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Gazek N, Feller AL, Vaiani E, Di Palma I, Savransky A, Ramírez P, Marino R, Pérez Garrido N, Lazzati JM, Herzovich V, Dujovne N. Treatment with TRIAC in pediatric patients with MCT8. ARCH ARGENT PEDIATR 2023; 121:e202202968. [PMID: 36883873 DOI: 10.5546/aap.2022-02968.eng] [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] [Subscribe] [Scholar Register] [Indexed: 03/08/2023]
Abstract
Monocarboxylate transporters (MCTs) allow the cellular entry of thyroid hormones, especially into the central nervous system (CNS), where they are crucial for neurodevelopment. MCT8 deficiency results in the combination of hypothyroidism in the CNS and peripheral hyperthyroidism, characterized by elevated T3 levels. The only treatment currently available is 3,3',5-triiodothyroacetic acid (TRIAC), a thyroid hormone analogue aimed at improving peripheral thyrotoxicosis and preventing the progression of neurological impairment. Here we assess the clinical, imaging, biochemical, and genetic characteristics of 4 patients with MCT8 deficiency who have received TRIAC to date, the doses used, and the response to treatment.
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Affiliation(s)
- Natalia Gazek
- Department of Endocrinology; Hospital de Pediatría S.A.M.I.C. Prof. Dr. Juan P. Garrahan, City of Buenos Aires, Argentina
| | - Ana L Feller
- Department of Endocrinology; Hospital de Pediatría S.A.M.I.C. Prof. Dr. Juan P. Garrahan, City of Buenos Aires, Argentina
| | - Elisa Vaiani
- Department of Endocrinology; Hospital de Pediatría S.A.M.I.C. Prof. Dr. Juan P. Garrahan, City of Buenos Aires, Argentina
| | - Isabel Di Palma
- Department of Endocrinology; Hospital de Pediatría S.A.M.I.C. Prof. Dr. Juan P. Garrahan, City of Buenos Aires, Argentina
| | - Andrea Savransky
- Department of Neurology; Hospital de Pediatría S.A.M.I.C. Prof. Dr. Juan P. Garrahan, City of Buenos Aires, Argentina
| | - Pablo Ramírez
- Department of Molecular Biology; Hospital de Pediatría S.A.M.I.C. Prof. Dr. Juan P. Garrahan, City of Buenos Aires, Argentina
| | - Roxana Marino
- Department of Molecular Biology; Hospital de Pediatría S.A.M.I.C. Prof. Dr. Juan P. Garrahan, City of Buenos Aires, Argentina
| | - Natalia Pérez Garrido
- Department of Molecular Biology; Hospital de Pediatría S.A.M.I.C. Prof. Dr. Juan P. Garrahan, City of Buenos Aires, Argentina
| | - Juan M Lazzati
- Division of the Laboratory of Endocrinology; Hospital de Pediatría S.A.M.I.C. Prof. Dr. Juan P. Garrahan, City of Buenos Aires, Argentina
| | - Viviana Herzovich
- Department of Endocrinology; Hospital de Pediatría S.A.M.I.C. Prof. Dr. Juan P. Garrahan, City of Buenos Aires, Argentina
| | - Noelia Dujovne
- Department of Endocrinology; Hospital de Pediatría S.A.M.I.C. Prof. Dr. Juan P. Garrahan, City of Buenos Aires, Argentina
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Gazek N, Dujovne N, Ayarzábal V, Teplisky D, Herzovich V, Felipe L. Diagnosis and management of Intratyroid Ectopic Thymus. Andes Pediatr 2021; 92:406-410. [PMID: 34479247 DOI: 10.32641/andespediatr.v92i3.3439] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Subscribe] [Scholar Register] [Received: 10/16/2020] [Accepted: 12/21/2020] [Indexed: 11/12/2022]
Abstract
