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Veligratli F, Alexandrou D, Shah S, Amin R, Dattani M, Gan HW, Famuboni A, Lopez-Garcia C, Trompeter R, Bockenhauer D. Tolvaptan and urea in paediatric hyponatraemia. Pediatr Nephrol 2024; 39:177-183. [PMID: 37466863 DOI: 10.1007/s00467-023-06091-w] [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: 04/26/2023] [Revised: 07/06/2023] [Accepted: 07/06/2023] [Indexed: 07/20/2023]
Abstract
BACKGROUND The syndrome of inappropriate antidiuretic hormone (SIADH) is usually treated with fluid restriction. This can be challenging in patients with obligate fluid intake for nutrition or medication. Pharmaceutical treatment with tolvaptan and urea is available but minimal paediatric data are available. We review the efficacy and safety of tolvaptan and urea in paediatric patients with SIADH. METHODS Retrospective review of paediatric inpatients with clinical diagnosis of SIADH. Patients were identified from pharmacy records based on tolvaptan and urea prescriptions. Relevant information was extracted from patient electronic records. The main outcome measures included the number of days to sodium normalisation, the daily change in plasma sodium concentration, and the maximum increase of plasma sodium concentration in 24 h. Reported side effects were captured. RESULTS Thirteen patients received tolvaptan and six urea. Five patients had both agents (tolvaptan converted to urea). Tolvaptan led to plasma sodium normalisation in 10/13 (77%) within 6 days (median 2.5 days, range [1, 6]), with a median change of sodium concentration of 7 mmol/L (- 1, 14) within the first 24 h of treatment. Three patients experienced a change in plasma sodium > 10 mmol/l/day but had no apparent side effects. Urea led to sodium normalisation in 5/6 (83%) patients. The median number of days to normalisation with urea was 2 (1, 10) with a median change of plasma sodium concentration of 2 mmol/L (- 1, 6) within the first 24 h. All patients tolerated tolvaptan and/or urea without unexpected side effects. CONCLUSIONS Tolvaptan and urea appear to be safe and effective when fluid restriction is challenging in paediatric SIADH. A higher resolution version of the Graphical abstract is available as Supplementary information.
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Affiliation(s)
- Faidra Veligratli
- Great Ormond Street Hospital for Children, NHS Foundation Trust, London, UK
| | - Demitra Alexandrou
- Great Ormond Street Hospital for Children, NHS Foundation Trust, London, UK
| | - Sarit Shah
- Great Ormond Street Hospital for Children, NHS Foundation Trust, London, UK
| | - Rakesh Amin
- Great Ormond Street Hospital for Children, NHS Foundation Trust, London, UK
| | - Mehul Dattani
- Great Ormond Street Hospital for Children, NHS Foundation Trust, London, UK
| | - Hoong-Wei Gan
- Great Ormond Street Hospital for Children, NHS Foundation Trust, London, UK
| | - Adeola Famuboni
- Great Ormond Street Hospital for Children, NHS Foundation Trust, London, UK
| | | | | | - Detlef Bockenhauer
- Great Ormond Street Hospital for Children, NHS Foundation Trust, London, UK.
- UCL Department of Renal Medicine, London, UK.
- Department of Paediatric Nephrology, University Hospital and Catholic University Leuven, Herestraat 49, 3000, Leuven, Belgium.
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Gan HW, Cerbone M, Dattani MT. Appetite- and weight-regulating neuroendocrine circuitry in hypothalamic obesity. Endocr Rev 2023:bnad033. [PMID: 38019584 DOI: 10.1210/endrev/bnad033] [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: 02/04/2023] [Revised: 10/25/2023] [Accepted: 11/27/2023] [Indexed: 11/30/2023]
Abstract
Since hypothalamic obesity (HyOb) was first described over 120 years ago by Joseph Babinski and Alfred Fröhlich, advances in molecular genetic laboratory techniques have allowed us to elucidate various components of the intricate neurocircuitry governing appetite and weight regulation connecting the hypothalamus, pituitary gland, brainstem, adipose tissue, pancreas and gastrointestinal tract. On a background of an increasing prevalence of population-level common obesity, the number of survivors of congenital (e.g. septo-optic dysplasia, Prader-Willi syndrome) and acquired (e.g. central nervous system tumours) hypothalamic disorders is increasing, thanks to earlier diagnosis and management as well as better oncological therapies. Although to date the discovery of several appetite-regulating peptides has led to the development of a range of targeted molecular therapies for monogenic obesity syndromes, outside of these disorders these discoveries have not translated into the development of efficacious treatments for other forms of HyOb. This review aims to summarise our current understanding of the neuroendocrine physiology of appetite and weight regulation, and explore our current understanding of the pathophysiology of HyOb.
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Affiliation(s)
- Hoong-Wei Gan
- Department of Endocrinology, Great Ormond Street Hospital for Children NHS Foundation Trust, Great Ormond Street, London WC1N 3JH, United Kingdom
- Genetics & Genomic Medicine Research & Teaching Department, University College London Great Ormond Street Institute for Child Health, 30 Guilford Street, London WC1N 1EH, United Kingdom
| | - Manuela Cerbone
- Department of Endocrinology, Great Ormond Street Hospital for Children NHS Foundation Trust, Great Ormond Street, London WC1N 3JH, United Kingdom
- Genetics & Genomic Medicine Research & Teaching Department, University College London Great Ormond Street Institute for Child Health, 30 Guilford Street, London WC1N 1EH, United Kingdom
| | - Mehul Tulsidas Dattani
- Department of Endocrinology, Great Ormond Street Hospital for Children NHS Foundation Trust, Great Ormond Street, London WC1N 3JH, United Kingdom
- Genetics & Genomic Medicine Research & Teaching Department, University College London Great Ormond Street Institute for Child Health, 30 Guilford Street, London WC1N 1EH, United Kingdom
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Mushtaq T, Ali SR, Boulos N, Boyle R, Cheetham T, Davies JH, Elder CJ, Gan HW, Hindmarsh PC, Katugampola H, Krone N, Salomon Estebanez M, Shenoy S, Tollerfield S, Wong SC, Regan F. Emergency and perioperative management of adrenal insufficiency in children and young people: British Society for Paediatric Endocrinology and Diabetes consensus guidance. Arch Dis Child 2023; 108:871-878. [PMID: 37045585 PMCID: PMC10646833 DOI: 10.1136/archdischild-2022-325156] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [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: 12/10/2022] [Accepted: 02/25/2023] [Indexed: 04/14/2023]
Abstract
Adrenal insufficiency (AI) is characterised by lack of cortisol production from the adrenal glands. This can be a primary adrenal disorder or secondary to adrenocorticotropic hormone deficiency or suppression from exogenous glucocorticoids. Symptoms of AI in children may initially be non-specific and include growth faltering, lethargy, poor feeding, weight loss, abdominal pain, vomiting and lingering illnesses. AI is treated with replacement doses of hydrocortisone. At times of physiological stress such as illness, trauma or surgery, there is an increased requirement for exogenous glucocorticoids, which if untreated can lead to an adrenal crisis and death. There are no unified guidelines for those <18 years old in the UK, leading to substantial variation in the management of AI. This paper sets out guidance for intercurrent illness, medical, dental and surgical procedures to allow timely and appropriate recognition and treatment of AI and adrenal crisis for children and young people.
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Affiliation(s)
- Talat Mushtaq
- Department of Paediatric Endocrinology, Leeds Teaching Hospitals NHS Trust, Leeds, UK
| | - Salma R Ali
- Developmental Endocrinology Research Group, University of Glasgow, Royal Hospital for Sick Children, Glasgow, UK
| | - Nabil Boulos
- Pharmacy Department, Southampton University Hospitals NHS Trust, Southampton, UK
| | - Roisin Boyle
- Department of Paediatric Endocrinology, Royal Hospital for Children, Glasgow, UK
| | - Tim Cheetham
- Department of Paediatric Endocrinology, Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne, UK
| | - Justin Huw Davies
- Department of Paediatric Endocrinology, University Hospital Southampton, Southampton, UK
| | - Charlotte Jane Elder
- Department of Paediatric Endocrinology, Sheffield Children's Hospital NHS Foundation Trust, Sheffield, UK
| | - Hoong-Wei Gan
- Department of Paediatric Endocrinology, Great Ormond Street Hospital for Children, London, UK
| | - Peter C Hindmarsh
- Developmental Endocrinology Research Group, University College London Hospitals, London, UK
| | - Harshini Katugampola
- Department of Paediatric Endocrinology, Great Ormond Street Hospital for Children, London, UK
| | - Nils Krone
- Academic Unit of Child Health, Department of Oncology and Metabolism, University of Sheffield, Sheffield, UK
| | - Maria Salomon Estebanez
- Department of Paediatric Endocrinology, Royal Manchester Children's Hospital, Manchester, UK
| | - Savitha Shenoy
- Department of Paediatric Endocrinology, Leicester Royal Infirmary, UHL NHS Trust, Leicester, UK
| | - Sally Tollerfield
- Department of Paediatric Endocrinology, Great Ormond Street Hospital for Children, London, UK
| | - Sze Choong Wong
- Department of Paediatric Endocrinology, Royal Hospital for Children, Glasgow, UK
| | - Fiona Regan
- Department of Paediatric Endocrinology, Guy's and St Thomas' Hospitals NHS Trust, London, UK
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Gan HW, Morillon P, Albanese A, Aquilina K, Chandler C, Chang YC, Drimtzias E, Farndon S, Jacques TS, Korbonits M, Kuczynski A, Limond J, Robinson L, Simmons I, Thomas N, Thomas S, Thorp N, Vargha-Khadem F, Warren D, Zebian B, Mallucci C, Spoudeas HA. National UK guidelines for the management of paediatric craniopharyngioma. Lancet Diabetes Endocrinol 2023; 11:694-706. [PMID: 37549682 DOI: 10.1016/s2213-8587(23)00162-6] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [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] [Received: 03/20/2023] [Revised: 05/25/2023] [Accepted: 06/01/2023] [Indexed: 08/09/2023]
Abstract
Although rare, craniopharyngiomas constitute up to 80% of tumours in the hypothalamic-pituitary region in childhood. Despite being benign, the close proximity of these tumours to the visual pathways, hypothalamus, and pituitary gland means that both treatment of the tumour and the tumour itself can cause pronounced long-term neuroendocrine morbidity against a background of high overall survival. To date, the optimal management strategy for these tumours remains undefined, with practice varying between centres. In light of these discrepancies, as part of a national endeavour to create evidence-based and consensus-based guidance for the management of rare paediatric endocrine tumours in the UK, we aimed to develop guidelines, which are presented in this Review. These guidelines were developed under the auspices of the UK Children's Cancer and Leukaemia Group and the British Society for Paediatric Endocrinology and Diabetes, with the oversight and endorsement of the Royal College of Paediatrics and Child Health using Appraisal of Guidelines for Research & Evaluation II methodology to standardise care for children and young people with craniopharyngiomas.
