from 12% to 6%. CONCLUSIONS Increasing the TG2A cut-off value for performing duodenal biopsies in children with type 1 diabetes mellitus and suspected celiac disease leads to a substantial reduction of unnecessary biopsies. We advocate to adapt the European Society for Pediatric Gastroenterology, Hepatology and Nutrition 2012 guidelines for this group of children, including monitoring patients with TG2A levels of less than 11 times the ULN over time.
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Affiliation(s)
- Margreet Wessels
- Department of Pediatrics, Rijnstate Hospital, Arnhem, The Netherlands; Department of Pediatrics, Leiden University Medical Center, Leiden, The Netherlands
| | - Anouk Velthuis
- Department of Pediatrics, Rijnstate Hospital, Arnhem, The Netherlands
| | - Ellen van Lochem
- Department of Medical Microbiology and Immunology, Rijnstate Hospital, Arnhem, The Netherlands
| | - Eline Duijndam
- Department of Pediatrics, Rijnstate Hospital, Arnhem, The Netherlands
| | | | - Ineke de Kruijff
- Department of Pediatrics, St Antonius Hospital, Utrecht, The Netherlands
| | - Victorien Wolters
- Department of Pediatric Gastroenterology, University Medical Center Utrecht-Wilhelmina Children's Hospital, Utrecht, The Netherlands
| | - Eveline Berghout
- Department of Pediatrics, Deventer Hospital, Deventer, The Netherlands
| | - Jos Meijer
- Department of Pathology, Rijnstate Hospital, Arnhem, The Netherlands
| | - Jan Alle Bokma
- Department of Pediatrics, Spaarne Hospital, Hoofddorp, The Netherlands
| | - Dick Mul
- Department of Pediatrics, Haga Hospital (Juliana Children's Hospital), The Hague, The Netherlands
| | - Janielle van der Velden
- Department of Pediatrics, Radboud University Nijmegen Medical Center, Nijmegen, The Netherlands
| | - Lian Roovers
- Clinical Research Department, Rijnstate Hospital, Arnhem, The Netherlands
| | - M Luisa Mearin
- Department of Pediatrics, Leiden University Medical Center, Leiden, The Netherlands
| | - Petra van Setten
- Department of Pediatrics, Rijnstate Hospital, Arnhem, The Netherlands
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van der Linde AAA, Schönbeck Y, van der Kamp HJ, van den Akker ELT, van Albada ME, Boelen A, Finken MJJ, Hannema SE, Hoorweg-Nijman G, Odink RJ, Schielen PCJI, Straetemans S, van Trotsenburg PS, Claahsen-van der Grinten HL, Verkerk PH. Evaluation of the Dutch neonatal screening for congenital adrenal hyperplasia. Arch Dis Child 2019; 104:653-657. [PMID: 30712004 DOI: 10.1136/archdischild-2018-315972] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [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: 08/02/2018] [Revised: 12/17/2018] [Accepted: 12/30/2018] [Indexed: 11/03/2022]
Abstract
BACKGROUND In 2002, a nationwide screening for congenital adrenal hyperplasia (CAH) was introduced in the Netherlands. The aim of our study is to evaluate the validity of the neonatal screening for CAH and to assess how many newborns with salt-wasting (SW) CAH have already been clinically diagnosed before the screening result was known. METHODS Retrospective, descriptive study. The following data of patients with positive screening results since implementation of the screening programme were collected (1 January 2002 up until 31 December 2013): gestational age, sex, diagnosis, clinical presentation and contribution of screening to the diagnosis. RESULTS In the evaluated period, 2 235 931 newborns were screened. 479 children had an abnormal screening result, 133 children were diagnosed with CAH (114 SW, 14 simple virilizing (SV)), five non-classic CAH. During this period, no patients with SW CAH were missed by neonatal screening (sensitivity was 100%). After exclusion of 17 cases with missing information on diagnosis, specificity was 99.98% and positive predictive value was 24.7%. Most false positives (30%) were attributable to prematurity. Of patients with SW CAH, 68% (71/104) patients were detected by neonatal screening and 33 (33/104) were clinically diagnosed. Of girls with SW CAH, 38% (14/37) were detected by neonatal screening and 62% (23/37) were clinically diagnosed. CONCLUSION The Dutch neonatal screening has an excellent sensitivity and high specificity. Both boys and girls can benefit from neonatal screening.
