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Humbert L, Proust-Lemoine E, Dubucquoi S, Kemp EH, Saugier-Veber P, Fabien N, Raymond-Top I, Cardot-Bauters C, Carel JC, Cartigny M, Chabre O, Chanson P, Delemer B, Do Cao C, Guignat L, Kahn JE, Kerlan V, Lefebvre H, Linglart A, Mallone R, Reynaud R, Sendid B, Souchon PF, Touraine P, Wémeau JL, Vantyghem MC. Lessons from prospective longitudinal follow-up of a French APECED cohort. J Clin Endocrinol Metab 2024:dgae211. [PMID: 38605470 DOI: 10.1210/clinem/dgae211] [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: 09/18/2023] [Revised: 03/05/2024] [Accepted: 04/01/2024] [Indexed: 04/13/2024]
Abstract
BACKGROUND APECED syndrome is a rare disease caused by biallelic mutations of the AIRE gene, usually presenting with the triad "hypoparathyroidism-adrenal failure-chronic mucocutaneous candidiasis (CMC)" and non-endocrine manifestations. The aim of this study was to determine the molecular profile of the AIRE gene, the prevalence of rare manifestations and to characterize immunological disturbances in a French cohort. PATIENTS AND METHODS A national, multicenter prospective observational study to collect genetic, clinical, biological and immunological data (NCT03751683). RESULTS 25 patients (23 families) were enrolled. Eleven distinct AIRE variants were identified, two of which were not previously reported: an intronic variant, c.653-70G > A, and a c.1066del (p.Arg356GlyfsX22) variant (exon 9). The most common was the Finnish variant c.769C > T (16 alleles), followed by the variant c.967_979del13 (15 alleles), which seemed associated with a less severe phenotype. 17/25 patients were homozygote. The median number of clinical manifestations was seven; 19/25 patients presented with the hypoparathyroidism-adrenal failure-CMC triad, 8/13 showed pulmonary involvement, 20/25 had ectodermal dystrophy, 8/25 had malabsorption, and 6/23 had asplenia. Fifteen out of 19 patients had NK cell lymphopenia with an increase in CD4+ and CD8+ T lymphocytes and an age-dependent alteration of B lymphocyte homeostasis compared with matched controls (p < 0.001), related to the severity of the disease. All tested sera (n = 18) were positive for anti-interferon-α, 15/18 for anti-interleukin-22 antibodies, and 13/18 for anti-interleukin-17F antibodies, without clear phenotypic correlation other than with CMC. CONCLUSION This first prospective cohort showed a high AIRE genotype variability, with two new gene variants. The prevalence of potentially life-threatening non-endocrine manifestations, was higher with systematic screening. These manifestations could, along with age-dependent B-cell lymphopenia, contribute to disease severity. Systematic screening for all the manifestations of the syndrome would allow earlier diagnosis, supporting vaccination, and targeted therapeutic approaches.
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Affiliation(s)
- Linda Humbert
- Department of Endocrinology, Diabetology and Metabolism, Huriez Hospital, Lille University Hospital, F-59000 Lille, France
| | - Emmanuelle Proust-Lemoine
- Department of Endocrinology, Diabetology and Metabolism, Huriez Hospital, Lille University Hospital, F-59000 Lille, France
| | - Sylvain Dubucquoi
- Institut d'Immunologie-HLA, Centre de Biologie-Pathologie, Boulevard du Professeur Jules Leclercq - 59037 Lille Cedex
- University of Lille, F-59000 Lille, France
| | - Elisabeth Helen Kemp
- Department of Oncology and Metabolism, Faculty of Medicine, Dentistry and Health, University of Sheffield, Medical School, Beech Hill Road, Sheffield S10 2RX, UK
| | - Pascale Saugier-Veber
- Univ Rouen Normandie, Inserm U1245, Normandie Univ and CHU Rouen, Department of Genetics and Reference Center for Developmental Disorders, F-76000 Rouen, France
| | | | - Isabelle Raymond-Top
- Institut d'Immunologie-HLA, Centre de Biologie-Pathologie, Boulevard du Professeur Jules Leclercq - 59037 Lille Cedex
| | - Catherine Cardot-Bauters
- Department of Endocrinology, Diabetology and Metabolism, Huriez Hospital, Lille University Hospital, F-59000 Lille, France
| | - Jean-Claude Carel
- AP-HP Nord Université Paris Cité, Hôpital Universitaire Robert-Debré, Service d'Endocrinologie Diabétologie Pédiatrique & INSERM NeuroDiderot, Centre de Référence Maladies Endocriniennes Rares de la Croissance, 48, Boulevard Sérurier, 75935 Paris cedex 19, France
| | - Maryse Cartigny
- Department of Pediatry, Hôpital Jeanne de Flandres, Lille University Hospital, F-59000 Lille, France
| | - Olivier Chabre
- Univ. Grenoble Alpes, Service d'Endocrinologie CHU Grenoble Alpes, Unité mixte de recherche INSERM-CEA-UGA UMR1036 38000 Grenoble Alpes
| | - Philippe Chanson
- Université Paris-Saclay, Inserm, Physiologie et Physiopathologie Endocriniennes, Assistance Publique-Hôpitaux de Paris, Hôpital Bicêtre, Service d'Endocrinologie et des Maladies de la Reproduction, Centre de Référence des Maladies Rares de l'Hypophyse, 94275 Le Kremlin-Bicêtre, France
| | - Brigitte Delemer
- Department of Endocrinology and Diabetology, CHU Reims, 45 Rue Cognacq Jay, 51 092 Reims, France
| | - Christine Do Cao
- Department of Endocrinology, Diabetology and Metabolism, Huriez Hospital, Lille University Hospital, F-59000 Lille, France
| | - Laurence Guignat
- Centre de Référence des Maladies Rares de la Surrénale, Endocrinologie, Hôpital Cochin, 123, Boulevard de Port Royal, 75014 Paris, France
| | - Jean Emmanuel Kahn
- Institut d'Immunologie-HLA, Centre de Biologie-Pathologie, Boulevard du Professeur Jules Leclercq - 59037 Lille Cedex
- Department of Internal Medicine, National Reference Center for Hypereosinophilic Syndromes (CEREO), Hôpital Foch, 40, Rue Worth, 92151, Suresnes, France and University of Paris Saclay, APHP, CHU Ambroise Paré, Boulogne-Billancourt, France
| | - Veronique Kerlan
- Department of Endocrinology, Diabetology and Metabolism CHU Brest, Hôpital de la Cavale Blanche, 29609 Brest Cedex France
| | - Herve Lefebvre
- Department of Endocrinology, University Hospital of Rouen, 1, rue de Germont, 76031 Rouen, France
| | - Agnès Linglart
- AP-HP, Service d'Endocrinologie et Diabète de l'Enfant, Hôpital Bicêtre Paris-Saclay, AP-HP, Centre de Référence des Maladies Rares du Métabolisme du Calcium et du Phosphate, Filière OSCAR, ERN BOND, ERN for Rare Endocrine Disorders, Plateforme d'Expertise des Maladies Rares de Paris Saclay, Université Paris Saclay, INSERM U1185, Le Kremlin-Bicêtre, France
| | - Roberto Mallone
- Clinical Department of Diabetology and Clinical Immunology, INSERM U1016 Cochin Institute, DeARLab Team Mallone-You, Groupe Hospitalier Cochin-Port-Royal, Bâtiment Cassini, 123, Boulevard de Port-Royal, 75014 Paris
| | - Rachel Reynaud
- Service de Pediatrie Multidisciplinaire CHU Timone Enfants APHM Aix Marseile Université Centre de Reference Maladies Hypophysaire Rares 13385 Marseille Cedex 05
| | - Boualem Sendid
- Institut de Microbiologie, Centre de Biologie Pathologie Génétique, Centre Hospitalier Universitaire de Lille, 1, Boulevard Pr J. Leclercq, 59037 Lille Cedex, Inserm U1285 - CNRS UMR 8576, 1 Place Verdun, 59037 Lille- France
| | - Pierre-François Souchon
- CHU de Reims - American Memorial Hospital - Service de Pédiatrie , 47 rue Cognac Jay, 51092 Reims Cedex, France
| | - Philippe Touraine
- Department of Endocrinology and Reproductive Medicine, AP-HP, Sorbonne University Medicine, 91-105 Bd de l'Hôpital, 75013 Paris France
| | - Jean-Louis Wémeau
- Department of Endocrinology, Diabetology and Metabolism, Huriez Hospital, Lille University Hospital, F-59000 Lille, France
- University of Lille, F-59000 Lille, France
| | - Marie-Christine Vantyghem
- Department of Endocrinology, Diabetology and Metabolism, Huriez Hospital, Lille University Hospital, F-59000 Lille, France
- University of Lille, F-59000 Lille, France
- Inserm U1190, Lille University, European Genomic Institute for Diabetes, F-59000 Lille, France
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Giabicani E, Willems M, Steunou V, Chantot-Bastaraud S, Thibaud N, Abi Habib W, Azzi S, Lam B, Bérard L, Bony-Trifunovic H, Brachet C, Brischoux-Boucher E, Caldagues E, Coutant R, Cuvelier ML, Gelwane G, Guemas I, Houang M, Isidor B, Jeandel C, Lespinasse J, Naud-Saudreau C, Jesuran-Perelroizen M, Perrin L, Piard J, Sechter C, Souchon PF, Storey C, Thomas D, Le Bouc Y, Rossignol S, Netchine I, Brioude F. Increasing knowledge in IGF1R defects: lessons from 35 new patients. J Med Genet 2019; 57:160-168. [PMID: 31586944 DOI: 10.1136/jmedgenet-2019-106328] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [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: 05/29/2019] [Revised: 08/06/2019] [Accepted: 08/24/2019] [Indexed: 12/20/2022]