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Affiliation(s)
- Hoong-Wei Gan
- Great Ormond Street Hospital for Children NHS Foundation Trust, London, UK; University College London Great Ormond Street Institute of Child Health, London, UK.
| | - Paul Morillon
- King's College Hospital NHS Foundation Trust, London, UK
| | - Assunta Albanese
- St George's University Hospitals NHS Foundation Trust, London, UK
| | - Kristian Aquilina
- Great Ormond Street Hospital for Children NHS Foundation Trust, London, UK
| | - Chris Chandler
- King's College Hospital NHS Foundation Trust, London, UK
| | - Yen-Ching Chang
- University College London Hospitals NHS Foundation Trust, London, UK
| | - Evangelos Drimtzias
- St James' University Hospital, Leeds Teaching Hospitals NHS Trust, Leeds, UK
| | - Sarah Farndon
- Bristol Royal Hospital for Children, University Hospitals Bristol NHS Foundation Trust, Bristol, UK
| | - Thomas S Jacques
- Great Ormond Street Hospital for Children NHS Foundation Trust, London, UK; University College London Great Ormond Street Institute of Child Health, London, UK
| | - Márta Korbonits
- William Harvey Research Institute, Barts and the London School of Medicine and Dentistry, Queen Mary University of London, London, UK
| | - Adam Kuczynski
- Great Ormond Street Hospital for Children NHS Foundation Trust, London, UK
| | - Jennifer Limond
- Department of Psychology, College of Life and Environmental Sciences, University of Exeter, Exeter, UK
| | - Louise Robinson
- Royal Manchester Children's Hospital, Manchester University NHS Foundation Trust, Manchester, UK
| | - Ian Simmons
- St James' University Hospital, Leeds Teaching Hospitals NHS Trust, Leeds, UK
| | - Nick Thomas
- King's College Hospital NHS Foundation Trust, London, UK
| | - Sophie Thomas
- Nottingham Children's Hospital, Queens Medical Centre, Nottingham University Hospitals NHS Trust, Nottingham, UK
| | - Nicola Thorp
- The Clatterbridge Cancer Centre NHS Foundation Trust, Clatterbridge Road, Bebington, UK
| | - Faraneh Vargha-Khadem
- Great Ormond Street Hospital for Children NHS Foundation Trust, London, UK; University College London Great Ormond Street Institute of Child Health, London, UK
| | - Daniel Warren
- St James' University Hospital, Leeds Teaching Hospitals NHS Trust, Leeds, UK
| | - Bassel Zebian
- King's College Hospital NHS Foundation Trust, London, UK
| | - Conor Mallucci
- Alder Hey Children's NHS Foundation Trust, Liverpool, UK
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Gan HW, Leeson C, Aitkenhead H, Dattani M. Inaccuracies in plasma oxytocin extraction and enzyme immunoassay techniques. Compr Psychoneuroendocrinol 2023; 15:100188. [PMID: 37360277 PMCID: PMC10285453 DOI: 10.1016/j.cpnec.2023.100188] [Citation(s) in RCA: 2] [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] [Subscribe] [Scholar Register] [Received: 08/16/2022] [Revised: 06/01/2023] [Accepted: 06/04/2023] [Indexed: 06/28/2023] Open
Abstract
Numerous studies have reported extensive associations between plasma oxytocin (OXT) concentrations and various human physiological and neurobehavioral processes. Measurement of OXT is fraught with difficulty due to its low molecular weight and plasma concentrations, with no consensus as to the optimal conditions for pre-analytical sample extraction, standards for immunoassay validation or the ideal protease inhibitors to prevent OXT degradation. Previous attempts at determining the efficacy of various purification techniques such as solid phase extraction (SPE) or ultrafiltration have only utilized human plasma samples, making it difficult to dissect out whether the effect of interference comes from the extraction process itself or cross-reactivity with other proteins. By testing these on pure OXT solutions, we demonstrate poor recovery efficacy and reliability of reversed phase SPE (maximum 58.1%) and ultrafiltration (<1%) techniques, and the potential for the former to introduce interference into enzyme immunoassay (EIA) measurements. The clonality of antibodies used in EIA kits also potentially contributes to the differences in the readings obtained, and we validate an EIA kit which did not require pre-analytical sample extraction with low cross-reactivity and high reliability (intraclass correlation coefficient 0.980 (95% CI 0.896-0.999). Biochemical techniques used for measuring plasma OXT concentrations must therefore be internally validated prior to translation into clinical studies.
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Affiliation(s)
- Hoong-Wei Gan
- Genetics & Genomic Medicine Research and Training Department, UCL Great Ormond Street Institute of Child Health, 30 Guilford Street, London, WC1N 1EH, United Kingdom
- Great Ormond Street Hospital for Children NHS Foundation Trust, Great Ormond Street, London, WC1N 3JH, United Kingdom
| | - Clare Leeson
- Great Ormond Street Hospital for Children NHS Foundation Trust, Great Ormond Street, London, WC1N 3JH, United Kingdom
| | - Helen Aitkenhead
- Great Ormond Street Hospital for Children NHS Foundation Trust, Great Ormond Street, London, WC1N 3JH, United Kingdom
| | - Mehul Dattani
- Genetics & Genomic Medicine Research and Training Department, UCL Great Ormond Street Institute of Child Health, 30 Guilford Street, London, WC1N 1EH, United Kingdom
- Great Ormond Street Hospital for Children NHS Foundation Trust, Great Ormond Street, London, WC1N 3JH, United Kingdom
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Walker DA, Aquilina K, Spoudeas H, Pilotto C, Gan HW, Meijer L. A new era for optic pathway glioma: A developmental brain tumor with life-long health consequences. Front Pediatr 2023; 11:1038937. [PMID: 37033188 PMCID: PMC10080591 DOI: 10.3389/fped.2023.1038937] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/07/2022] [Accepted: 02/13/2023] [Indexed: 04/11/2023] Open
Abstract
Optic pathway and hypothalamic glioma (OPHG) are low-grade brain tumors that arise from any part of the visual pathways frequently involving the hypothalamus. The tumors grow slowly and present with features driven by their precise anatomical site, their age at presentation and the stage of growth and development of the host neural and orbital bony tissues. Up to 50% of optic pathway glioma arise in association with Neurofibromatosis type 1 (NF1), which affects 1 in 3,000 births and is a cancer predisposition syndrome. As low-grade tumors, they almost never transform to malignant glioma yet they can threaten life when they present under two years of age. The main risks are to threaten vision loss by progressive tumor damage to optic pathways; furthermore, invasion of the hypothalamus can lead to diencephalic syndrome in infancy and hypopituitarism later in life. Progressive cognitive and behavioural dysfunction can occur, as part of NF1 syndromic features and in sporadic cases where large bulky tumors compress adjacent structures and disrupt neuro-hypothalamic pathways. Persistently progressive tumors require repeated treatments to attempt to control vision loss, other focal brain injury or endocrine dysfunction. In contrast tumors presenting later in childhood can be seen to spontaneously arrest in growth and subsequently progress after periods of stability. These patterns are influenced by NF status as well as stages of growth and development of host tissues. The past two decades has seen an expansion in our understanding and knowledge of the clinical and scientific features of these tumors, their modes of presentation, the need for careful visual and endocrine assessment. This influences the decision-making surrounding clinical management with surgery, radiotherapy, chemotherapy and most recently, the potential benefit of molecularly targeted drug therapy. This article, based upon the authors' clinical and research experience and the published literature will highlight advances in approach to diagnosis, the established role of vision loss as justification of treatments and the emerging evidence of endocrine and neurological consequences that need to be incorporated into judgements for case selection for therapy or observation. Consideration is given to the current state of biological evidence justifying current trials of new therapies, the genetic studies of the NF1 gene and the potential for new approaches to OPHG detection and treatment. The outstanding health system priorities from the perspective of children, their parents and health system commissioners or insurers are discussed.
