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De Sanctis V, Ahmed S, Soliman A, Alyafei F, Alaaraj N, Al Maadheed M, Clelland C. A rare case of Ovarian Juvenile Granulosa Cell Tumor in an Infant with Isosexual Pseudo Puberty and a Revision of Literature. Acta Biomed 2021; 92:e2021319. [PMID: 34487069 PMCID: PMC8477099 DOI: 10.23750/abm.v92i4.11572] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/05/2021] [Accepted: 04/07/2021] [Indexed: 11/23/2022]
Abstract
Juvenile ovarian granulosa cell tumors (JGCTs) are described infrequently in pediatrics, and their finding in infants is exceptional. We highlight the presenting symptoms, radiologic images, operative management, and histopathologic findings of a 9-month-old female with isosexual pseudopuberty. An updated revision of literature in infants below the age of 12 months is also reported.
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Affiliation(s)
| | - Shayma Ahmed
- Pediatric Endocrinology Department, Hamad Medical Corporation.
| | - Ashraf Soliman
- Pediatric Endocrinology Department, Hamad Medical Corporation .
| | - Fawzia Alyafei
- Pediatric Endocrinology Department, Hamad Medical Corporation.
| | - Nada Alaaraj
- Pediatric Endocrinology Department, Hamad Medical Corporation .
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Demirbilek H, Cayir A, Flanagan SE, Yıldırım R, Kor Y, Gurbuz F, Haliloğlu B, Yıldız M, Baran RT, Akbas ED, Demiral M, Ünal E, Arslan G, Vuralli D, Buyukyilmaz G, Al-Khawaga S, Saeed A, Al Maadheed M, Khalifa A, Onal H, Yuksel B, Ozbek MN, Bereket A, Hattersley AT, Hussain K, De Franco E. Clinical Characteristics and Long-term Follow-up of Patients with Diabetes Due To PTF1A Enhancer Mutations. J Clin Endocrinol Metab 2020; 105:5902291. [PMID: 32893856 PMCID: PMC7526731 DOI: 10.1210/clinem/dgaa613] [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] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/11/2020] [Accepted: 09/02/2020] [Indexed: 12/13/2022]
Abstract
CONTEXT Biallelic mutations in the PTF1A enhancer are the commonest cause of isolated pancreatic agenesis. These patients do not have severe neurological features associated with loss-of-function PTF1A mutations. Their clinical phenotype and disease progression have not been well characterized. OBJECTIVE To evaluate phenotype and genotype characteristics and long-term follow-up of patients with PTF1A enhancer mutations. SETTING Twelve tertiary pediatric endocrine referral centers. PATIENTS Thirty patients with diabetes caused by PTF1A enhancer mutations. Median follow-up duration was 4 years. MAIN OUTCOME MEASURES Presenting and follow-up clinical (birthweight, gestational age, symptoms, auxology) and biochemical (pancreatic endocrine and exocrine functions, liver function, glycated hemoglobin) characteristics, pancreas imaging, and genetic analysis. RESULTS Five different homozygous mutations affecting conserved nucleotides in the PTF1A distal enhancer were identified. The commonest was the Chr10:g.23508437A>G mutation (n = 18). Two patients were homozygous for the novel Chr10:g.23508336A>G mutation. Birthweight was often low (median SDS = -3.4). The majority of patients presented with diabetes soon after birth (median age of diagnosis: 5 days). Only 2/30 presented after 6 months of age. All patients had exocrine pancreatic insufficiency. Five had developmental delay (4 mild) on long-term follow-up. Previously undescribed common features in our cohort were transiently elevated ferritin level (n = 12/12 tested), anemia (19/25), and cholestasis (14/24). Postnatal growth was impaired (median height SDS: -2.35, median BMI SDS: -0.52 SDS) with 20/29 (69%) cases having growth retardation. CONCLUSION We report the largest series of patients with diabetes caused by PTF1A enhancer mutations. Our results expand the disease phenotype, identifying recurrent extrapancreatic features which likely reflect long-term intestinal malabsorption.