Abstract
BACKGROUND The type 1 insulin-like growth factor receptor (IGF1R) is a keystone of fetal growth regulation by mediating the effects of IGF-I and IGF-II. Recently, a cohort of patients carrying an IGF1R defect was described, from which a clinical score was established for diagnosis. We assessed this score in a large cohort of patients with identified IGF1R defects, as no external validation was available. Furthermore, we aimed to develop a functional test to allow the classification of variants of unknown significance (VUS) in vitro. METHODS DNA was tested for either deletions or single nucleotide variant (SNV) and the phosphorylation of downstream pathways studied after stimulation with IGF-I by western blot analysis of fibroblast of nine patients. RESULTS We detected 21 IGF1R defects in 35 patients, including 8 deletions and 10 heterozygous, 1 homozygous and 1 compound-heterozygous SNVs. The main clinical characteristics of these patients were being born small for gestational age (90.9%), short stature (88.2%) and microcephaly (74.1%). Feeding difficulties and varying degrees of developmental delay were highly prevalent (54.5%). There were no differences in phenotypes between patients with deletions and SNVs of IGF1R. Functional studies showed that the SNVs tested were associated with decreased AKT phosphorylation. CONCLUSION We report eight new pathogenic variants of IGF1R and an original case with a homozygous SNV. We found the recently proposed clinical score to be accurate for the diagnosis of IGF1R defects with a sensitivity of 95.2%. We developed an efficient functional test to assess the pathogenicity of SNVs, which is useful, especially for VUS.
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Affiliation(s)
- Eloïse Giabicani
- Sorbonne Université, UFR Médecine, Paris, France .,AP-HP, Hôpital Armand Trousseau-Explorations Fonctionnelles Endocriniennes, Paris, France.,INSERM, Centre de Recherche Saint-Antoine, Paris, France
| | | | | | | | - Nathalie Thibaud
- AP-HP, Hôpital Armand Trousseau-Explorations Fonctionnelles Endocriniennes, Paris, France
| | | | - Salah Azzi
- INSERM, Centre de Recherche Saint-Antoine, Paris, France
| | - Bich Lam
- INSERM, Centre de Recherche Saint-Antoine, Paris, France
| | - Laurence Bérard
- AP-HP, Hôpital Armand Trousseau-Explorations Fonctionnelles Endocriniennes, Paris, France
| | | | - Cécile Brachet
- U.L.B., Pediatric Endocrinology, Reine Fabiola Children's Hospital, Brussels, Belgium
| | | | | | - Regis Coutant
- CHU Angers, Endocrinologie et Diabétologie Pédiatriques, Angers, France
| | | | - Georges Gelwane
- AP-HP, Hôpital Robert Debré, Endocrinologie et Diabétologie Pédiatriques, Paris, France.,Université Paris Diderot, Hôpital Robert Debré, Paris, France
| | | | - Muriel Houang
- Sorbonne Université, UFR Médecine, Paris, France.,AP-HP, Hôpital Armand Trousseau-Explorations Fonctionnelles Endocriniennes, Paris, France.,INSERM, Centre de Recherche Saint-Antoine, Paris, France
| | | | - Claire Jeandel
- CHRU Montpellier Pôle Mère et enfant, Pédiatrie Spécialisée Endocrinologie Gynécologie de l'Enfant et de l'Adolescent, Montpellier, France
| | | | | | - Monique Jesuran-Perelroizen
- Endocrinologie-pédiatrique, Cabinet libéral, Toulouse, France.,AFPEL, Association Française des Pédiatres Endocrinologues Libéraux, Lille, France
| | - Laurence Perrin
- Université Paris Diderot, Hôpital Robert Debré, Paris, France.,AP-HP, Hôpital Robert Debré, Génétique Clinique, Paris, France
| | - Juliette Piard
- Université de Franche-Comté, CHU Besançon, Centre de Génétique Humaine, Besançon, France
| | - Claire Sechter
- Université de Franche-Comté, CHU Jean Minjoz, Unité d'Endocrinologie et Diabétologie Pédiatriques, Besançon, France
| | - Pierre-François Souchon
- American Memorial Hospital, Diabétologie et Endocrinologie Pédiatriques, CHU Reims, Reims, France
| | - Caroline Storey
- AP-HP, Hôpital Robert Debré, Endocrinologie et Diabétologie Pédiatriques, Paris, France.,Université Paris Diderot, Hôpital Robert Debré, Paris, France
| | | | - Yves Le Bouc
- Sorbonne Université, UFR Médecine, Paris, France.,INSERM, Centre de Recherche Saint-Antoine, Paris, France
| | - Sylvie Rossignol
- Hopitaux universitaires de Strasbourg, Service de Pédiatrie 1, Strasbourg, France.,INSERM U1112, Institut de Génétique Médicale d'Alsace, Laboratoire de Génétique Médicale, Strasbourg, France
| | - Irène Netchine
- Sorbonne Université, UFR Médecine, Paris, France.,AP-HP, Hôpital Armand Trousseau-Explorations Fonctionnelles Endocriniennes, Paris, France.,INSERM, Centre de Recherche Saint-Antoine, Paris, France
| | - Frédéric Brioude
- Sorbonne Université, UFR Médecine, Paris, France.,AP-HP, Hôpital Armand Trousseau-Explorations Fonctionnelles Endocriniennes, Paris, France.,INSERM, Centre de Recherche Saint-Antoine, Paris, France
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Humbert L, Dubucquoi S, Kemp E, Saugier-Veber P, Fabien N, Isabelle RT, Cardot-Bauters C, Maciejewski Cartigny M, Delemer B, Docao C, Carel JC, Guignat L, Kerlan V, Lefevre H, Vanhove L, Sendid B, Souchon PF, Weill J, Vantyghem MC, Wemeau JL, Proust Lemoine E. SUN-040 Autoimmune Polyendocrinopathy Candidiasis Ectodermal Dystrophy (APECED) Syndrome: Prospective Screening of Asplenism and Pneumonitis in a Cohort of 25 Patients. J Endocr Soc 2019. [PMCID: PMC6553308 DOI: 10.1210/js.2019-sun-040] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
Background: APECED syndrome is a rare monogenic disease caused by homozygous mutation of AIRE gene. It classically presents with chronic mucocutaneous candidiasis, hypoparathyroidism, and adrenal insufficiency with an early onset in childhood. Non-endocrine manifestations as ectodermic dystrophy, asplenism and pneumonitis are also observed but their incidence remains unknown and their mechanisms not well understood. APECED has been poorly reported in France although it is widely described in several European countries. The aim of this study was to report on rare manifestations of APECED syndrome in a French cohort. Patients and methods: We performed a multicentric prospective observational study in France in order to collect clinical, biological, immunological and genetic data, after written informed consent in the frame of a PHRC (Hospital Project of Clinical Research #1927). Bronchiolitis, splenic atrophy and ocular manifestations were systematically investigated. Results We enrolled 25 patients between 2009 and 2016. Clinically, the median age at diagnosis was 12 while the median age of the first manifestation was 6, so there was diagnostic delay. The median number of manifestations was seven. 76 % of patients presented with the classical triad. Reduction of lung function was observed in 62% of patients, asplenism in 26%, and ocular manifestation in 33%. Genetically, eleven mutations of the AIRE gene were identified, two of which never previously reported: an intronic variation c.653-70G>A (intron 5) in a patient with hypoparathyroidism as unique manifestation , and c.1066del (p.Arg356GlyfsX22) (exon 9) in a patient from Guadeloupe with composite heterozygous mutations (c.967_979del13; exon 8). The most common AIRE mutation was the mutation R257X. Median age was 26 and sex ratio was 1.1. Biologically, 100% of tested sera were positive for anti-IFNα-antibodies, 15/18 for anti-IL-22, and 13/18 for anti-IL-17F antibodies. Conclusion: This series shows a high genotypic and phenotypic variability of APECED in France, that could be explained by different ethnic origins. The systematic screening for non-classic manifestations shows a more frequent occurrence than in other series. Systematic screening of asplenism and bronchiolitis could be a useful strategy to make an earlier diagnosis, to prevent infections by vaccination and to treat earlier pulmonary involvement. Lastly, antibodies against Th17 cytokines appear as good soluble markers for diagnosis of non-classical presentation of the syndrome.