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Affiliation(s)
- David A. Walker
- Emeritus Professor Paediatric Oncology, University of Nottingham, Nottingham, United Kingdom
- Correspondence: David A. Walker
| | - Kristian Aquilina
- Department of NeuroEndocrinology, Great Ormond Street Hospital, London, United Kingdom
| | - Helen Spoudeas
- Department of NeuroEndocrinology, Great Ormond Street Hospital, London, United Kingdom
| | - Chiara Pilotto
- Pediatric Clinic, ASUFC Santa Maria Della Misericordia, Udine, Italy
| | - Hoong-Wei Gan
- Department of NeuroEndocrinology, Great Ormond Street Hospital, London, United Kingdom
| | - Lisethe Meijer
- Kinderoncologie, Prinses Máxima Centrum Voor Kinderoncologie BV, Utrecht, Netherlands
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Picariello S, Cerbone M, D'Arco F, Gan HW, O’Hare P, Aquilina K, Opocher E, Hargrave D, Spoudeas HA. LGG-33. A 40-year cohort study of evolving hypothalamic dysfunction in 90 infants and young children (<3y) with optic pathway gliomas. Neuro Oncol 2022. [PMCID: PMC9165210 DOI: 10.1093/neuonc/noac079.345] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
BACKGROUND: Despite high survival, paediatric optic pathway hypothalamic gliomas are associated with significant morbidity and late mortality. Those youngest at presentation have the worst outcomes. METHODS: We aimed to assess presenting disease, tumour location and treatment factors implicated in the evolution of neuroendocrine, metabolic and neuro-behavioural morbidity in children diagnosed before their 3rd birthday and followed over four decades (1981- 2020). RESULTS: Ninety infants/young children followed-up for 9.5 years (range 0.5-25.0) were included in the study. Fifty-two (57.8%) patients experienced endo-metabolic dysfunction (EMD), the large majority (46) had hypothalamic involvement (H+) and lower endocrine event free survival (EEFS) rates. Median time to first endocrine event was 3.4 years, with EEFS declining up to 13.6 years after diagnosis. EMD was greatly increased by a diencephalic syndrome presentation (85.2% vs 46%, p=0.001), H+ (OR 6.1 95% CI 1.7 – 21.7, p 0.005), radiotherapy (OR 16.2, 95% CI 1.7 – 158.6, p=0.017) and surgery (OR 4.8 95% CI 1.3- 17.2, p=0.015), all associated with anterior pituitary disorders. Obesity occurred in 25% of cases and clustered with the endocrinopathies. Posterior pituitary disorders were recorded in 15 subjects (16.7%), only after surgery and/or as a consequence of hydrocephalus in those with suprasellar tumours and hypothalamic disease. Neuro-behavioural deficits occurred in over half (52) of the cohort and were associated with H+ (OR 2.5 95% C.I. 1.1 – 5.9, p=0.043) and radiotherapy (OR 23.1 C.I. 2.9 – 182, p=0.003). CONCLUSIONS: Very young children with OPHG carry a high risk of endo-metabolic and neuro-behavioural comorbidities which deserve better understanding and timely/parallel support from diagnosis to improve outcomes. These evolve in a complex hierarchical pattern overtime whose aetiology appears predominantly determined by injury from the hypothalamic tumour location alongside adjuvant treatment strategies.
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Affiliation(s)
- Stefania Picariello
- Neuro-oncology Unit, Department of Paediatric Oncology, Santobono-Pausilipon Children’s Hospital , Naples , Italy
- Department of Woman, Child and General and Specialized Surgery, University of Campania Luigi Vanvitelli , Naples , Italy
| | - Manuela Cerbone
- Department of Endocrinology, Great Ormond Street Hospital for Children , London , United Kingdom
- Section of Molecular Basis of Rare Disease, University College London Great Ormond Street Hospital Institute of Child Health , London , United Kingdom
| | - Felice D'Arco
- Department of Radiology, Great Ormond Street Hospital for Children , London , United Kingdom
| | - Hoong-Wei Gan
- Department of Endocrinology, Great Ormond Street Hospital for Children , London , United Kingdom
- Section of Molecular Basis of Rare Disease, University College London Great Ormond Street Hospital Institute of Child Health , London , United Kingdom
| | - Patricia O’Hare
- Department of Oncology, Great Ormond Street Hospital for Children , London , United Kingdom
| | - Kristian Aquilina
- Department of Neurosurgery, Great Ormond Street Hospital for Children , London , United Kingdom
| | - Enrico Opocher
- Department of Oncology, Great Ormond Street Hospital for Children , London , United Kingdom
- Pediatric Hematology, Oncology and Stem Cell Transplant Division, Padua University Hospital , Padua , Italy
| | - Darren Hargrave
- Department of Oncology, Great Ormond Street Hospital for Children , London , United Kingdom
| | - Helen Alexandra Spoudeas
- Department of Endocrinology, Great Ormond Street Hospital for Children , London , United Kingdom
- Section of Molecular Basis of Rare Disease, University College London Great Ormond Street Hospital Institute of Child Health , London , United Kingdom
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Green K, Dahl C, Jorgensen M, O'Hare P, Opocher E, Slater O, Gains J, Chang YC, Aquilina K, Bowman R, Oldridge B, Jacques TS, Stone T, Gan HW, Bluebond-Langner M, Hargrave D. LGG-46. Survival Of The Fittest? A Prognostic Evaluation of Paediatric Low-Grade Glioma (PLGG) Survivor Functional Outcomes. Neuro Oncol 2022. [PMCID: PMC9165037 DOI: 10.1093/neuonc/noac079.358] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Abstract
INTRODUCTION: Whilst most patients with PLGG will survive, varying morbidities derived from patient,tumour & treatment characteristics can afflict life-long disabling functional impairments. No PLGG studies have evaluated potential prognostic factors for important functional outcomes. METHODS: We performed retrospective analysis of all children diagnosed with PLGG at GOSH 1980-2021.Review of medical notes recorded patient demographics,tumour characteristics & treatment data.Functional outcomes included endocrine,educational,visual (in OPG),auditory & physical function.Multivariate regression analysis(p<0.05) examined associations between biological prognostic variables & functional outcomes. RESULTS: 814 patients were diagnosed with PLGG.731(90%) had 5-years follow-up from diagnosis & were included for functional analysis.Median age at diagnosis 7 years(0-17.9); 50.6%Male,12.2% NF1.Tumours were cerebral(27%),cerebellar(27%),hypothalamo-chiasmatic(19%),brainstem(7%),or other(20%);with disseminated disease in 5%.Pilocytic Astrocytoma constituted 46%.Molecular profiling of 133 revealed 5%BRAFV600E mutation,42%BRAF-KIAA1549 fusion.Treatments included: Surgery(70%),Chemotherapy(20%),& Radiotherapy(21%).20-year-OS 94%,PFS 76%;median follow-up 16 years(5-38). Documented neurocognitive deficiency(30%) associated with chemotherapy(HR2.36,95%CI 1.49-3.75,P<0.001), radiotherapy(HR 2.25,95%CI1.5-3.36,P<0.001) & male gender(HR 0.68,95%CI 0.49-0.95,P0.02)as independent poor-prognostic risk-factors.Chemotherapy(HR 5.7,95%CI1.4-22.3,P0.01) & radiotherapy(HR6.77,95%CI2.1-22.0,P0.001) were independent risk-factors for requirement of Educational-Health-Care-Plans(25%).9% attended specialised schools. Combined-limb-MRC-grade <18/20(6.4%) was independently-associated with receiving chemotherapy(HR 2.77,95%CI1.29-5.93,P0.01),& radiotherapy(HR 6.28,95%CI3.25-12.15,P<0.001).6% mobilised by wheelchair.Resolution of seizures occurred in 68% of 176 following PLGG treatment. Single/multiple endocrinopathies occurred in 9.3%/11%.Presence of 2+Endocrinopathies was associated with chemotherapy(HR6.82,95%CI4.0-14.4,P<0.001), radiotherapy(HR7.81,95%CI4.3-14.3,P<0.001),NF1(HR2.9,95%CI1.3-6,P0.01),OPGs(HR 1.3,95%CI1.2-1.5,P<0.001);with younger diagnostic-age(HR0.80,95%CI0.74-0.87,P<0.001) & initial surgical resection(HR0.3,95%CI0.15-0.7,P0.03) independent protective factors. Receiving chemotherapy/radiotherapy were independent prognostic-factors for Post-PLGG-treatment Brock grade 1+ hearing impairments(2.2%).Visual outcomes in 146 OPG patients:blindness in atleast 1 eye(4.8%),registered visual impairment(9.6%),& visual-aid use(6.2%). CONCLUSIONS: Whilst overall outcomes for PLGG are optimistic, some patients have significant functional impairments detrimental to quality-of-life.Further evaluation of longer-term functional outcomes and prognostic associations is justified.