INTRODUCTION Intrathyroidal ectopic thymus (IET) is a rare benign condition caused by the aberrant thymic migra tion during embryogenesis. It is usually incidentally diagnosed as a thyroid nodule. OBJECTIVE To report the intrathyroidal location of ectopic thymic tissue and to describe the ultrasound findings in children. PATIENTS AND METHOD Retrospective descriptive review of the medical charts and thyroid ultrasound studies of children with nodular images in the thyroid gland, in a third level national pediatric hospital, from January 2010 to August 2017. Solid hypoecogenic intrathyroid lesions with multiple linear tracts or hyperechogenic points that did not change their characteristics during fo llow-up were considered intrathyroidal thymos. The ultrasound follow-up was performed every 4-6 months. The ultrasound characteristics of the lesions (location, laterality, size and shape), the indi cation of the ultrasound scan and the follow-up time were analyzed. RESULTS Of 147 patients with thyroid nodules, we identified 12 children with lesions suggestive of an IET (8.1%). The mean age at diagnosis was 3.9 years (range 0-8). It was an incidental finding in all cases. Imaging findings were unilateral in eight patients and bilateral in four patients. All lesions were located in the mid and/or posterior portion of the gland. We adopted a watch-and-wait approach with ultrasound follow-up (mean 2.2 years; range 0.83-4) in all patients except in a 7-year-old boy who presented uncertain findings and underwent surgery, confirming IET in the pathological study. CONCLUSIONS Thymic inclu sions in the thyroid gland are a rare but increasingly frequent finding, possibly related to the increased use of ultrasound studies. Pediatricians and radiologists should be aware of this entity to differentiate it from other thyroid lesions, avoiding unnecessary studies and/or treatments in these patients.
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Dujovne N, Lucero MB, Gazek N, Pitoia F, Felipe L, Ayarzabal V, López Marti J, Ciaccio M, Herzovich V. [Response to lenvatinib in a pediatric patient with respiratory failure associated with papillary thyroid carcinoma]. ARCH ARGENT PEDIATR 2021; 119:e70-e74. [PMID: 33458996 DOI: 10.5546/aap.2021.e70] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2020] [Accepted: 09/04/2020] [Indexed: 11/12/2022]
Abstract
Papillary thyroid cancer is the most common thyroid tumor in childhood. In advanced stages, it can present with respiratory failure. The treatment of choice is total thyroidectomy and radioactive iodine. In cases of unresectable tumors, therapy with multikinase inhibitors should be considered. A 10-year-old girl was referred for progressive respiratory failure. A diagnosis of papillary thyroid cancer with pulmonary metastases was made. Due to the presence of an unresectable tumor not subject to surgery, the compassionate use of lenvatinib was indicated, showing a rapid and favorable clinical response with resolution of respiratory failure on the ninth day. Early diagnosis of papillary thyroid cancer prevents severe respiratory morbidity caused by late diagnoses. The use of lenvatinib should be considered as a previous step towards first-line therapies (surgery and radioactive iodine) in cases with great local and distant involvement.