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Affiliation(s)
| | | | - Elizabeth Kemp
- Human Metabolism, University of Sheffield, Sheffield, , United Kingdom
| | | | - Nicole Fabien
- UF D'AUTO-IMMUNITE, Centre Hospitalier Lyon-Sud, Pierre Benite, , France
| | | | | | | | | | | | | | | | - Veronique Kerlan
- Service d'Endocrinologie, Hopital de la Cavale Blanche, Brest, , France
| | | | | | | | | | - Jacques Weill
- Ped and Endo Unit, Hopital Jeanne de Flandre, Lille, , France
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4
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Diallo AM, Novella JL, Lukas C, Souchon PF, Dramé M, François M, Decoudier B, Barraud S, Salmon AS, Ancelle D, Arndt C, Delemer B. Early predictors of diabetic retinopathy in type 1 diabetes: The Retinopathy Champagne Ardenne Diabète (ReCAD) study. J Diabetes Complications 2018; 32:753-758. [PMID: 29980433 DOI: 10.1016/j.jdiacomp.2018.05.011] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/24/2017] [Revised: 04/30/2018] [Accepted: 05/15/2018] [Indexed: 10/16/2022]
Abstract
AIMS To determine the relationship between early markers of diabetes control and diabetic retinopathy (DR) in type 1 diabetes. METHODS A historic cohort study was conducted on 712 patients from the CARéDIAB database. HbA1c and usual metabolic parameters were measured one year after diagnosis of diabetes. First occurrences of severe hypoglycemia and ketoacidosis during follow-up were selected as time-dependent markers of diabetes control. Data were analyzed in a Cox model using SPSS software to predict DR with significance level at p-value <0.05. RESULTS In multivariate regression, any diabetic retinopathy was predicted by HbA1c (HR = 1.38; CI = 1.25-1.52; p < 0.0001), severe hypoglycemia (HR = 3; CI = 1.99-4.52; p < 0.0001), ketoacidosis (HR = 1.96; CI = 1.17-3.22; p = 0.009), and age at diagnosis (HR = 1.016; CI = 1.002-1.031; p = 0.02). Proliferative DR was predicted by HbA1c (HR = 1.67; CI = 1.51-1.79; p < 0.0001), severe hypoglycemia (HR = 3.67; CI = 2.74-5.25; p < 0.0001), and ketoacidosis (HR = 2.37; CI = 1.56-3.18; p < 0.0001). CONCLUSION This study shows that the failure to achieve diabetes control after the first year of diagnosis as well as early episodes of acute diabetes complications may contribute to the occurrence of diabetic retinopathy in type 1 diabetes patients.
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Affiliation(s)
- Alpha Mamadou Diallo
- Service d'Endocrinologie, Diabète et Nutrition, CHU de Reims, Avenue du Général Koenig, 51092 Reims, France.
| | - Jean-Luc Novella
- Université de Reims Champagne-Ardenne, EA 3797 (Santé Publique, Vieillissement, Qualité de vie, et Réadaptation des Sujets Fragiles), 51, rue Cognacq-Jay, 51095 Reims Cedex, France
| | - Céline Lukas
- Service d'Endocrinologie, Diabète et Nutrition, CHU de Reims, Avenue du Général Koenig, 51092 Reims, France
| | | | - Moustapha Dramé
- Université de Reims Champagne-Ardenne, EA 3797 (Santé Publique, Vieillissement, Qualité de vie, et Réadaptation des Sujets Fragiles), 51, rue Cognacq-Jay, 51095 Reims Cedex, France
| | - Maud François
- Service d'Endocrinologie, Diabète et Nutrition, CHU de Reims, Avenue du Général Koenig, 51092 Reims, France
| | - Bénédicte Decoudier
- Service d'Endocrinologie, Diabète et Nutrition, CHU de Reims, Avenue du Général Koenig, 51092 Reims, France
| | - Sara Barraud
- Service d'Endocrinologie, Diabète et Nutrition, CHU de Reims, Avenue du Général Koenig, 51092 Reims, France
| | - Anne-Sophie Salmon
- Service de Pédiatrie, CHU de Reims, 48 rue Cognacq Jay, 51092 Reims Cedex, France
| | - Déborah Ancelle
- Service d'Endocrinologie, Diabète et Nutrition, CHU de Reims, Avenue du Général Koenig, 51092 Reims, France
| | - Carl Arndt
- Service d'Ophtalmologie, CHU de Reims, Avenue du Général Koenig, 51092 Reims, France
| | - Brigitte Delemer
- Service d'Endocrinologie, Diabète et Nutrition, CHU de Reims, Avenue du Général Koenig, 51092 Reims, France
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Dard R, Herve B, Leblanc T, de Villartay JP, Collopy L, Vulliami T, Drunat S, Gorde S, Babik A, Souchon PF, Agadr A, Abilkassem R, Elalloussi M, Verloes A, Doco-Fenzy M. DNA ligase IV deficiency: Immunoglobulin class deficiency depends on the genotype. Pediatr Allergy Immunol 2017; 28:298-303. [PMID: 28039949 DOI: 10.1111/pai.12694] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/23/2023]
Affiliation(s)
- Rodolphe Dard
- Service de Génétique, Hopital Maison Blanche, CHU Reims, Reims, France.,Service de Génétique, CHI Poissy, Poissy, France
| | | | - Thierry Leblanc
- Service d'Immunologie et d'hématologie pédiatrique, Hopital Robert Debré, Paris, France
| | - Jean-Pierre de Villartay
- Necker Faculty of Medicine, Institut IMAGINE, INSERM URM 1163, Paris Sorbonne cite, Paris Descartes University, Paris, France
| | - Laura Collopy
- Centre for Genomics and Child Health, Blizard Institute, Barts and The London School of Medicine and Dentistry, Queen Mary University of London, London, UK
| | - Tom Vulliami
- Centre for Genomics and Child Health, Blizard Institute, Barts and The London School of Medicine and Dentistry, Queen Mary University of London, London, UK
| | | | - Stephanie Gorde
- Service de Pédiatrie, American Memorial Hospital, Reims, France
| | - Abel Babik
- Service de Pédiatrie, American Memorial Hospital, Reims, France
| | | | - Aomar Agadr
- Department of Pediatric and General Neonatology, Rabat Military Hospital, Rabat, Morocco
| | - Rachid Abilkassem
- Department of Pediatric and General Neonatology, Rabat Military Hospital, Rabat, Morocco
| | - Mustapha Elalloussi
- Department of Pediatrics and Stomatologic, Rabat Military Hospital, Rabat, Morocco
| | - Alain Verloes
- Service de Génétique, Hopital Robert Debré, Paris, France
| | - Martine Doco-Fenzy
- Service de Génétique, Hopital Maison Blanche, CHU Reims, Reims, France.,EA 3801, SFR CAP'sante Reims, Reims, France
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6
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Roucher-Boulez F, Mallet-Motak D, Samara-Boustani D, Jilani H, Ladjouze A, Souchon PF, Simon D, Nivot S, Heinrichs C, Ronze M, Bertagna X, Groisne L, Leheup B, Naud-Saudreau C, Blondin G, Lefevre C, Lemarchand L, Morel Y. NNT mutations: a cause of primary adrenal insufficiency, oxidative stress and extra-adrenal defects. Eur J Endocrinol 2016; 175:73-84. [PMID: 27129361 DOI: 10.1530/eje-16-0056] [Citation(s) in RCA: 43] [Impact Index Per Article: 5.4] [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] [Received: 01/19/2016] [Accepted: 04/29/2016] [Indexed: 12/21/2022]
Abstract
OBJECTIVE Nicotinamide nucleotide transhydrogenase (NNT), one of the several genes recently discovered in familial glucocorticoid deficiencies (FGD), is involved in reactive oxygen species detoxification, suggesting that extra-adrenal manifestations may occur, due to the sensitivity to oxidative stress of other organs rich in mitochondria. Here, we sought to identify NNT mutations in a large cohort of patients with primary congenital adrenal insufficiency without molecular etiology and evaluate the degree of adrenal insufficiency and onset of extra-adrenal damages. METHODS Sanger or massive parallel sequencing of NNT and patient monitoring. RESULTS Homozygous or compound heterozygous NNT mutations occurred frequently (26%, 13 unrelated families, 18 patients) in our cohort. Seven new mutations were identified: p.Met337Val, p.Ala863Glu, c.3G>A (p.Met1?), p.Arg129*, p.Arg379*, p.Val665Profs*29 and p.Ala704Serfs*19. The most frequent mutation, p.Arg129*, was found recurrently in patients from Algeria. Most patients were diagnosed belatedly (8-18 months) after presenting severe hypoglycemia; others experiencing stress conditions were diagnosed earlier. Five patients also had mineralocorticoid deficiency at onset. One patient had congenital hypothyroidism and two cryptorchidism. In follow-up, we noticed gonadotropic and genitalia impairments (precocious puberty, testicular inclusions, interstitial Leydig cell adenoma, azoospermia), hypothyroidism and hypertrophic cardiomyopathy. Intrafamilial phenotype heterogeneity was also observed. CONCLUSIONS NNT should be sequenced, not only in FGD, but also in all primary adrenal insufficiencies for which the most frequent etiologies have been ruled out. As NNT is involved in oxidative stress, careful follow-up is needed to evaluate mineralocorticoid biosynthesis extent, and gonadal, heart and thyroid function.