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Affiliation(s)
| | | | | | - Patricia O'Hare
- Great Ormond Street Hospital , London , United Kingdom
- Belfast Children's hospital , Belfast , United Kingdom
| | - Enrico Opocher
- Great Ormond Street Hospital , London , United Kingdom
- University Hospital Padua , Padua , Italy
| | - Olga Slater
- Great Ormond Street Hospital , London , United Kingdom
| | - Jenny Gains
- Great Ormond Street Hospital , London , United Kingdom
- University College London Hospital , London , United Kingdom
| | - Yen-Ching Chang
- Great Ormond Street Hospital , London , United Kingdom
- University College London Hospital , London , United Kingdom
| | | | | | | | | | - Thomas Stone
- University College London , London , United Kingdom
| | - Hoong-Wei Gan
- Great Ormond Street Hospital , London , United Kingdom
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Picariello S, Cerbone M, D’Arco F, Gan HW, O’Hare P, Aquilina K, Opocher E, Hargrave D, Spoudeas HA. A 40-Year Cohort Study of Evolving Hypothalamic Dysfunction in Infants and Young Children (<3 years) with Optic Pathway Gliomas. Cancers (Basel) 2022; 14:cancers14030747. [PMID: 35159015 PMCID: PMC8833541 DOI: 10.3390/cancers14030747] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2021] [Revised: 01/16/2022] [Accepted: 01/27/2022] [Indexed: 11/16/2022] Open
Abstract
Simple Summary Serious, poorly understood health issues affect young children with optic pathway tumours. We studied the risk of developing life-limiting hormonal, metabolic, and neurobehavioural disorders by tumour position, recurrence, and treatment, in those diagnosed under 3 years. We found the highest risk for future complex health issues in those presenting with failure to thrive, under one year of age, and/or a tumour involving a deep midbrain area called the hypothalamus. Time, repeated tumour growth, and salvage therapies (radiotherapy, surgery) contributed. We highlight the need for a better understanding of tumour-induced midbrain injury and for neurobehavioural and hormonal support to inform rehabilitation in the growing years, during and beyond cure, to optimise quality of life for these survivors and their families. This might inform oncology treatment strategies and determine new areas for support and collaborative neuroscience research in this high survival group. Abstract Despite high survival, paediatric optic pathway hypothalamic gliomas are associated with significant morbidity and late mortality. Those youngest at presentation have the worst outcomes. We aimed to assess presenting disease, tumour location, and treatment factors implicated in the evolution of neuroendocrine, metabolic, and neurobehavioural morbidity in 90 infants/children diagnosed before their third birthday and followed-up for 9.5 years (range 0.5–25.0). A total of 52 (57.8%) patients experienced endo-metabolic dysfunction (EMD), the large majority (46) of whom had hypothalamic involvement (H+) and lower endocrine event-free survival (EEFS) rates. EMD was greatly increased by a diencephalic syndrome presentation (85.2% vs. 46%, p = 0.001)), H+ (OR 6.1 95% CI 1.7–21.7, p 0.005), radiotherapy (OR 16.2, 95% CI 1.7–158.6, p = 0.017) and surgery (OR 4.8 95% CI 1.3–17.2, p = 0.015), all associated with anterior pituitary disorders. Obesity occurred in 25% of cases and was clustered with the endocrinopathies. Neurobehavioural deficits occurred in over half (52) of the cohort and were associated with H+ (OR 2.5 95% C.I. 1.1–5.9, p = 0.043) and radiotherapy (OR 23.1 C.I. 2.9–182, p = 0.003). Very young children with OPHG carry a high risk of endo-metabolic and neurobehavioural comorbidities which deserve better understanding and timely/parallel support from diagnosis to improve outcomes. These evolve in complex, hierarchical patterns over time whose aetiology appears predominantly determined by injury from the hypothalamic tumour location alongside adjuvant treatment strategies.
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Affiliation(s)
- Stefania Picariello
- Neuro-Oncology Unit, Department of Paediatric Oncology, Santobono-Pausilipon Children’s Hospital, 80123 Naples, Italy;
- Department of Woman, Child and General and Specialized Surgery, University of Campania Luigi Vanvitelli, 80138 Naples, Italy
| | - Manuela Cerbone
- Department of Endocrinology, Great Ormond Street Hospital for Children, London WC1N 3JH, UK; (H.-W.G.); (H.A.S.)
- Section of Molecular Basis of Rare Disease, University College London Great Ormond Street Hospital Institute of Child Health, London WC1N 1EH, UK
- Correspondence:
| | - Felice D’Arco
- Department of Radiology, Great Ormond Street Hospital for Children, London WC1N 3JH, UK
| | - Hoong-Wei Gan
- Department of Endocrinology, Great Ormond Street Hospital for Children, London WC1N 3JH, UK; (H.-W.G.); (H.A.S.)
- Section of Molecular Basis of Rare Disease, University College London Great Ormond Street Hospital Institute of Child Health, London WC1N 1EH, UK
| | - Patricia O’Hare
- Department of Oncology, Great Ormond Street Hospital for Children, London WC1N 3JH, UK; (P.O.); (E.O.); (D.H.)
| | - Kristian Aquilina
- Department of Neurosurgery, Great Ormond Street Hospital for Children, London WC1N 3JH, UK;
| | - Enrico Opocher
- Department of Oncology, Great Ormond Street Hospital for Children, London WC1N 3JH, UK; (P.O.); (E.O.); (D.H.)
- Pediatric Hematology, Oncology and Stem Cell Transplant Division, Padua University Hospital, 35128 Padua, Italy
| | - Darren Hargrave
- Department of Oncology, Great Ormond Street Hospital for Children, London WC1N 3JH, UK; (P.O.); (E.O.); (D.H.)
| | - Helen A. Spoudeas
- Department of Endocrinology, Great Ormond Street Hospital for Children, London WC1N 3JH, UK; (H.-W.G.); (H.A.S.)
- Section of Molecular Basis of Rare Disease, University College London Great Ormond Street Hospital Institute of Child Health, London WC1N 1EH, UK
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Hage C, Gan HW, Ibba A, Patti G, Dattani M, Loche S, Maghnie M, Salvatori R. Advances in differential diagnosis and management of growth hormone deficiency in children. Nat Rev Endocrinol 2021; 17:608-624. [PMID: 34417587 DOI: 10.1038/s41574-021-00539-5] [Citation(s) in RCA: 22] [Impact Index Per Article: 7.3] [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: 07/06/2021] [Indexed: 02/07/2023]
Abstract
Growth hormone (GH) deficiency (GHD) in children is defined as impaired production of GH by the pituitary gland that results in growth failure. This disease might be congenital or acquired, and occurs in isolation or in the setting of multiple pituitary hormone deficiency. Isolated GHD has an estimated prevalence of 1 patient per 4000-10,000 live births and can be due to multiple causes, some of which are yet to be determined. Establishing the correct diagnosis remains key in children with short stature, as initiating treatment with recombinant human GH can help them attain their genetically determined adult height. During the past two decades, our understanding of the benefits of continuing GH therapy throughout the transition period from childhood to adulthood has increased. Improvements in transitional care will help alleviate the consequent physical and psychological problems that can arise from adult GHD, although the consequences of a lack of hormone replacement are less severe in adults than in children. In this Review, we discuss the differential diagnosis in children with GHD, including details of clinical presentation, neuroimaging and genetic testing. Furthermore, we highlight advances and issues in the management of GHD, including details of transitional care.
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Affiliation(s)
- Camille Hage
- Division of Endocrinology, Diabetes, & Metabolism, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Hoong-Wei Gan
- Genetics & Genomic Medicine Research and Teaching Department, University College London Great Ormond Street Hospital Institute of Child Health, London, UK
- Department of Paediatric Endocrinology, Great Ormond Street Hospital for Children NHS Foundation Trust, London, UK
| | - Anastasia Ibba
- Paediatric Endocrine Unit, Paediatric Hospital Microcitemico "A. Cao", AO Brotzu, Cagliari, Italy
| | - Giuseppa Patti
- Department of Paediatrics, IRCCS Istituto Giannina Gaslini, Genova, Italy
- Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health (DINOGMI), University of Genova, Genova, Italy
| | - Mehul Dattani
- Genetics & Genomic Medicine Research and Teaching Department, University College London Great Ormond Street Hospital Institute of Child Health, London, UK
- Department of Paediatric Endocrinology, Great Ormond Street Hospital for Children NHS Foundation Trust, London, UK
| | - Sandro Loche
- Paediatric Endocrine Unit, Paediatric Hospital Microcitemico "A. Cao", AO Brotzu, Cagliari, Italy
| | - Mohamad Maghnie
- Department of Paediatrics, IRCCS Istituto Giannina Gaslini, Genova, Italy
- Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health (DINOGMI), University of Genova, Genova, Italy
| | - Roberto Salvatori
- Division of Endocrinology, Diabetes, & Metabolism, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, USA.