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Affiliation(s)
- Annelieke A A van der Linde
- Department of Paediatric Endocrinology, Radboud University Nijmegen Medical Centre, Nijmegen, The Netherlands.,Department of Paediatrics, Amphia Hospital, Breda, The Netherlands
| | | | - Hetty J van der Kamp
- Department of Paediatrics, Utrecht University Hospital, Utrecht, The Netherlands
| | | | - Mirjam E van Albada
- Department of Paediatrics, University Medical Centre, Groningen, The Netherlands
| | - Anita Boelen
- Department of Endocrinology and Metabolism, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
| | - Martijn J J Finken
- Department of Paediatrics, VU University Medical Centre, Amsterdam, The Netherlands
| | - Sabine E Hannema
- Department of Paediatric Endocrinology, Erasmus MC, Rotterdam, The Netherlands.,Department of Paediatrics, Leiden University Medical Centre, Leiden, The Netherlands
| | - Gera Hoorweg-Nijman
- Department of Paediatrics, St Antonius Hospital, Nieuwegein, The Netherlands
| | - Roelof J Odink
- Department of Paediatrics, Catharina Hospital, Eindhoven, The Netherlands
| | - Peter C J I Schielen
- Reference Laboratory for Neonatal Screening, Centre for Health Protection Research, National Institute for Public Health and the Environment, Bilthoven, The Netherlands
| | | | - Paul S van Trotsenburg
- Department of Paediatric Endocrinology, Emma Children's Hospital Academic Medical Center, Amsterdam University Medical Center, location University of Amsterdam, Amsterdam, The Netherlands
| | | | - Paul H Verkerk
- TNO, Department of Child Health, Leiden, The Netherlands
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Heinen CA, de Vries EM, Alders M, Bikker H, Zwaveling-Soonawala N, van den Akker ELT, Bakker B, Hoorweg-Nijman G, Roelfsema F, Hennekam RC, Boelen A, van Trotsenburg ASP, Fliers E. Mutations in IRS4 are associated with central hypothyroidism. J Med Genet 2018; 55:693-700. [PMID: 30061370 PMCID: PMC6161650 DOI: 10.1136/jmedgenet-2017-105113] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2018] [Revised: 05/27/2018] [Accepted: 06/12/2018] [Indexed: 12/22/2022]
Abstract
BACKGROUND Four genetic causes of isolated congenital central hypothyroidism (CeH) have been identified, but many cases remain unexplained. We hypothesised the existence of other genetic causes of CeH with a Mendelian inheritance pattern. METHODS We performed exome sequencing in two families with unexplained isolated CeH and subsequently Sanger sequenced unrelated idiopathic CeH cases. We performed clinical and biochemical characterisation of the probands and carriers identified by family screening. We investigated IRS4 mRNA expression in human hypothalamus and pituitary tissue, and measured serum thyroid hormones and Trh and Tshb mRNA expression in hypothalamus and pituitary tissue of Irs4 knockout mice. RESULTS We found mutations in the insulin receptor substrate 4 (IRS4) gene in two pairs of brothers with CeH (one nonsense, one frameshift). Sequencing of IRS4 in 12 unrelated CeH cases negative for variants in known genes yielded three frameshift mutations (two novel) in three patients and one male sibling. All male carriers (n=8) had CeH with plasma free thyroxine concentrations below the reference interval. MRI of the hypothalamus and pituitary showed no structural abnormalities (n=12). 24-hour thyroid-stimulating hormone (TSH) secretion profiles in two adult male patients showed decreased basal, pulsatile and total TSH secretion. IRS4 mRNA was expressed in human hypothalamic nuclei, including the paraventricular nucleus, and in the pituitary gland. Female knockout mice showed decreased pituitary Tshb mRNA levels but had unchanged serum thyroid hormone concentrations. CONCLUSIONS Mutations in IRS4 are associated with isolated CeH in male carriers. As IRS4 is involved in leptin signalling, the phenotype may be related to disrupted leptin signalling.
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Affiliation(s)
- Charlotte A Heinen
- Department of Endocrinology and Metabolism, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands.,Department of Paediatric Endocrinology, Emma Children's Hospital, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands
| | - Emmely M de Vries
- Department of Endocrinology and Metabolism, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands
| | - Mariëlle Alders
- Department of Clinical Genetics, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands
| | - Hennie Bikker
- Department of Clinical Genetics, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands
| | - Nitash Zwaveling-Soonawala
- Department of Paediatric Endocrinology, Emma Children's Hospital, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands
| | | | - Boudewijn Bakker
- Department of Paediatrics, Reinier de Graaf Hospital, Delft, The Netherlands
| | - Gera Hoorweg-Nijman
- Department of Paediatrics, St. Antonius Hospital, Nieuwegein, The Netherlands
| | - Ferdinand Roelfsema
- Department of Endocrinology and Metabolism, Leiden University Medical Center, Leiden, The Netherlands
| | - Raoul C Hennekam
- Department of Paediatrics, Emma Children's Hospital, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands
| | - Anita Boelen
- Department of Endocrinology and Metabolism, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands
| | - A S Paul van Trotsenburg
- Department of Paediatric Endocrinology, Emma Children's Hospital, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands
| | - Eric Fliers
- Department of Endocrinology and Metabolism, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands
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