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Affiliation(s)
- Florence Roucher-Boulez
- Molecular Endocrinology and Rare DiseasesLyon University Hospital, Bron, France Claude Bernard Lyon 1 UniversityLyon, France
| | | | - Dinane Samara-Boustani
- Pediatric Endocrinology, Gynecology and DiabetologyNecker University Hospital, Paris, France
| | - Houweyda Jilani
- Molecular Endocrinology and Rare DiseasesLyon University Hospital, Bron, France
| | | | | | | | - Sylvie Nivot
- Department of PediatricsRennes Teaching Hospital, Rennes, France
| | - Claudine Heinrichs
- Pediatric EndocrinologyQueen Fabiola Children's University Hospital, Brussels, Belgium
| | - Maryline Ronze
- Endocrinology DepartmentL.-Hussel Hospital, Vienne, France
| | - Xavier Bertagna
- Endocrinology DepartmentCochin University Hospital, Paris, France
| | - Laure Groisne
- Endocrinology DepartmentLyon University Hospital, Bron-Lyon, France
| | - Bruno Leheup
- Paediatric and Clinical Genetic DepartmentNancy University Hospital, Vandoeuvre les Nancy, France
| | | | - Gilles Blondin
- Pediatric Endocrinology and DiabetologyBretagne Sud Hospital Center, Lorient, France
| | | | - Laetitia Lemarchand
- Pediatric DepartmentLa Rochelle-Ré-Aunis Hospital Group, La Rochelle, France
| | - Yves Morel
- Molecular Endocrinology and Rare DiseasesLyon University Hospital, Bron, France Claude Bernard Lyon 1 UniversityLyon, France
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7
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Jaisson S, Souchon PF, Desmons A, Salmon AS, Delemer B, Gillery P. Early Formation of Serum Advanced Glycation End-Products in Children with Type 1 Diabetes Mellitus: Relationship with Glycemic Control. J Pediatr 2016; 172:56-62. [PMID: 26947567 DOI: 10.1016/j.jpeds.2016.01.066] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/28/2015] [Revised: 12/16/2015] [Accepted: 01/27/2016] [Indexed: 12/24/2022]
Abstract
OBJECTIVES To quantify serum advanced glycation end-products (AGEs) at the onset of type 1 diabetes mellitus and to determine their potential usefulness as retrospective indicators of glycemic balance. STUDY DESIGN Carboxymethyllysine (CML) and pentosidine concentrations were determined by liquid chromatography-tandem mass spectrometry in 3 groups of children with type 1 diabetes mellitus: group (Gr) 1, subjects included at disease onset (n = 36); Gr2, subjects with diabetes of 5 years duration (n = 48); Gr3, subjects with diabetes of 10 years duration and in control subjects (n = 33). Hemoglobin A1c (HbA1c) values were recorded over the entire course of treatment for assessing long-term glycemic balance. RESULTS Serum AGE concentrations were increased in all groups of subjects with diabetes compared with control subjects, but were highest in Gr1 (for CML: 0.155, 0.306, 0.219, and 0.224 mmol/mol Lys in control, Gr1, Gr2, and Gr3 subjects, respectively; for pentosidine: 312, 492, 365, and 403 nmol/mol Lys, respectively). AGE concentrations were closely correlated with HbA1c values (r = 0.78 for CML; r = 0.49 for pentosidine). In Gr2 and Gr3, the overall glycemic balance estimated by average HbA1c values was positively correlated with CML and pentosidine concentrations, especially in the first year of follow-up. CONCLUSION Our results indicate that AGE concentrations are elevated in serum at the time of diabetes mellitus diagnosis, suggesting that the deleterious role of AGEs in the development of long-term complications should be taken into account even at the initial stages of the disease. Moreover, in some circumstances, AGEs could serve as surrogate markers of HbA1c for monitoring glycemic control.
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Affiliation(s)
- Stéphane Jaisson
- Laboratory of Pediatric Biology and Research, University Hospital of Reims, Reims, France; Laboratory of Biochemistry and Molecular Biology, Extracellular Matrix and Cell Dynamics Unit 7369, Centre National de Recherche Scientifique/Université de Reims Champagne-Ardenne, Faculty of Medicine, University of Reims, Reims, France
| | | | - Aurore Desmons
- Laboratory of Pediatric Biology and Research, University Hospital of Reims, Reims, France; Laboratory of Biochemistry and Molecular Biology, Extracellular Matrix and Cell Dynamics Unit 7369, Centre National de Recherche Scientifique/Université de Reims Champagne-Ardenne, Faculty of Medicine, University of Reims, Reims, France
| | - Anne-Sophie Salmon
- Endocrinology Unit, Department of Pediatrics, University Hospital of Reims, Reims, France
| | - Brigitte Delemer
- Department of Endocrinology, Diabetes, and Nutrition, University Hospital of Reims, Reims, France
| | - Philippe Gillery
- Laboratory of Pediatric Biology and Research, University Hospital of Reims, Reims, France; Laboratory of Biochemistry and Molecular Biology, Extracellular Matrix and Cell Dynamics Unit 7369, Centre National de Recherche Scientifique/Université de Reims Champagne-Ardenne, Faculty of Medicine, University of Reims, Reims, France
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8
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McKnight JA, Wild SH, Lamb MJE, Cooper MN, Jones TW, Davis EA, Hofer S, Fritsch M, Schober E, Svensson J, Almdal T, Young R, Warner JT, Delemer B, Souchon PF, Holl RW, Karges W, Kieninger DM, Tigas S, Bargiota A, Sampanis C, Cherubini V, Gesuita R, Strele I, Pildava S, Coppell KJ, Magee G, Cooper JG, Dinneen SF, Eeg-Olofsson K, Svensson AM, Gudbjornsdottir S, Veeze H, Aanstoot HJ, Khalangot M, Tamborlane WV, Miller KM. Glycaemic control of Type 1 diabetes in clinical practice early in the 21st century: an international comparison. Diabet Med 2015; 32:1036-50. [PMID: 25510978 DOI: 10.1111/dme.12676] [Citation(s) in RCA: 239] [Impact Index Per Article: 26.6] [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: 12/11/2014] [Indexed: 11/29/2022]
Abstract
AIMS Improving glycaemic control in people with Type 1 diabetes is known to reduce complications. Our aim was to compare glycaemic control among people with Type 1 diabetes using data gathered in regional or national registries. METHODS Data were obtained for children and/or adults with Type 1 diabetes from the following countries (or regions): Western Australia, Austria, Denmark, England, Champagne-Ardenne (France), Germany, Epirus, Thessaly and Thessaloniki (Greece), Galway (Ireland), several Italian regions, Latvia, Rotterdam (The Netherlands), Otago (New Zealand), Norway, Northern Ireland, Scotland, Sweden, Volyn (Ukraine), USA and Wales) from population or clinic-based registries. The sample size with available data varied from 355 to 173 880. Proportions with HbA1c < 58 mmol/mol (< 7.5%) and ≥ 75 mmol/mol (≥ 9.0%) were compared by age and sex. RESULTS Data were available for 324 501 people. The proportions with HbA1c 58 mmol/mol (< 7.5%) varied from 15.7% to 46.4% among 44 058 people aged < 15 years, from 8.9% to 49.5% among 50 766 people aged 15-24 years and from 20.5% to 53.6% among 229 677 people aged ≥ 25 years. Sex differences in glycaemic control were small. Proportions of people using insulin pumps varied between the 12 sources with data available. CONCLUSION These results suggest that there are substantial variations in glycaemic control among people with Type 1 diabetes between the data sources and that there is room for improvement in all populations, especially in young adults.