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Ryalls MR, Gan HW, Davison JE. Adrenoleukodystrophy in the Differential Diagnosis of Boys Presenting with Primary Adrenal Insufficiency without Adrenal Antibodies. J Clin Res Pediatr Endocrinol 2021; 13:212-217. [PMID: 32394691 PMCID: PMC8186336 DOI: 10.4274/jcrpe.galenos.2020.2020.0214] [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
Adrenoleukodystrophy (ALD) is an X-linked, metabolic disorder caused by deficiency of peroxisomal ALD protein resulting in accumulation of very-long chain fatty acids (VLCFA), primarily in the adrenal cortex and central nervous system. Approximately 35-40% of boys with ALD develop cerebral ALD (CALD), which causes rapidly progressive cerebral demyelination, loss of neurologic function, and death. Approximately 70-80% of boys with ALD have impaired adrenal function prior to the onset of neurologic symptoms. We present a boy who had recurrent episodes of hypoglycaemia from age two years and was diagnosed with adrenal insufficiency without adrenal antibodies at age 5.5 years. Following initial normal VLCFA levels, subsequent VLCFA analysis demonstrated elevated C26 fatty acids consistent with peroxisomal dysfunction and suggestive of ALD, which was confirmed via molecular genetic analysis of the ABCD1 gene. Brain imaging at age 7 suggested cerebral involvement and the child underwent successful allogeneic hematopoietic stem cell transplantation. At last assessment (11.5 years old), he was performing as expected for age. This case highlights the importance of pursuing a diagnosis when clinical suspicion remains, and the significance of VLCFA analysis for patients with adrenal insufficiency without adrenal antibodies in securing an ALD diagnosis. Subsequent brain imaging surveillance can detect early, pre-symptomatic cerebral disease, allowing for timely treatment and successful arrest of cerebral disease progression.
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Affiliation(s)
- Michael R. Ryalls
- Royal Surrey County Hospital NHS Foundation Trust, Department of Paediatric, Guildford, UK,* Address for Correspondence: Royal Surrey County Hospital NHS Foundation Trust, Department of Paediatric, Guildford, UK Phone: +01483 571122 E-mail:
| | - Hoong-Wei Gan
- Great Ormond Street Hospital for Children NHS Foundation Trust, Paediatric Endocrinology and Diabetes; University College of London Institute of Child Health, London, UK
| | - James E. Davison
- Great Ormond Street Hospital for Children NHS Foundation Trust, Metabolic Medicine, London, UK
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12
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Affiliation(s)
- Hoong-Wei Gan
- Great Ormond Street Hospital for Children NHS Foundation Trust, London, UK.,UCL Great Ormond Street Institute of Child Health, London, UK
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Zurita ALP, Linglart A, Alves I, Auriemma RS, Boarini M, Bryce J, DeSanctis L, Ertl DA, Gan HW, Grasemann C, Högler W, Javaid MK, Mohnike K, Mordenti M, Raimann A, Sangiorgi L, Roos M, Skarberg R, Soucek O, Toke J, van den Akker E, Vicente A, Faisal AS, Appelman-Dijkstra N. The European Registry for Rare Bone and Mineral Conditions (EuRR-Bone): First year experience of the use of an e-reporting tool. Bone Rep 2021. [DOI: 10.1016/j.bonr.2021.100849] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
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Gan HW, Bhatt JM, Denvir L, Randell T, Sachdev P. Monogenic diabetes mellitus in cystic fibrosis. Arch Dis Child 2019; 104:887-889. [PMID: 30269055 DOI: 10.1136/archdischild-2018-316141] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/30/2018] [Revised: 09/13/2018] [Accepted: 09/15/2018] [Indexed: 01/02/2023]
Abstract
We present a non-consanguineous family of three siblings who presented with diabetes mellitus (DM), two of whom had genetically confirmed cystic fibrosis (CF), with one pancreatic-sufficient mutation in the cystic fibrosis transmembrane conductance regulator (CFTR) gene (ΔF508/R117H;IVS8-5T). A detailed history revealed family members from three successive generations diagnosed with 'type 1' or 'type 2' diabetes, leading to genetic investigations for monogenic DM. A heterozygous frameshift mutation in the hepatocyte nuclear factor 1 homeobox alpha (HNF1A) gene (c.404delA) was subsequently confirmed in all three siblings, which is known to cause monogenic diabetes and is exquisitely sensitive to sulfonylurea therapy. Following this diagnosis, both siblings with CF and HNF1A monogenic diabetes were started on gliclazide therapy, while their older brother who had been wrongly diagnosed with type 1 diabetes was switched from insulin to gliclazide, all with excellent therapeutic responses.
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Affiliation(s)
- Hoong-Wei Gan
- Department of Paediatric Endocrinology, Nottingham Children's Hospital, Nottingham University Hospitals NHS Trust, Nottingham, UK.,Genetics and Genomic Medicine Programme, University College London Great Ormond Street Institute of Child Health, London, UK
| | - Jayesh Mahendra Bhatt
- Department of Paediatric Respiratory Medicine, Nottingham Children's Hospital, Nottingham University Hospitals NHS Trust, Nottingham, UK
| | - Louise Denvir
- Department of Paediatric Endocrinology, Nottingham Children's Hospital, Nottingham University Hospitals NHS Trust, Nottingham, UK
| | - Tabitha Randell
- Department of Paediatric Endocrinology, Nottingham Children's Hospital, Nottingham University Hospitals NHS Trust, Nottingham, UK
| | - Pooja Sachdev
- Department of Paediatric Endocrinology, Nottingham Children's Hospital, Nottingham University Hospitals NHS Trust, Nottingham, UK
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15
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Gan HW, Aquilina K, Morillon P, Albanese A, Barkas K, Chandler C, Chang YC, Daousi C, Drimtzias E, Farndon S, Jacques T, Korbonits M, Kuczynski A, Limond J, Robinson L, Simmons I, Thomas N, Thomas S, Thorpe N, Vargha-Khadem F, Warren D, Zebian B, Mallucci C, Gamble A, Wilne S, Harrison B, Spoudeas H. CRAN-08. NATIONAL UK GUIDELINES FOR THE INVESTIGATION, TREATMENT AND LONG-TERM FOLLOW-UP OF PAEDIATRIC CRANIOPHARYNGIOMA. Neuro Oncol 2018. [DOI: 10.1093/neuonc/noy059.045] [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] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Affiliation(s)
- Hoong-Wei Gan
- University College London Great Ormond Street Institute of Child Health, London, UK
- Great Ormond Street Hospital for Children NHS Foundation Trust, London, UK
| | - Kristian Aquilina
- Great Ormond Street Hospital for Children NHS Foundation Trust, London, UK
| | | | - Assunta Albanese
- St. George’s University Hospitals NHS Foundation Trust, London, UK
| | | | - Chris Chandler
- King’s College Hospital NHS Foundation Trust, London, UK
| | - Yen-Ching Chang
- University College London Hospitals NHS Foundation Trust, London, UK
| | | | | | - Sarah Farndon
- East and North Hertfordshire NHS Trust, Stevenage, UK
| | - Tom Jacques
- Great Ormond Street Hospital for Children NHS Foundation Trust, London, UK
| | | | - Adam Kuczynski
- Great Ormond Street Hospital for Children NHS Foundation Trust, London, UK
| | | | - Louise Robinson
- Royal Manchester Children’s Hospital, Central Manchester University Hospitals NHS Foundation Trust, Manchester, UK
| | - Ian Simmons
- Leeds Teaching Hospitals NHS Trust, Leeds, UK
| | - Nick Thomas
- King’s College Hospital NHS Foundation Trust, London, UK
| | - Sophie Thomas
- Nottingham Children’s Hospital, Nottingham University Hospitals NHS Trust, Nottingham, UK
| | - Nicola Thorpe
- The Clatterbridge Cancer Centre NHS Foundation Trust, Birkenhead, UK
| | - Faraneh Vargha-Khadem
- University College London Great Ormond Street Institute of Child Health, London, UK
- Great Ormond Street Hospital for Children NHS Foundation Trust, London, UK
| | | | - Bassel Zebian
- King’s College Hospital NHS Foundation Trust, London, UK
| | - Conor Mallucci
- Alder Hey Children’s NHS Foundation Trust, Liverpool, UK
| | - Ashley Gamble
- UK Children’s Cancer and Leukaemia Group, Leicester, UK
| | - Sophie Wilne
- Nottingham Children’s Hospital, Nottingham University Hospitals NHS Trust, Nottingham, UK
| | - Barney Harrison
- Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, UK
| | - Helen Spoudeas
- Great Ormond Street Hospital for Children NHS Foundation Trust, London, UK
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Kok K, Sproat C, Chong MS, Chandler C, Thomas N, Gan HW. Congenital Epidermoid Cyst Presenting as Isolated Painful Trigeminal Neuropathy: Indications for Neuroimaging in the Diagnostic Process. J Oral Facial Pain Headache 2017; 31:e10-e14. [PMID: 29073668 DOI: 10.11607/ofph.1949] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
This article reports a case of a cerebellopontine angle epidermoid cyst presenting as isolated painful trigeminal neuropathy. The indolent nature of these uncommon benign tumors leads to frequent delays in their presentation and diagnosis, with patients often initially undergoing dental procedures. This is illustrated in the present case reported here, which highlights the difficulties in identifying trigeminal neuralgia (TN), particularly in its early phases, and supports current recommendations for routine neuroimaging in suspected cases of painful trigeminal neuropathy, which, unlike classic TN, is caused by a disorder other than neurovascular compression (even in the absence of additional neurologic symptoms or signs) and is present particularly in younger patients with atypical features. Additionally, this case report offers a unique patient perspective of living with TN, with a detailed description by one of the authors of the nature of the pain and its impact.