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Affiliation(s)
- Huseyin Demirbilek
- Hacettepe University Faculty of Medicine, Department of Pediatric Endocrinology, Ankara, Turkey
- Diyarbakır Children’s Hospital, Clinics of Pediatric Endocrinology, Diyarbakir, Turkey
- Correspondence and Reprint Requests: Huseyin Demirbilek, MD, Hacettepe University Faculty of Medicine, Department of Paediatric Endocrinology, 06130; Ankara, Turkey. E-mail:
| | - Atilla Cayir
- Erzurum Training and Research Hospital, Clinics of Pediatric Endocrinology, Erzurum, Turkey
| | - Sarah E Flanagan
- Institute of Biomedical and Clinical Science, University of Exeter Medical School, Exeter, UK
| | - Ruken Yıldırım
- Diyarbakır Children’s Hospital, Clinics of Pediatric Endocrinology, Diyarbakir, Turkey
| | - Yılmaz Kor
- Adana Training and Research Hospital, Clinics of Pediatric Endocrinology, Adana, Turkey
| | - Fatih Gurbuz
- Cukurova University Faculty of Medicine, Department of Pediatric Endocrinology, Adana, Turkey
| | - Belma Haliloğlu
- Diyarbakır Children’s Hospital, Clinics of Pediatric Endocrinology, Diyarbakir, Turkey
- Yeditepe University School of Medicine, Department of Pediatric Endocrinology, Istanbul, Turkey
| | - Melek Yıldız
- Kanuni Sultan Suleyman Training and Research Hospital, Clinics of Pediatric Endocrinology, Istanbul, Turkey
- Istanbul University, Istanbul Faculty of Medicine, Department of Pediatric Endocrinology, Istanbul, Turkey
| | - Rıza Taner Baran
- Diyarbakır Children’s Hospital, Clinics of Pediatric Endocrinology, Diyarbakir, Turkey
| | - Emine Demet Akbas
- Adana Training and Research Hospital, Clinics of Pediatric Endocrinology, Adana, Turkey
| | - Meliha Demiral
- Gazi Yasargil Training and Research Hospital, Pediatric Endocrinology, Diyarbakır, Turkey
| | - Edip Ünal
- Gazi Yasargil Training and Research Hospital, Pediatric Endocrinology, Diyarbakır, Turkey
| | - Gulcin Arslan
- University of Health Science, Behcet Uz Training and Research Hospital, Department of Pediatric Endocrinology, Izmir, Turkey
| | - Dogus Vuralli
- Hacettepe University Faculty of Medicine, Department of Pediatric Endocrinology, Ankara, Turkey
| | - Gonul Buyukyilmaz
- Ankara City Hospital, Department of Pediatric Endocrinology, Ankara, Turkey
| | - Sara Al-Khawaga
- College of Health & Life Sciences, Hamad Bin Khalifa University, Qatar Foundation, Doha, Qatar
| | - Amira Saeed
- Department of Pediatrics, Division of Endocrinology, Sidra Medicine, Doha, Qatar
| | - Maryam Al Maadheed
- Department of Pediatrics, Division of Endocrinology, Sidra Medicine, Doha, Qatar
| | - Amel Khalifa
- College of Health & Life Sciences, Hamad Bin Khalifa University, Qatar Foundation, Doha, Qatar
| | - Hasan Onal
- Cukurova University Faculty of Medicine, Department of Pediatric Endocrinology, Adana, Turkey
| | - Bilgin Yuksel
- Cukurova University Faculty of Medicine, Department of Pediatric Endocrinology, Adana, Turkey
| | - Mehmet Nuri Ozbek
- Diyarbakır Children’s Hospital, Clinics of Pediatric Endocrinology, Diyarbakir, Turkey
- Gazi Yasargil Training and Research Hospital, Pediatric Endocrinology, Diyarbakır, Turkey
| | - Abdullah Bereket
- Maramara University Faculty of Medicine, Department of Pediatric Endocrinology, Istanbul, Turkey
| | - Andrew T Hattersley
- Institute of Biomedical and Clinical Science, University of Exeter Medical School, Exeter, UK
| | - Khalid Hussain
- Department of Pediatrics, Division of Endocrinology, Sidra Medicine, Doha, Qatar
| | - Elisa De Franco