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Affiliation(s)
- J A McKnight
- Metabolic Unit, Western General Hospital, Edinburgh and University of Edinburgh, UK
- Scottish Diabetes Research Network Epidemiology Group
| | - S H Wild
- Centre for Population Health Sciences, University of Edinburgh, UK
- Scottish Diabetes Research Network Epidemiology Group
| | - M J E Lamb
- Centre for Population Health Sciences, University of Edinburgh, UK
- Scottish Diabetes Research Network Epidemiology Group
| | - M N Cooper
- Telethon Kids Institute, The University of Western Australia, Perth, Australia
- Department of Endocrinology and Diabetes, Princess Margaret Hospital for Children, Perth, Australia
| | - T W Jones
- Telethon Kids Institute, The University of Western Australia, Perth, Australia
- Department of Endocrinology and Diabetes, Princess Margaret Hospital for Children, Perth, Australia
- School of Paediatrics and Child Health, The University of Western Australia, Perth, Australia
| | - E A Davis
- Telethon Kids Institute, The University of Western Australia, Perth, Australia
- Department of Endocrinology and Diabetes, Princess Margaret Hospital for Children, Perth, Australia
- School of Paediatrics and Child Health, The University of Western Australia, Perth, Australia
| | - S Hofer
- Department of Pediatrics, Medical University of Innsbruck, Austria
- German/Austria DPV database
| | - M Fritsch
- Department of Pediatrics, Medical University of Vienna, Austria
- German/Austria DPV database
| | - E Schober
- Department of Pediatrics, Medical University of Vienna, Austria
- German/Austria DPV database
| | - J Svensson
- Department of Pediatrics, Copenhagen University Hospital Herlev, Denmark
| | - T Almdal
- Department of Medicine F, Copenhagen University Hospital, Hellerup, Denmark
| | - R Young
- Salford Royal Foundation NHS Trust, Salford, UK
| | - J T Warner
- Children's Hospital for Wales, Cardiff, UK
- National Pediatric Diabetes Audit and the Royal College of Paediatrics and Child Health
| | - B Delemer
- Department of Endocrinology, Diabetes and Nutrition, American Memorial Hospital, University Hospital of Rheims, France
| | - P F Souchon
- Department of Pediatrics, American Memorial Hospital, University Hospital of Rheims, France
- CARéDIAB Network
| | - R W Holl
- Institute of Epidemiology and Medical Biometry, ZIBMT, University of Ulm, Germany
- German/Austria DPV database
| | - W Karges
- Division of Endocrinology, RWTH Aachen University, Germany
- German/Austria DPV database
| | - D M Kieninger
- Diabetes Division, Department of Paediatrics, Universitätsmedizin Johannes Gutenberg Universität Mainz, Germany
- German/Austria DPV database
| | - S Tigas
- Department of Endocrinology, University of Ioannina, Greece
| | - A Bargiota
- Department of Endocrinology and Metabolic Diseases, University of Thessaly, Greece
| | - C Sampanis
- Second Department of Internal Medicine, Aristotle University of Thessaloniki, Hippokratio General Hospital, Thessaloniki, Greece
| | - V Cherubini
- Department of Women's and Children's Health, SalesiHospital, Ancona, Italy
- RIDI Study Group
| | - R Gesuita
- Centre of Epidemiology and Biostatistics, Polytechnic University of Marche, Italy
| | - I Strele
- Department of Public Health and Epidemiology, Riga Stradins University, Riga, Latvia
| | - S Pildava
- The Centre for Disease Prevention and Control of Latvia, Riga, Latvia
| | - K J Coppell
- Edgar Diabetes and Obesity Research, Department of Medicine, University of Otago, Dunedin, New Zealand
| | - G Magee
- Daisy Hill Hospital, Newry, County Down, UK
| | - J G Cooper
- Norwegian Adult Diabetes Register, Noklus, Bergen, Norway
| | - S F Dinneen
- Galway University Hospitals, Galway, Ireland
- NUI Galway, Galway, Ireland
- Galway University Hospitals Department of Diabetes, Endocrinology and Metabolism
| | - K Eeg-Olofsson
- Department of Medicine, Sahlgrenska University Hospital, University of Gothenburg, Göteborg, Sweden
- National Diabetes Register in Sweden
| | - A-M Svensson
- Centre of Registers in Region VöstraGötaland, Göteborg, Sweden
- National Diabetes Register in Sweden
| | - S Gudbjornsdottir
- Department of Medicine, Sahlgrenska University Hospital, University of Gothenburg, Göteborg, Sweden
- Centre of Registers in Region VöstraGötaland, Göteborg, Sweden
- National Diabetes Register in Sweden
| | - H Veeze
- Diabeter, National Centre for Pediatric and Adolescent Diabetes, Rotterdam, the Netherlands
| | - H-J Aanstoot
- Diabeter, National Centre for Pediatric and Adolescent Diabetes, Rotterdam, the Netherlands
| | - M Khalangot
- Shupyk National Medical Academy of Postgraduate Education and Komisarenko Institute of Endocrinology and Metabolism, Kiev, Ukraine
- Ukrainian Diabetes Register Team
| | - W V Tamborlane
- Yale University, New Haven, CT, USA
- T1D Exchange Clinic Network
| | - K M Miller
- Jaeb Centre for Health Research, Tampa, FL, USA
- T1D Exchange Clinic Network
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9
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Landais E, Leroy C, Kleinfinger P, Brunet S, Koubi V, Pietrement C, Poli-Mérol ML, Fiquet C, Souchon PF, Beri M, Jonveaux P, Garnotel R, Gaillard D, Doco-Fenzy M. A pure familial 6q15q21 split duplication associated with obesity and transmitted with partial reduction. Am J Med Genet A 2015; 167:1275-84. [PMID: 25900228 DOI: 10.1002/ajmg.a.36995] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [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: 05/07/2014] [Accepted: 12/29/2014] [Indexed: 01/06/2023]
Abstract
Familial transmission of chromosome 6 duplications is rare. We report on the first observation of a maternally-inherited pure segmental 6q duplication split into two segments, 6q15q16.3 and 6q16.3q21, and associated with obesity. Obesity has previously been correlated to chromosome 6 q-arm deletion but has not yet been assessed in duplications. The aim of this study was to characterize the structure of these intrachromosomal insertional translocations by classic cytogenetic banding, array-CGH, FISH, M-banding and genotyping using microsatellites and SNP array analysis, in a mother and four offspring. The duplicated 6q segments, 9.75 Mb (dup 1) and 7.05 Mb (dup 2) in size in the mother, were inserted distally into two distinct chromosome 6q regions. They were transmitted to four offspring. A son and a daughter inherited the two unbalanced insertions and displayed, like the mother, an abnormal phenotype with facial dysmorphism, intellectual disability, and morbid obesity. Curiously, two daughters with a normal phenotype inherited only the smaller segment, 6q16.3q21. The abnormal phenotype was associated with the larger proximal 6q15q16.3 duplication. We hypothesize a mechanism for this exceptional phenomenon of recurrent reduction and transmission of the duplication during meiosis in a family. We expect the interpretation of our findings to be useful for genetic counseling and for understanding the mechanisms underlying these large segmental 6q duplications and their evolution.