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Hacohen Y, Messina S, Gan HW, Wright S, Chandratre S, Leite MI, Fallon P, Vincent A, Ciccarelli O, Wassmer E, Lim M, Palace J, Hemingway C. Endocrinopathies in paediatric-onset neuromyelitis optica spectrum disorder with aquaporin 4 (AQP4) antibody. Mult Scler 2017; 24:679-684. [DOI: 10.1177/1352458517726593] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
The involvement of the diencephalic regions in neuromyelitis optica spectrum disorder (NMOSD) may lead to endocrinopathies. In this study, we identified the following endocrinopathies in 60% (15/25) of young people with paediatric-onset aquaporin 4-Antibody (AQP4-Ab) NMOSD: morbid obesity ( n = 8), hyperinsulinaemia ( n = 5), hyperandrogenism ( n = 5), amenorrhoea ( n = 5), hyponatraemia ( n = 4), short stature ( n = 3) and central hypothyroidism ( n = 2) irrespective of hypothalamic lesions. Morbid obesity was seen in 88% (7/8) of children of Caribbean origin. As endocrinopathies were prevalent in the majority of paediatric-onset AQP4-Ab NMOSD, endocrine surveillance and in particular early aggressive weight management is required for patients with AQP4-Ab NMOSD.
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Affiliation(s)
- Yael Hacohen
- Department of Paediatric Neurology, Great Ormond Street Hospital for Children, London, UK/Department of Neuroinflammation, Queen Square Multiple Sclerosis Centre, UCL Institute of Neurology, London, UK/Department of Neurosciences, Great Ormond Street Hospital for Children, London, UK
| | - Silvia Messina
- Neurology Department, John Radcliffe Hospital, Oxford, UK
| | - Hoong-Wei Gan
- Department of Paediatric Endocrinology, Great Ormond Street Hospital, London, UK
| | - Sukhvir Wright
- Department of Paediatric Neurology, Birmingham Children’s Hospital, Birmingham, UK
| | - Saleel Chandratre
- Department of Paediatric Neurology, John Radcliffe Hospital, Oxford, UK
| | - Maria Isabel Leite
- Neurology Department, John Radcliffe Hospital, Oxford, UK/Nuffield Department of Clinical Neurosciences, John Radcliffe Hospital, University of Oxford, Oxford, UK
| | - Penny Fallon
- Department of Paediatric Neurology, St George’s Hospital, London, UK
| | - Angela Vincent
- Nuffield Department of Clinical Neurosciences, John Radcliffe Hospital, University of Oxford, Oxford, UK
| | - Olga Ciccarelli
- Department of Neuroinflammation, Queen Square Multiple Sclerosis Centre, UCL Institute of Neurology, London, UK
| | - Evangeline Wassmer
- Department of Paediatric Neurology, Birmingham Children’s Hospital, Birmingham, UK
| | - Ming Lim
- Department of Children’s Neurosciences, Evelina London Children’s Hospital, Guy’s and St Thomas’ NHS Foundation Trust, King’s Health Partners Academic Health Science Centre, London, UK
| | | | - Cheryl Hemingway
- Department of Paediatric Neurology, Great Ormond Street Hospital for Children, London, UK
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Gan HW, Wong DJN, Dean BJF, Hall AS. Do expanded seven-day NHS services improve clinical outcomes? Analysis of comparative institutional performance from the "NHS Services, Seven Days a Week" project 2013-2016. BMC Health Serv Res 2017; 17:552. [PMID: 28797268 PMCID: PMC5553994 DOI: 10.1186/s12913-017-2505-8] [Citation(s) in RCA: 7] [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] [Subscribe] [Scholar Register] [Received: 04/29/2016] [Accepted: 08/03/2017] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The cause of adverse weekend clinical outcomes remains unknown. In 2013, the "NHS Services, Seven Days a Week" project was initiated to improve access to services across the seven-day week. Three years on, we sought to analyse the impact of such changes across the English NHS. METHODS Aggregated trust-level data on crude mortality rates, Summary Hospital-Level Mortality Indicator (SHMI), mean length of stay (LOS), A&E admission and four-hour breach rates were obtained from national Hospital Episode Statistics and A&E datasets across the English NHS, excluding mental and community health trusts. Trust annual reports were analysed to determine the presence of any seven-day service reorganisation in 2013-2014. Funnel plots were generated to compare institutional performance and a difference in differences analysis was performed to determine the impact of seven-day changes on clinical outcomes between 2013 and 2014, 2014-2015 and 2015-2016. Data was summarised as mean (SD). RESULTS Of 159 NHS trusts, 79 (49.7%) instituted seven-day changes in 2013-2014. Crude mortality rates, A&E admission rates and mean LOS remained relatively stable between 2013 and 2016, whilst A&E four-hour breach rates nearly doubled from 5.3 to 9.7%. From 2013 to 2014 to 2014-2015 and 2015-2016, there were no significant differences in the change in crude mortality (2014-2015 p = 0.8, 2015-2016 p = 0.9), SHMI (2014-2015 p = 0.5, 2015-2016 p = 0.5), mean LOS (2014-2015 p = 0.5, 2015-2016 p = 0.4), A&E admission (2014-2015 p = 0.6, 2015-2016 p = 1.0) or four-hour breach rates (2014-2015 p = 0.06, 2015-2016 p = 0.6) between trusts that had implemented seven-day changes compared to those which had not. CONCLUSIONS Adverse weekend clinical outcomes may not be ameliorated by large scale reorganisations aimed at improving access to health services across the week. Such changes may negatively impact care quality without additional financial investment, as demonstrated by worsening of some outcomes. Detailed prospective research is required to determine whether such reallocation of finite resources is clinically effective.
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Affiliation(s)
- Hoong-Wei Gan
- Section for Genetics & Epigenetics in Health & Disease, Genetics & Genomic Medicine Programme, University College London Institute of Child Health, 30 Guilford Street, London, WC1N 1EH, UK. .,The London Centre for Paediatric Endocrinology & Diabetes, Great Ormond Street Hospital for Children NHS Foundation Trust, London, UK.
| | - Danny Jon Nian Wong
- National Institute of Academic Anaesthesia Health Services Research Centre, Department of Applied Health Research, University College London, London, UK
| | - Benjamin John Floyd Dean
- Nuffield Department of Orthopaedics, Rheumatology & Musculoskeletal Sciences (NDORMS), Botnar Research Institute, Institute of Musculoskeletal Sciences, Nuffield Orthopaedic Centre, Oxford, UK
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Liao L, Gan HW, Hwa V, Dattani M, Dauber A. Two Siblings with a Mutation in CCDC8 Presenting with Mild Short Stature: A Case of 3-M Syndrome. Horm Res Paediatr 2017; 88:364-370. [PMID: 28675896 PMCID: PMC7261367 DOI: 10.1159/000477907] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/09/2017] [Accepted: 05/30/2017] [Indexed: 01/04/2023] Open
Abstract
BACKGROUND Short stature can be caused by mutations in a multitude of different genes. 3-M syndrome is a rare growth disorder marked by severe pre- and postnatal growth retardation along with subtle dysmorphic features. There have only been 2 prior reports of mutations in CCDC8 causing 3-M syndrome. METHODS Two patients presenting with mild short stature underwent whole exome sequencing. The mutation was confirmed via Sanger sequencing. We compare the clinical characteristics of our 2 patients to patients previously reported with mutations in the same gene. RESULTS Exome sequencing identified a homozygous frameshift mutation in CCDC8 in both patients. They presented with a much milder phenotype than previously described patients with the same mutation. CONCLUSION In this study, we report a case of 2 sisters with relatively mild short stature who were found via exome sequencing to carry a previously reported homozygous mutation in CCDC8. These patients expand the anthropometric phenotype of 3-M syndrome and demonstrate the power of exome sequencing in the diagnosis of children with short stature. 3-M syndrome should be considered in children with mild skeletal abnormalities, normal/high growth hormone-IGF axis parameters, and normal intelligence.