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Affiliation(s)
| | | | | | - Fabián Pitoia
- División de Endocrinología, Hospital de Clínicas, Universidad de Buenos Aires
| | - Laura Felipe
- Servicio de Diagnóstico por Imágenes, Hospital J. P. Garrahan
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Trobo S, Ramirez P, Perez- Garrido N, Touzon M, Vaiani E, Costanzo M, Herzovich V, Moresco A, Dujovne N, Lubieniecki F, Galeano J, Chantada G, Obregon MG, Belgorosky A, Marino R. SUN-047 Germline and Somatic Mutations in DICER1 Gene Associated with Different Hereditary Tumours in Paediatric Patients. J Endocr Soc 2019. [PMCID: PMC6553004 DOI: 10.1210/js.2019-sun-047] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Affiliation(s)
- Sofia Trobo
- Laboratorio de Biologia Molecular,Hospital de Pediatria Garrahan, Buenos Aires, , Argentina
| | - Pablo Ramirez
- Laboratorio de Biologia Molecular,Hospital de Pediatria Garrahan, Buenos Aires, , Argentina
| | - Natalia Perez- Garrido
- Laboratorio de Biologia Molecular,Hospital de Pediatria Garrahan, Buenos Aires, , Argentina
| | - Maria Touzon
- Research Unit Garrahan -CONICET, Hospital de Pediatria Dr. Juan P. Garrahan, Buenos Aires, , Argentina
| | - Elisa Vaiani
- Servicio de Endocrinologia, Hospital de Pediatria Garrahan, Buenos Aires, , Argentina
| | - Mariana Costanzo
- Servicio de Endocrinologia, Hospital de Pediatria Garrahan, Buenos Aires, , Argentina
| | - Viviana Herzovich
- Servicio de Endocrinologia, Hospital de Pediatria Garrahan, Buenos Aires, , Argentina
| | - Angela Moresco
- Servicio de Genetica, Hospital de Pediatria Garrahan, Buenos Aires, , Argentina
| | - Noelia Dujovne
- Servicio de Endocrinologia, Hospital de Pediatria Garrahan, Buenos Aires, , Argentina
| | - Fabiana Lubieniecki
- Servicio de Patologia, Hospital de Pediatria Garrahan, Buenos Aires, , Argentina
| | - Jesica Galeano
- Laboratorio de Biologia Molecular,Hospital de Pediatria Garrahan, Buenos Aires, , Argentina
| | - Guillermo Chantada
- Research Unit Garrahan -CONICET, Hospital de Pediatria Dr. Juan P. Garrahan, Buenos Aires, , Argentina
| | | | - Alicia Belgorosky
- Research Unit Garrahan -CONICET, Hospital de Pediatria Dr. Juan P. Garrahan, Buenos Aires, , Argentina
| | - Roxana Marino
- Laboratorio de Biologia Molecular,Hospital de Pediatria Garrahan, Buenos Aires, , Argentina
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Florio S, Mattone MC, Gazek N, Belgorosky A, Herzovich V, Dujovne N. [Muscle weakness with hypokalemia and hyperthyroidism in an adolescent with Down syndrome]. ARCH ARGENT PEDIATR 2019; 117:e37-e40. [PMID: 30652453 DOI: 10.5546/aap.2019.e37] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2017] [Accepted: 09/11/2018] [Indexed: 11/12/2022]
Abstract
Acute hypokalemic paralysis is a rare cause of acute weakness. Thyrotoxic periodic paralysis (TPP) is an unusual complication of hyperthyroidism. It is characterized by sudden onset of hypokalemia condition resulting from a shift of potassium into cells and paralysis that primarily affects the lower extremities. Failure to recognize TPP may lead to improper management. Treatment of TPP includes replacing potassium rapidly, using nonselective beta-blockers and correcting the underlying hyperthyroidism as soon as possible. TPP is curable once euthyroid state is achieved. We describe a 13-year-old male with Down syndrome who presented with acute onset of lower extremity weakness secondary to acute hypokalemia and was found to have new onset Graves' disease.
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Affiliation(s)
- Selene Florio
- Servicio de Endocrinología, Hospital de Pediatría "Prof. Dr. Juan P. Garrahan", Buenos Aires, Argentina
| | - María C Mattone
- Servicio de Endocrinología, Hospital de Pediatría "Prof. Dr. Juan P. Garrahan", Buenos Aires, Argentina
| | - Natalia Gazek
- Servicio de Endocrinología, Hospital de Pediatría "Prof. Dr. Juan P. Garrahan", Buenos Aires, Argentina
| | - Alicia Belgorosky
- Servicio de Endocrinología, Hospital de Pediatría "Prof. Dr. Juan P. Garrahan", Buenos Aires, Argentina
| | - Viviana Herzovich
- Servicio de Endocrinología, Hospital de Pediatría "Prof. Dr. Juan P. Garrahan", Buenos Aires, Argentina
| | - Noelia Dujovne
- Servicio de Endocrinología, Hospital de Pediatría "Prof. Dr. Juan P. Garrahan", Buenos Aires, Argentina.