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Affiliation(s)
- Emilie Landais
- CHU-Reims, HMB, Service de Génétique, France.,CHU-Reims, HMB, Plateforme Régionale de Biologie Innovante, France
| | - Camille Leroy
- CHU-Reims, HMB, Service de Génétique, France.,Université de Reims Champagne-Ardenne, UFR de médecine, France
| | | | | | - Valérie Koubi
- Service de génétique Médicale, Laboratoire de génétique moléculaire, CHU Hopital Necker enfants malades, Paris, France
| | | | - Marie-Laurence Poli-Mérol
- Université de Reims Champagne-Ardenne, UFR de médecine, France.,CHU-Reims, American Memorial Hospital, Service de Chirurgie pédiatrique, France
| | - Caroline Fiquet
- CHU-Reims, American Memorial Hospital, Service de Chirurgie pédiatrique, France.,SFR CAP Santé, Reims, EA 3801, France
| | | | - Mylène Beri
- CHU-Nancy, Laboratoire de Génétique Médicale, Nancy Université, France
| | - Philippe Jonveaux
- CHU-Nancy, Laboratoire de Génétique Médicale, Nancy Université, France
| | - Roselyne Garnotel
- CHU-Reims, Laboratoire de Biochimie Médicale et Biologie Moléculaire, CNRS UMR 6198, UFR, Médecine, France
| | - Dominique Gaillard
- CHU-Reims, HMB, Service de Génétique, France.,Université de Reims Champagne-Ardenne, UFR de médecine, France
| | - Martine Doco-Fenzy
- CHU-Reims, HMB, Service de Génétique, France.,SFR CAP Santé, Reims, EA 3801, France
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10
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Cossiez Cacard MA, Coulombe J, Bernard P, Kaci N, Bressieux JM, Souchon PF, Motte J, Legeai-Mallet L, Hadj-Rabia S, Eschard C. Familial hypochondroplasia and acanthosis nigricans with FGFR3 K650T mutation. J Eur Acad Dermatol Venereol 2015; 30:897-8. [PMID: 25809207 DOI: 10.1111/jdv.13061] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Affiliation(s)
- M A Cossiez Cacard
- Service de pédiatrie, American Memorial Hospital, CHU de Reims, Reims, France
| | - J Coulombe
- Service de dermatologie, Centre de référence des maladies génétiques à expression cutanée, Institut Imagine, Hôpital Universitaire Necker-Enfants Malades, Assistance Publique-Hôpitaux de Paris, Université Paris Descartes - Sorbonne Paris Cité, Paris, France
| | - P Bernard
- Service de dermatologie, Hôpital Robert Debré, CHU de Reims, Reims, France
| | - N Kaci
- INSERM U1163, Hospital Necker-Enfants Malades, University Paris Descartes Sorbonne Paris Cité, Institut Imagine, Paris, France
| | - J M Bressieux
- Service de dermatologie, Centre hospitalier de Troyes, Troyes, France
| | - P F Souchon
- Service de pédiatrie, American Memorial Hospital, CHU de Reims, Reims, France
| | - J Motte
- Service de pédiatrie, American Memorial Hospital, CHU de Reims, Reims, France
| | - L Legeai-Mallet
- INSERM U1163, Hospital Necker-Enfants Malades, University Paris Descartes Sorbonne Paris Cité, Institut Imagine, Paris, France
| | - S Hadj-Rabia
- Service de dermatologie, Centre de référence des maladies génétiques à expression cutanée, Institut Imagine, Hôpital Universitaire Necker-Enfants Malades, Assistance Publique-Hôpitaux de Paris, Université Paris Descartes - Sorbonne Paris Cité, Paris, France.,INSERM U1163, Hospital Necker-Enfants Malades, University Paris Descartes Sorbonne Paris Cité, Institut Imagine, Paris, France
| | - C Eschard
- Service de dermatologie, Hôpital Robert Debré, CHU de Reims, Reims, France
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11
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Salenave S, Ancelle D, Bahougne T, Raverot G, Kamenický P, Bouligand J, Guiochon-Mantel A, Linglart A, Souchon PF, Nicolino M, Young J, Borson-Chazot F, Delemer B, Chanson P. Macroprolactinomas in children and adolescents: factors associated with the response to treatment in 77 patients. J Clin Endocrinol Metab 2015; 100:1177-86. [PMID: 25532043 DOI: 10.1210/jc.2014-3670] [Citation(s) in RCA: 59] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/13/2023]
Abstract
BACKGROUND Pituitary adenomas are rare in children and adolescents. The response of macroprolactinomas to dopamine agonists (DA) in this age group has been less extensively studied than in adults. OBJECTIVE We retrospectively analyzed data on a large cohort of young patients with macroprolactinomas. PATIENTS AND METHODS Patients aged younger than 20 years at macroprolactinoma diagnosis and seen in three tertiary referral centers between 1983 and 2013 were studied by analyzing their clinical and genetic (AIP and MEN1) characteristics. Hormonal and tumoral responses to DA were analyzed, and the patients' status at their last visit, after a mean (±SD) follow-up of 8.2 ± 5.8 years, was assessed. RESULTS The cohort comprised 77 patients (26 males, 51 females). Mean age at diagnosis was 16.1 ± 2.5 years (range, 4.5-20 y). In both sexes, the most frequent revealing symptom was a pubertal disorder (49%), followed by visual problems (24%) and growth retardation (24%). Basal prolactin (PRL) levels and maximal tumor diameter were significantly higher in boys than in girls (7168 ng/mL, 202-40 168 vs 1433 ng/mL, 115-20 000, P = .002; and 33 ± 14 mm, 15-64 vs 19 ± 9 mm; 10-50, P < .001, respectively). PRL levels normalized in 74% of the patients treated with DA. A mutation of AIP or MEN1 was found in 14% of the patients. Factors associated with resistance to DA were young age, higher PRL levels, larger volume, and the presence of a MEN1 (but not an AIP) mutation. CONCLUSION Macroprolactinomas are rare below the age of 20 years, mainly occurring in girls and during adolescence. Like adults, young patients are very sensitive to DA, which should therefore be considered the first-line treatment. DA resistance is associated with a higher PRL level and larger tumor size, both parameters being closely linked together. About 14% of these young patients have an AIP or MEN1 mutation, this latter being an independent predictor of DA resistance.
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Affiliation(s)
- Sylvie Salenave
- Service d'Endocrinologie et des Maladies de la Reproduction and Centre de Référence des Maladies Endocriniennes Rares de la Croissance (S.S., T.B., P.K., J.Y., P.C.), and Service de Génétique Moléculaire, Pharmacogénétique, et Hormonologie (J.B., A.G.-M.), and Service d'Endocrinologie Pédiatrique and Centre de Référence des Maladies Rares du Métabolisme Phospho-Calcique, (A.L.), Assistance Publique-Hôpitaux de Paris, Hôpital de Bicêtre, Le Kremlin-Bicêtre, F-94275, France; Service d'Endocrinologie (D.A., B.D.) and Service de Pédiatrie (P.-F.S.), Centre Hospitalier Universitaire de Reims, Hôpital Robert Debré, Reims, F-51092, France; Faculté de Médecine (G.R., M.N., F.B.-C.), Université de Lyon, Lyon 1, Lyon-Est, Lyon F-69372 France; Fédération d'Endocrinologie (G.R., F.B.-C.) and Service d'Endocrinologie Pédiatrique (M.N.), Hôpital Femme-Mère-Enfant, Groupement Hospitalier Est, Hospices Civils de Lyon, Lyon, F-69003, France; Institut National de la Santé et de la Recherche Médicale Unité 1028 (G.R.), Centre National de la Recherche Scientifique, Unité Mixte de Recherche 5292, Lyon Neuroscience Research Center, Service de Neurooncology-Neuroinflammation, and INSERM Unité 1052 (F.B.-C.), Unité Mixte de Recherche Centre National de la Recherche Scientifique Unité 5286, Centre de Recherche en Cancérologie de Lyon, Equipe Tumeurs Endocrines, Lyon, F-69000, France; Unité Mixte de Recherche Scientifique Unité 693 (P.K., J.B., A.M., A.L., J.Y., P.C.), Faculté de Médecine Paris-Sud, Université Paris-Sud 11, Le Kremlin-Bicêtre F-94276, France; INSERM Unité 986 (A.L.) and INSERM Unité 693 (P.K., J.B., A.M., J.Y., P.C.), Le Kremlin-Bicêtre F-94276, France
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12
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Brue T, Quentien MH, Khetchoumian K, Bensa M, Capo-Chichi JM, Delemer B, Balsalobre A, Nassif C, Papadimitriou DT, Pagnier A, Hasselmann C, Patry L, Schwartzentruber J, Souchon PF, Takayasu S, Enjalbert A, Van Vliet G, Majewski J, Drouin J, Samuels ME. Mutations in NFKB2 and potential genetic heterogeneity in patients with DAVID syndrome, having variable endocrine and immune deficiencies. BMC Med Genet 2014; 15:139. [PMID: 25524009 PMCID: PMC4411703 DOI: 10.1186/s12881-014-0139-9] [Citation(s) in RCA: 59] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/26/2014] [Accepted: 12/11/2014] [Indexed: 01/09/2023]
Abstract
Background DAVID syndrome is a rare condition combining anterior pituitary hormone deficiency with common variable immunodeficiency. NFKB2 mutations have recently been identified in patients with ACTH and variable immunodeficiency. A similar mutation was previously found in Nfkb2 in the immunodeficient Lym1 mouse strain, but the effect of the mutation on endocrine function was not evaluated. Methods We ascertained six unrelated DAVID syndrome families. We performed whole exome and traditional Sanger sequencing to search for causal genes. Lym1 mice were examined for endocrine developmental anomalies. Results Mutations in the NFKB2 gene were identified in three of our families through whole exome sequencing, and in a fourth by direct Sanger sequencing. De novo origin of the mutations could be demonstrated in three of the families. All mutations lie near the C-terminus of the protein-coding region, near signals required for processing of NFΚB2 protein by the alternative pathway. Two of the probands had anatomical pituitary anomalies, and one had growth and thyroid hormone as well as ACTH deficiency; these findings have not been previously reported. Two children of one of the probands carried the mutation and have to date exhibited only an immune phenotype. No mutations were found near the C-terminus of NFKB2 in the remaining two probands; whole exome sequencing has been performed for one of these. Lym1 mice, carrying a similar Nfkb2 C-terminal mutation, showed normal pituitary anatomy and expression of proopiomelanocortin (POMC). Conclusions We confirm previous findings that mutations near the C-terminus of NFKB2 cause combined endocrine and immunodeficiencies. De novo status of the mutations was confirmed in all cases for which both parents were available. The mutations are consistent with a dominant gain-of-function effect, generating an unprocessed NFKB2 super-repressor protein. We expand the potential phenotype of such NFKB2 mutations to include additional pituitary hormone deficiencies as well as anatomical pituitary anomalies. The lack of an observable endocrine phenotype in Lym1 mice suggests that the endocrine component of DAVID syndrome is either not due to a direct role of NFKB pathways on pituitary development, or else that human and mouse pituitary development differ in its requirements for NFKB pathway function. Electronic supplementary material The online version of this article (doi:10.1186/s12881-014-0139-9) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Thierry Brue
- Aix-Marseille University, Centre de Recherche en Neurobiologie et Neurophysiologie de Marseille (CRN2M), Centre National de la Recherche Scientifique, Unité Mixte de Recherche 7286, Faculté de Médecine de Marseille, 13344, Marseille, France. .,Assistance Publique-Hôpitaux de Marseille (APHM), Department of Endocrinology, Centre de Référence des Maladies Rares d'Origine Hypophysaire, Hôpital de la Timone, 13005, Marseille, France.