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Affiliation(s)
- Lihong Liao
- Cincinnati Center for Growth Disorders, Division of Endocrinology, Cincinnati Children’s Hospital Medical Center, Cincinnati, OH, USA
| | - Hoong-Wei Gan
- Section of Genetics and Epigenetics in Health and Disease, University College London Great Ormond Street Institute of Child Health, London, UK
| | - Vivian Hwa
- Cincinnati Center for Growth Disorders, Division of Endocrinology, Cincinnati Children’s Hospital Medical Center, Cincinnati, OH, USA
| | - Mehul Dattani
- Section of Genetics and Epigenetics in Health and Disease, University College London Great Ormond Street Institute of Child Health, London, UK
| | - Andrew Dauber
- Cincinnati Center for Growth Disorders, Division of Endocrinology, Cincinnati Children’s Hospital Medical Center, Cincinnati, OH, USA
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Guzzetti C, Losa L, Improda N, Pang G, Phatarakijnirund V, Gan HW, Hayward R, Aquilina K, Ederies A, Spoudeas HA. CR-19PROSPECTIVE DYNAMIC EVALUATION OF HYPOTHALAMO-PITUITARY FUNCTION IN PAEDIATRIC CRANIOPHARYNGIOMA, BY HYPOTHALAMIC INJURY AND TREATMENT; A SINGLE CENTRE SERIES. Neuro Oncol 2016. [DOI: 10.1093/neuonc/now068.19] [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: 11/14/2022] Open
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Aquilina K, Daniels DJ, Spoudeas H, Phipps K, Gan HW, Boop FA. Optic pathway glioma in children: does visual deficit correlate with radiology in focal exophytic lesions? Childs Nerv Syst 2015; 31:2041-9. [PMID: 26277358 DOI: 10.1007/s00381-015-2855-7] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.2] [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: 06/07/2015] [Accepted: 07/28/2015] [Indexed: 11/25/2022]
Abstract
PURPOSE Unlike pilocytic astrocytomas in other parts of the brain, optic pathway gliomas (OPG) are usually diffuse lesions involving the anterior optic pathways and hypothalamus. Their infiltrative nature often precludes complete surgical resection. We sought to determine whether careful magnetic resonance (MR) analysis, correlated with visual deficits, could be sufficient to identify those focal lesions that may be amenable to more aggressive surgical resection at presentation. METHODS We retrospectively reviewed the medical records of patients from two sites: children under 20 years of age treated for OPG between 1985 and 2009 at St Jude's Children's Research Hospital and children under 16 years of age treated at Great Ormond Street Hospital, London, UK, between 1984 and 2011. Patients with isolated optic nerve tumors were excluded. Visual acuity and visual field data at presentation were reviewed and correlated with MR characteristics, including extent of optic pathway involvement, symmetry, and lateral extension. RESULTS Two hundred and one children were treated for OPG between 1984 and 2011 in the two institutions; 74 had neurofibromatosis 1 (NF1). At presentation, visual loss was symmetrical in 132 patients and asymmetrical in 69. Potential correlation between pattern of visual loss and tumor characteristics on routine MRI was found in only 13 patients with asymmetrical vision. There was no difference between patients with and without NF1. CONCLUSION The decision for aggressive surgical resection for optic pathway gliomas should be based on clinical criteria, particularly in children with good vision in one eye and poor vision in the other, as current MRI results do not reliably predict visual field deficits.
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Affiliation(s)
- Kristian Aquilina
- Department of Neurosurgery, Great Ormond Street Hospital, London, UK
| | - David J Daniels
- Department of Neurosurgery, University of Tennessee Health Science Center, Memphis, TN, USA.,Division of Pediatric Neurosurgery, St Jude Children's Research Hospital, Memphis, TN, USA
| | - Helen Spoudeas
- Developmental Endocrinology Research Group, Clinical & Molecular Genetics Unit, University College London Institute of Child Health, London, UK
| | - Kim Phipps
- Department of Neurosurgery, Great Ormond Street Hospital, London, UK
| | - Hoong-Wei Gan
- Developmental Endocrinology Research Group, Clinical & Molecular Genetics Unit, University College London Institute of Child Health, London, UK
| | - Frederick A Boop
- Department of Neurosurgery, University of Tennessee Health Science Center, Memphis, TN, USA. .,Division of Pediatric Neurosurgery, St Jude Children's Research Hospital, Memphis, TN, USA. .,Semmes Murphey Clinic, 6325 Humphreys Blvd., Memphis, TN, 38120, USA.
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Gan HW, Phipps K, Aquilina K, Gaze MN, Hayward R, Spoudeas HA. Neuroendocrine Morbidity After Pediatric Optic Gliomas: A Longitudinal Analysis of 166 Children Over 30 Years. J Clin Endocrinol Metab 2015. [PMID: 26218754 DOI: 10.1210/jc.2015-2028] [Citation(s) in RCA: 70] [Impact Index Per Article: 7.8] [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: 11/19/2022]
Abstract
CONTEXT Fifty percent of pediatric low-grade gliomas affect the optic pathway, hypothalamus, and suprasellar areas (OP/HSGs), resulting in significant long-term neuroendocrinopathy. OBJECTIVE This study aimed to dissect tumor- from treatment-related risk factors for OP/HSG-associated neuroendocrinopathy. DESIGN This was a retrospective case notes analysis of 166 children with newly diagnosed OP/HSGs at our quaternary center between 1980 and 2010 by multivariate Cox, linear, and logistic regression. RESULTS Patients were of median (range) age 4.9 (0.2-15.4) years at diagnosis and followed up for 8.3 (0.04-26.8) years. Despite high 20-year overall survival (81.0%), progression-free and endocrine event-free survival (EEFS) were 47.2 and 20.8%, respectively. EEFS declined up to 15 years post-diagnosis, with hypothalamic involvement (P < .001) being implicated more than radiotherapy (P = .008) in earlier endocrinopathy; the reverse being true of its density (radiotherapy P < .001; hypothalamic involvement P = .006). GH deficiency (GHD) was most common (40.3%), followed by central precocious puberty (CPP, 26.0%), gonadotropin (GnD; 20.4%), TSH (13.3%), and ACTH (13.3%) deficiencies. GHD increased with later treatment eras (P < .01), but replacement did not increase progression. CPP was associated with future GnD (P < .05). Posterior pituitary dysfunction (PPD; 7.2%) occurred in 57.9% after only biopsies or shunt procedures, and was associated with 6/13 deaths; 50.2% became obese. Tumor extent, surgery, and increased endocrinopathy, rather than radiotherapy, predicted visuocognitive morbidity. CONCLUSIONS This first longitudinal OP/HSG-specific study demonstrates that hypothalamo-pituitary dysfunction evolves hierarchically over decades. Tumor location predicts its speed of onset and radiotherapy its density. GnD can evolve from previous CPP, whereas life-threatening PPD can occur after any surgery. Our data suggest that recent radiation-avoiding chemotherapeutic strategies have increased GHD without improving survival.
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Affiliation(s)
- Hoong-Wei Gan
- Section for Genetics and Epigenetics in Health and Disease, Genetics and Genomic Medicine Programme (H.-W.G.), University College London Institute of Child Health, London WC1N 1EH, United Kingdom; The London Center for Pediatric Endocrinology & Diabetes (H.-W.G., H.A.S.), Great Ormond Street Hospital for Children NHS Foundation Trust, London WC1N 3JH, United Kingdom; Department of Neurosurgery (K.P., K.A., R.H.), Great Ormond Street Hospital for Children NHS Foundation Trust, London WC1N 3JH, United Kingdom; and Children and Young People's Cancer Services (M.N.G.), University College London Hospitals NHS Foundation Trust, London NW1 2PG, United Kingdom
| | - Kim Phipps
- Section for Genetics and Epigenetics in Health and Disease, Genetics and Genomic Medicine Programme (H.-W.G.), University College London Institute of Child Health, London WC1N 1EH, United Kingdom; The London Center for Pediatric Endocrinology & Diabetes (H.-W.G., H.A.S.), Great Ormond Street Hospital for Children NHS Foundation Trust, London WC1N 3JH, United Kingdom; Department of Neurosurgery (K.P., K.A., R.H.), Great Ormond Street Hospital for Children NHS Foundation Trust, London WC1N 3JH, United Kingdom; and Children and Young People's Cancer Services (M.N.G.), University College London Hospitals NHS Foundation Trust, London NW1 2PG, United Kingdom
| | - Kristian Aquilina
- Section for Genetics and Epigenetics in Health and Disease, Genetics and Genomic Medicine Programme (H.-W.G.), University College London Institute of Child Health, London WC1N 1EH, United Kingdom; The London Center for Pediatric Endocrinology & Diabetes (H.-W.G., H.A.S.), Great Ormond Street Hospital for Children NHS Foundation Trust, London WC1N 3JH, United Kingdom; Department of Neurosurgery (K.P., K.A., R.H.), Great Ormond Street Hospital for Children NHS Foundation Trust, London WC1N 3JH, United Kingdom; and Children and Young People's Cancer Services (M.N.G.), University College London Hospitals NHS Foundation Trust, London NW1 2PG, United Kingdom
| | - Mark Nicholas Gaze
- Section for Genetics and Epigenetics in Health and Disease, Genetics and Genomic Medicine Programme (H.-W.G.), University College London Institute of Child Health, London WC1N 1EH, United Kingdom; The London Center for Pediatric Endocrinology & Diabetes (H.-W.G., H.A.S.), Great Ormond Street Hospital for Children NHS Foundation Trust, London WC1N 3JH, United Kingdom; Department of Neurosurgery (K.P., K.A., R.H.), Great Ormond Street Hospital for Children NHS Foundation Trust, London WC1N 3JH, United Kingdom; and Children and Young People's Cancer Services (M.N.G.), University College London Hospitals NHS Foundation Trust, London NW1 2PG, United Kingdom
| | - Richard Hayward