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Di Pinto D, Balestracci A, Dujovne N, de Palma I, Adragna M, Delgado N. [Nephrourologic pathology in girls with Turner syndrome]. ARCH ARGENT PEDIATR 2011; 108:353-7. [PMID: 20672195 DOI: 10.1590/s0325-00752010000400011] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2010] [Accepted: 06/02/2010] [Indexed: 11/22/2022]
Abstract
Nephrourologic malformations in Turner syndrome are frequent, its diagnosis and follow-up is important in order to diminish the morbidity of this disease. The aim of this retrospective study was to analyze the nephrourologic pathology in 72 girls with Turner syndrome followed between 1989 and 2008 at Garrahan Hospital. The prevalence of nephrourologic involvement was 33% (24 patients). The most frequent findings were urinary system malformations, isolated (10 pacientes, 42%) or associated with renal malformations (9 patients, 37%); 5 patients (21%) had only renal malformations. Fifty percent of patients developed complications (8 urinary tract infection, 2 proteinuria and 2 arterial hypertension); however, none progressed to chronic renal failure. The prevalence of nephrourologic involvement was 33% and a half of these girls developed complications, our findings show the need of routine nephrological follow-up of girls with Turner syndrome and nephrourologic malformations.
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Affiliation(s)
- Diana Di Pinto
- Hospital Nacional de Pediatría "Prof. Dr. Juan P. Garrahan".
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Baquedano MS, Ciaccio M, Dujovne N, Herzovich V, Longueira Y, Warman DM, Rivarola MA, Belgorosky A. Two novel mutations of the TSH-beta subunit gene underlying congenital central hypothyroidism undetectable in neonatal TSH screening. J Clin Endocrinol Metab 2010; 95:E98-103. [PMID: 20534762 DOI: 10.1210/jc.2010-0223] [Citation(s) in RCA: 33] [Impact Index Per Article: 2.4] [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 Patients with TSH-beta subunit defects and congenital hypothyroidism are missed by TSH-based neonatal screening. OBJECTIVE Our objective was to report the molecular consequences of a novel splice-junction mutation and a novel missense mutation in the TSH-beta subunit gene found in two patients with congenital central hypothyroidism and conventional treatment-resistant anemia. RESULTS Patient 1 had a homozygous G to A nucleotide change at the 5' donor splice site of exon/intron 2. This resulted in a silent change at codon 34 of the mature protein. In vitro splicing assays showed that the mutant minigene dramatically affected pre-mRNA processing, causing exon 2 to be completely skipped. The putative product from a new out-of-frame translational start point in exon 3 is expected to yield a nonsense 25-amino-acid peptide. In patient 2, sequence analysis revealed a compound heterozygosis for the already reported 313delT (C105Vfs114X) mutation and for a second novel mutation in exon 3, substituting G for A at cDNA nucleotide position 323, resulting in a C88Y change. This cysteine residue is conserved among all dimeric pituitary and placental glycoprotein hormone-beta subunits. Data from in silico analysis confirmed that the C88Y mutation would affect subunit conformation. Indeed, two different bioinformatics approaches, PolyPhen and SIFT analysis, predicted C88Y to be a damaging substitution. CONCLUSIONS In isolated TSH deficiency, the exact molecular diagnosis is mandatory for diagnosis of isolated pituitary deficiency, delineation of prognosis, and genetic counseling. Moreover, diagnosis of central hypothyroidism should be considered in the face of severe infant anemia of uncertain etiology.
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Affiliation(s)
- María Sonia Baquedano
- Servicio de Endocrinologia, Hospital de Pediatria Garrahan, Buenos Aires C1245AAM, Argentina
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