| | - Marie-Hélène Quentien
- Aix-Marseille University, Centre de Recherche en Neurobiologie et Neurophysiologie de Marseille (CRN2M), Centre National de la Recherche Scientifique, Unité Mixte de Recherche 7286, Faculté de Médecine de Marseille, 13344, Marseille, France. .,Assistance Publique-Hôpitaux de Marseille (APHM), Department of Endocrinology, Centre de Référence des Maladies Rares d'Origine Hypophysaire, Hôpital de la Timone, 13005, Marseille, France.
| | - Konstantin Khetchoumian
- Laboratoire de Génétique moléculaire, Institut de recherches cliniques de Montréal, 110 Avenue des Pins Ouest, Montréal, QC, H2W 1R7, Canada.
| | - Marco Bensa
- Ospedale Bufalini, Department of Paediatrics, Cesena, FC, Italy.
| | | | - Brigitte Delemer
- Departments of Endocrinology and of Pediatrics, Centre Hospitalier Robert Debré, 51092, Reims, France.
| | - Aurelio Balsalobre
- Laboratoire de Génétique moléculaire, Institut de recherches cliniques de Montréal, 110 Avenue des Pins Ouest, Montréal, QC, H2W 1R7, Canada.
| | - Christina Nassif
- Centre de Recherche du CHU Ste-Justine, 3175 Cote Ste-Catherine, Montreal, QC, Canada.
| | - Dimitris T Papadimitriou
- Department of Pediatric-Adolescent Endocrinology and Diabetes, Athens Medical Center, Athens, Greece.
| | - Anne Pagnier
- Clinique universitaire de pédiatrie, CHU de Grenoble, Grenoble, France.
| | - Caroline Hasselmann
- Centre de Recherche du CHU Ste-Justine, 3175 Cote Ste-Catherine, Montreal, QC, Canada.
| | - Lysanne Patry
- Centre de Recherche du CHU Ste-Justine, 3175 Cote Ste-Catherine, Montreal, QC, Canada.
| | | | - Pierre-François Souchon
- Departments of Endocrinology and of Pediatrics, Centre Hospitalier Robert Debré, 51092, Reims, France.
| | - Shinobu Takayasu
- Laboratoire de Génétique moléculaire, Institut de recherches cliniques de Montréal, 110 Avenue des Pins Ouest, Montréal, QC, H2W 1R7, Canada.
| | - Alain Enjalbert
- Aix-Marseille University, Centre de Recherche en Neurobiologie et Neurophysiologie de Marseille (CRN2M), Centre National de la Recherche Scientifique, Unité Mixte de Recherche 7286, Faculté de Médecine de Marseille, 13344, Marseille, France. .,Assistance Publique-Hôpitaux de Marseille (APHM), Department of Endocrinology, Centre de Référence des Maladies Rares d'Origine Hypophysaire, Hôpital de la Timone, 13005, Marseille, France.
| | - Guy Van Vliet
- Endocrinology Service and Research Center, Department of Pediatrics, CHU Ste-Justine, University of Montreal, Montreal, QC, Canada.
| | - Jacek Majewski
- Department of Human Genetics, McGill University, Montreal, QC, Canada.
| | - Jacques Drouin
- Laboratoire de Génétique moléculaire, Institut de recherches cliniques de Montréal, 110 Avenue des Pins Ouest, Montréal, QC, H2W 1R7, Canada.
| | - Mark E Samuels
- Centre de Recherche du CHU Ste-Justine, 3175 Cote Ste-Catherine, Montreal, QC, Canada. .,Department of Medicine, University of Montreal, Montreal, QC, Canada.
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13
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Busiah K, Drunat S, Vaivre-Douret L, Bonnefond A, Simon A, Flechtner I, Gérard B, Pouvreau N, Elie C, Nimri R, De Vries L, Tubiana-Rufi N, Metz C, Bertrand AM, Nivot-Adamiak S, de Kerdanet M, Stuckens C, Jennane F, Souchon PF, Le Tallec C, Désirée C, Pereira S, Dechaume A, Robert JJ, Phillip M, Scharfmann R, Czernichow P, Froguel P, Vaxillaire M, Polak M, Cavé H. Neuropsychological dysfunction and developmental defects associated with genetic changes in infants with neonatal diabetes mellitus: a prospective cohort study [corrected]. Lancet Diabetes Endocrinol 2013; 1:199-207. [PMID: 24622368 DOI: 10.1016/s2213-8587(13)70059-7] [Citation(s) in RCA: 67] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
Abstract
BACKGROUND Neonatal diabetes mellitus is a rare genetic form of pancreatic β-cell dysfunction. We compared phenotypic features and clinical outcomes according to genetic subtypes in a cohort of patients diagnosed with neonatal diabetes mellitus before age 1 year, without β-cell autoimmunity and with normal pancreas morphology. METHODS We prospectively investigated patients from 20 countries referred to the French Neonatal Diabetes Mellitus Study Group from 1995 to 2010. Patients with hyperglycaemia requiring treatment with insulin before age 1 year were eligible, provided that they had normal pancreatic morphology as assessed by ultrasonography and negative tests for β-cell autoimmunity. We assessed changes in the 6q24 locus, KATP-channel subunit genes (ABCC8 and KCNJ11), and preproinsulin gene (INS) and investigated associations between genotype and phenotype, with special attention to extra-pancreatic abnormalities. FINDINGS We tested 174 index patients, of whom 47 (27%) had no detectable genetic defect. Of the remaining 127 index patients, 40 (31%) had 6q24 abnormalities, 43 (34%) had mutations in KCNJ11, 31 (24%) had mutations in ABCC8, and 13 (10%) had mutations in INS. We reported developmental delay with or without epilepsy in 13 index patients (18% of participants with mutations in genes encoding KATP channel subunits). In-depth neuropsychomotor investigations were done at median age 7 years (IQR 1-15) in 27 index patients with mutations in KATP channel subunit genes who did not have developmental delay or epilepsy. Developmental coordination disorder (particularly visual-spatial dyspraxia) or attention deficits were recorded in all index patients who had this testing. Compared with index patients who had mutations in KATP channel subunit genes, those with 6q24 abnormalities had specific features: developmental defects involving the heart, kidneys, or urinary tract (8/36 [22%] vs 2/71 [3%]; p=0·002), intrauterine growth restriction (34/37 [92%] vs 34/70 [48%]; p<0·0001), and early diagnosis (median age 5·0 days, IQR 1·0-14·5 vs 45·5 days, IQR 27·2-95·0; p<0·0001). Remission of neonatal diabetes mellitus occurred in 89 (51%) index patients at a median age of 17 weeks (IQR 9·5-39·0; median follow-up 4·7 years, IQR 1·5-12·8). Recurrence was common, with no difference between the groups who had 6q24 abnormalities versus mutations in KATP channel subunit genes (82% vs 86%; p=0·36). INTERPRETATION Neonatal diabetes mellitus is often associated with neuropsychological dysfunction and developmental defects that are specific to the underlying genetic abnormality. A multidisciplinary assessment is therefore essential when patients are diagnosed. Features of neuropsychological dysfunction and developmental defects should be tested for in adults with a history of neonatal diabetes mellitus. FUNDING Agence Nationale de la Recherche-Maladies Rares Research Program Grant, the Transnational European Research Grant on Rare Diseases, the Société Francophone du Diabète-Association Française du Diabète, the Association Française du Diabète, Aide aux Jeunes Diabétiques, a CIFRE grant from the French Government, HRA-Pharma, the French Ministry of Education and Research, and the Société Française de Pédiatrie.