- Section for Genetics and Epigenetics in Health and Disease, Genetics and Genomic Medicine Programme (H.-W.G.), University College London Institute of Child Health, London WC1N 1EH, United Kingdom; The London Center for Pediatric Endocrinology & Diabetes (H.-W.G., H.A.S.), Great Ormond Street Hospital for Children NHS Foundation Trust, London WC1N 3JH, United Kingdom; Department of Neurosurgery (K.P., K.A., R.H.), Great Ormond Street Hospital for Children NHS Foundation Trust, London WC1N 3JH, United Kingdom; and Children and Young People's Cancer Services (M.N.G.), University College London Hospitals NHS Foundation Trust, London NW1 2PG, United Kingdom
| | - Helen Alexandra Spoudeas
- Section for Genetics and Epigenetics in Health and Disease, Genetics and Genomic Medicine Programme (H.-W.G.), University College London Institute of Child Health, London WC1N 1EH, United Kingdom; The London Center for Pediatric Endocrinology & Diabetes (H.-W.G., H.A.S.), Great Ormond Street Hospital for Children NHS Foundation Trust, London WC1N 3JH, United Kingdom; Department of Neurosurgery (K.P., K.A., R.H.), Great Ormond Street Hospital for Children NHS Foundation Trust, London WC1N 3JH, United Kingdom; and Children and Young People's Cancer Services (M.N.G.), University College London Hospitals NHS Foundation Trust, London NW1 2PG, United Kingdom
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Gan HW, Bulwer C, Jeelani O, Levine MA, Korbonits M, Spoudeas HA. Treatment-resistant pediatric giant prolactinoma and multiple endocrine neoplasia type 1. Int J Pediatr Endocrinol 2015; 2015:15. [PMID: 26180530 PMCID: PMC4503293 DOI: 10.1186/s13633-015-0011-5] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/02/2015] [Accepted: 06/30/2015] [Indexed: 11/28/2022]
Abstract
Background Pediatric pituitary adenomas are rare, accounting for <3 % of all childhood intracranial tumors, the majority of which are prolactinomas. Consequently, they are often misdiagnosed as other suprasellar masses such as craniopharyngiomas in this age group. Whilst guidelines exist for the treatment of adult prolactinomas, the management of childhood presentations of these benign tumors is less clear, particularly when dopamine agonist therapy fails. Given their rarity, childhood-onset pituitary adenomas are more likely to be associated with a variety of genetic syndromes, the commonest being multiple endocrine neoplasia type 1 (MEN-1). Case description We present a case of an early-onset, treatment-resistant giant prolactinoma occurring in an 11-year-old peripubertal boy that was initially sensitive, but subsequently highly resistant to dopamine agonist therapy, ultimately requiring multiple surgical debulking procedures and proton beam irradiation. Our patient is now left with long-term tumor- and treatment-related neuroendocrine morbidities including blindness and panhypopituitarism. Only after multiple consultations and clinical data gained from 20-year-old medical records was a complex, intergenerationally consanguineous family history revealed, compatible with MEN-1, with a splice site mutation (c.784-9G > A) being eventually identified in intron 4 of the MEN1 gene, potentially explaining the difficulties in management of this tumor. Genetic counseling and screening has now been offered to the wider family. Conclusions This case emphasizes the need to consider pituitary adenomas in the differential diagnosis of all pediatric suprasellar tumors by careful endocrine assessment and measurement of at least a serum prolactin concentration. It also highlights the lack of evidence for the optimal management of pediatric drug-resistant prolactinomas. Finally, the case we describe demonstrates the importance of a detailed family history and the role of genetic testing for MEN1 and AIP mutations in all cases of pediatric pituitary adenoma.
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Affiliation(s)
- Hoong-Wei Gan
- Section for Genetics and Epigenetics in Health and Disease, Genetics and Genomic Medicine Programme, University College London Institute of Child Health, 30 Guilford Street, London, WC1N 1EH UK ; The London Centre for Pediatric Endocrinology & Diabetes, Neuroendocrine Division, Great Ormond Street Hospital for Children NHS Foundation Trust, Great Ormond Street, London, WC1N 3JH UK
| | - Chloe Bulwer
- Section for Experimental & Personalized Medicine, Genetics & Genomic Medicine Programme, University College London Institute of Child Health, 30 Guilford Street, London, WC1N 1EH UK
| | - Owase Jeelani
- Department of Neurosurgery, Great Ormond Street Hospital for Children NHS Foundation Trust, Great Ormond Street, London, WC1N 3JH UK
| | - Michael Alan Levine
- Division of Endocrinology and Diabetes, The Children's Hospital of Philadelphia, 34th and Civic Center Boulevard, Philadelphia, PA 19104 USA ; Department of Pediatrics, University of Pennsylvania Perelman School of Medicine, 34th and Civic Center Boulevard, Philadelphia, PA 19104 USA
| | - Márta Korbonits
- Centre for Endocrinology, Barts and the London School of Medicine & Dentistry, Queen Mary University of London, Charterhouse Square, London, EC1M 6BQ UK
| | - Helen Alexandra Spoudeas
- The London Centre for Pediatric Endocrinology & Diabetes, Neuroendocrine Division, Great Ormond Street Hospital for Children NHS Foundation Trust, Great Ormond Street, London, WC1N 3JH UK
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Affiliation(s)
- Hoong-Wei Gan
- Developmental Endocrinology Research Group, UCL Institute of Child Health, London, UK The London Centre for Paediatric Endocrinology & Diabetes, Great Ormond Street Hospital for Children NHS Foundation Trust, London, UK
| | - Helen A Spoudeas
- The London Centre for Paediatric Endocrinology & Diabetes, Great Ormond Street Hospital for Children NHS Foundation Trust, London, UK The London Centre for Paediatric Endocrinology & Diabetes, University College London Hospitals NHS Foundation Trust, London, UK
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Chow J, Tan CH, Ong SH, Goh YS, Gan HW, Tan VH, Chai SC. Transradial percutaneous coronary intervention in acute ST elevation myocardial infarction and high-risk patients: experience in a single centre without cardiothoracic surgical backup. Singapore Med J 2011; 52:257-262. [PMID: 21552786] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/30/2023]
Abstract
INTRODUCTION Primary transradial percutaneous coronary intervention (TRI) is shown to be efficacious in stable patients with acute coronary syndrome. We aimed to evaluate the application of primary TRI for acute ST elevation myocardial infarction (STEMI), including among high-risk patients from our registry. METHODS This was a single-centre case series comprising 138 patients who underwent primary TRI for STEMI between May 2007 and June 2008. TRI was attempted with a 6-Fr guiding catheter in all patients regardless of Killip class status. Outcome measures were success rates of primary TRI, door-to-balloon time, procedure duration and volume of contrast used. All patients were followed up for major adverse cardiac events in-hospital, at 30 days and six months. RESULTS A total of 138 patients had primary TRI attempted for STEMI. Four patients failed primary TRI and required a femoral approach. The remaining 134 patients underwent primary TRI. The mean patient age was 56.4 years. Most patients with acute STEMI presented in Killip class I and II (91.8 percent). Only 8.2 percent were in Killip class III or IV on admission. 50 percent of patients presented with anterior STEMI. The median door-to-balloon time for this group was 92 (interquartile range [IQR] 77-121) minutes, with a median procedure time of 39 (IQR 29-51) minutes. The success rate of primary TRI was 97.1 percent. CONCLUSION Success rate, procedural and radiation time for TRI are comparable to those achieved via the femoral approach. Primary TRI is therefore a feasible and effective approach for acute STEMI, even in high-risk patients.
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Affiliation(s)
- J Chow
- Department of Cardiology, Changi General Hospital, 2 Simei Street 3, Singapore 529889
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Gan HW, Lim BC, Teo WS. Electrocardiographical case. Young woman with frequent syncope attacks. Singapore Med J 2007; 48:1061-1064. [PMID: 17975699] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/25/2023]
Abstract
A 29-year-old woman with frequent syncope attacks was referred for electrophysiological study and consideration for radio-frequency ablation of her ventricular arrhythmias. Her ECG showed features of right ventricular outflow tract premature contraction. Differential diagnoses for the causes of syncope in this patient include: right ventricular outflow tract tachycardia, arrythmogenic right ventricular dysplasia, and neurocardiogenic syncope. She underwent a tilt table test, which showed a malignant cardioinhibitory response. She developed abrupt syncope with 32 seconds of asystole during the test. She was given intravenous atropine and was resuscitated. A dual chamber rate-responsive pacemaker was implanted for her the next day. She was discharged well subsequently. Although the prognosis in patients with prolonged aystole in malignant vasovagal syncope is unknown, most doctors will still choose to implant a permanent pacemaker for patients with malignant neurocardiogenic syncope when the sinus arrest is prolonged.
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Affiliation(s)
- H W Gan
- National Heart Centre, Mistri Wing, 17 Third Hospital Avenue, Singapore 168752.
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Gan HW. [Alternative simplifying method for construction of dental prosthesis directly from bite]. Nihon Hotetsu Shika Gakkai Zasshi 1989; 33:724-7. [PMID: 2489730 DOI: 10.2186/jjps.33.724] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
Fifty years ago, dentists had always used modelling compound to take functional bite pattern as a method for making the occlusal surface of a crown in order to simplify the final occlusal adjustment. Therefore, the writer adopted the same method to fabricate crown bridge with inlay wax and to construct denture with paraffin wax. The results achieved the same simplification during occlusal adjustment procedure.
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