- Institute of Biomedical and Clinical Science, University of Exeter Medical School, Exeter, UK
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Gad H, Al-Jarrah B, Saraswathi S, Petropoulos IN, Ponirakis G, Khan A, Singh P, Al Khodor S, Elawad M, Almasri W, Abdelrahman H, Elawwa A, Khalifa A, Shamekh A, Al-Khalaf F, Petrovski G, Al Zyoud M, Al Maadheed M, Hendaus MA, Hussain K, Akobeng AK, Malik RA. Corneal nerve loss in children with type 1 diabetes mellitus without retinopathy or microalbuminuria. J Diabetes Investig 2020; 11:1594-1601. [PMID: 32491258 PMCID: PMC7610109 DOI: 10.1111/jdi.13313] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [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] [Received: 05/07/2020] [Revised: 05/18/2020] [Accepted: 05/28/2020] [Indexed: 12/12/2022] Open
Abstract
Aims/Introduction Corneal confocal microscopy is a rapid, non‐invasive ophthalmic technique to identify subclinical neuropathy. The aim of this study was to quantify corneal nerve morphology in children with type 1 diabetes mellitus compared with age‐matched healthy controls using corneal confocal microscopy. Materials and Methods A total of 20 participants with type 1 diabetes mellitus (age 14 ± 2 years, diabetes duration 4.08 ± 2.91 years, glycated hemoglobin 9.3 ± 2.1%) without retinopathy or microalbuminuria and 20 healthy controls were recruited from outpatient clinics. Corneal confocal microscopy was undertaken, and corneal nerve fiber density (n/mm2), corneal nerve branch density (n/mm2), corneal nerve fiber length (mm/mm2), corneal nerve fiber tortuosity and inferior whorl length (mm/mm2) were quantified manually. Results Corneal nerve fiber density (22.73 ± 8.84 vs 32.92 ± 8.59; P < 0.001), corneal nerve branch density (26.19 ± 14.64 vs 47.34 ± 20.01; P < 0.001), corneal nerve fiber length (13.26 ± 4.06 vs 19.52 ± 4.54; P < 0.001) and inferior whorl length (15.50 ± 5.48 vs 23.42 ± 3.94; P < 0.0001) were significantly lower, whereas corneal nerve fiber tortuosity (14.88 ± 5.28 vs 13.52 ± 3.01; P = 0.323) did not differ between children with type 1 diabetes mellitus and controls. Glycated hemoglobin correlated with corneal nerve fiber tortuosity (P < 0.006) and aspartate aminotransferase correlated with corneal nerve fiber density (P = 0.039), corneal nerve branch density (P = 0.003) and corneal nerve fiber length (P = 0.037). Conclusion Corneal confocal microscopy identifies significant subclinical corneal nerve loss, especially in the inferior whorl of children with type 1 diabetes mellitus without retinopathy or microalbuminuria.
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Affiliation(s)
- Hoda Gad
- Medicine Department, Weill Cornell Medicine-Qatar, Doha, Qatar
| | - Bara Al-Jarrah
- Gastroenterology Department, Sidra Medicine, Doha, Qatar
| | | | | | | | - Adnan Khan
- Medicine Department, Weill Cornell Medicine-Qatar, Doha, Qatar
| | - Parul Singh
- Research Department, Sidra Medicine, Doha, Qatar
| | | | - Mamoun Elawad
- Gastroenterology Department, Sidra Medicine, Doha, Qatar
| | - Wesam Almasri
- Gastroenterology Department, Sidra Medicine, Doha, Qatar
| | | | - Ahmed Elawwa
- Endocrinology Department, Sidra Medicine, Doha, Qatar
| | - Amel Khalifa
- Endocrinology Department, Sidra Medicine, Doha, Qatar
| | - Ahmed Shamekh
- Endocrinology Department, Sidra Medicine, Doha, Qatar
| | | | | | | | | | | | | | | | - Rayaz A Malik
- Medicine Department, Weill Cornell Medicine-Qatar, Doha, Qatar.,Institute of Cardiovascular Medicine, University of Manchester, Manchester, UK
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