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Affiliation(s)
- Kanetee Busiah
- INSERM U845, Université Paris Descartes, Sorbonne Paris Cité, Department of Paediatric Endocrinology, Gynaecology, and Diabetology, Necker-Enfants Malades Teaching Hospital, Assistance Publique-Hôpitaux de Paris, IMAGINE affiliate, Paris, France
| | - Séverine Drunat
- Department of Genetics, Robert-Debré Teaching Hospital, Assistance Publique-Hôpitaux de Paris, Paris, France
| | - Laurence Vaivre-Douret
- Inserm UMR-S0669 Université Paris Sud, Paris Descartes, Sorbonne Paris Cité, Department of Paediatrics, Cochin Teaching Hospital, Assistance Publique-Hôpitaux de Paris, Paris, France
| | - Amélie Bonnefond
- CNRS-UMR-8199, Lille Pasteur Institute, Lille, France; EGID-FR3508, Lille, France; Lille 2 University, Lille, France
| | - Albane Simon
- Department of Paediatrics, André Mignot Hospital, Le Chesnay, France
| | - Isabelle Flechtner
- Department of Paediatric Endocrinology, Gynaecology, and Diabetology, Necker-Enfants Malades Teaching Hospital, Assistance Publique-Hôpitaux de Paris, IMAGINE affiliate, Paris, France
| | - Bénédicte Gérard
- Department of Genetics, Robert-Debré Teaching Hospital, Assistance Publique-Hôpitaux de Paris, Paris, France
| | - Nathalie Pouvreau
- Department of Genetics, Robert-Debré Teaching Hospital, Assistance Publique-Hôpitaux de Paris, Paris, France
| | - Caroline Elie
- Clinical Research Unit, Necker-Enfants Malades Teaching Hospital, Assistance Publique-Hôpitaux de Paris, Université Paris Descartes, Sorbonne Paris Cité, Paris, France
| | - Revital Nimri
- The Jesse Z and Sara Lea Shafer Institute of Endocrinology and Diabetes, The National Center for Childhood Diabetes, Schneider Children's Medical Centre of Israel, Petah Tikva, Israel
| | - Liat De Vries
- The Jesse Z and Sara Lea Shafer Institute of Endocrinology and Diabetes, The National Center for Childhood Diabetes, Schneider Children's Medical Centre of Israel, Petah Tikva, Israel
| | - Nadia Tubiana-Rufi
- Department of Paediatric Endocrinology and Diabetology, Robert-Debré Teaching Hospital, Assistance Publique-Hôpitaux de Paris, Paris, France
| | - Chantal Metz
- Department of Paediatrics, Brest Teaching Hospital, Brest, France
| | | | | | - Marc de Kerdanet
- Department of Paediatrics, Rennes Teaching Hospital, Rennes, France
| | - Chantal Stuckens
- Department of Paediatrics, Jeanne de Flandre Teaching Hospital, Lille, France
| | - Farida Jennane
- Department of Paediatric Endocrinology and Diabetology, A Harouchi Paediatric Teaching Hospital, Casablanca, Morocco
| | | | - Claire Le Tallec
- Department of Paediatrics, Paediatric Teaching Hospital, Toulouse, France
| | - Christelle Désirée
- Department of Genetics, Robert-Debré Teaching Hospital, Assistance Publique-Hôpitaux de Paris, Paris, France
| | - Sabrina Pereira
- Department of Genetics, Robert-Debré Teaching Hospital, Assistance Publique-Hôpitaux de Paris, Paris, France
| | - Aurélie Dechaume
- CNRS-UMR-8199, Lille Pasteur Institute, Lille, France; EGID-FR3508, Lille, France; Lille 2 University, Lille, France
| | - Jean-Jacques Robert
- Department of Paediatric Endocrinology, Gynaecology, and Diabetology, Necker-Enfants Malades Teaching Hospital, Assistance Publique-Hôpitaux de Paris, IMAGINE affiliate, Paris, France
| | - Moshe Phillip
- The Jesse Z and Sara Lea Shafer Institute of Endocrinology and Diabetes, The National Center for Childhood Diabetes, Schneider Children's Medical Centre of Israel, Petah Tikva, Israel
| | - Raphaël Scharfmann
- Université Paris Descartes, Sorbonne Paris Cité, INSERM U845, Paris, France
| | - Paul Czernichow
- Department of Paediatric Endocrinology, Gynaecology, and Diabetology, Necker-Enfants Malades Teaching Hospital, Assistance Publique-Hôpitaux de Paris, IMAGINE affiliate, Paris, France
| | - Philippe Froguel
- CNRS-UMR-8199, Lille Pasteur Institute, Lille, France; EGID-FR3508, Lille, France; Lille 2 University, Lille, France; Department of Genomics of Common Disease, School of Public Health, Hammersmith Hospital, Imperial College London, London, UK
| | - Martine Vaxillaire
- CNRS-UMR-8199, Lille Pasteur Institute, Lille, France; EGID-FR3508, Lille, France; Lille 2 University, Lille, France
| | - Michel Polak
- INSERM U845, Université Paris Descartes, Sorbonne Paris Cité, Department of Paediatric Endocrinology, Gynaecology, and Diabetology, Necker-Enfants Malades Teaching Hospital, Assistance Publique-Hôpitaux de Paris, IMAGINE affiliate, Paris, France.
| | - Hélène Cavé
- Department of Genetics, Robert-Debré Teaching Hospital, Assistance Publique-Hôpitaux de Paris, Paris, France; Université Paris Diderot, Sorbonne Paris Cité, Paris, France
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14
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Quentien MH, Delemer B, Papadimitriou DT, Souchon PF, Jaussaud R, Pagnier A, Munzer M, Jullien N, Reynaud R, Galon-Faure N, Enjalbert A, Barlier A, Brue T. Deficit in anterior pituitary function and variable immune deficiency (DAVID) in children presenting with adrenocorticotropin deficiency and severe infections. J Clin Endocrinol Metab 2012; 97:E121-8. [PMID: 22013103 DOI: 10.1210/jc.2011-0407] [Citation(s) in RCA: 36] [Impact Index Per Article: 3.0] [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] [Indexed: 02/12/2023]
Abstract
CONTEXT Among 22 independent patients from the GENHYPOPIT network who had ACTH deficiency and no identified mutation of TPIT, three of them (13.6%) displayed common variable immunodeficiency (CVID), characterized by defective Ig production. OBJECTIVE Our objective was to describe an as yet unrecognized disease association. DESIGN We considered the hypothesis of ACTH deficiency being associated with antipituitary autoimmunity or lymphocytic hypophysitis. In the context of a functional network between the immune and endocrine systems, we also tested the hypothesis of a common genetic cause using a candidate gene approach. SETTING This was a multicentric study in three academic hospitals. PATIENTS We report four patients from three unrelated families presenting with ACTH deficiency and CVID. MAIN OUTCOME MEASURES Detection of antipituitary autoantibodies, and sequencing of candidate genes (LIF, IKAROS, EOS) were the main outcome measures. RESULTS All patients including a pedigree with two affected siblings had ACTH deficit diagnosed from 5-15 yr, with symptomatic hypoglycemia, and CVID diagnosed from 2-8 yr revealed by recurrent infections. Three of the four patients had a hypoplastic pituitary. One patient had low IGF-I and subnormal GH response to stimulation, suggesting that secretion of other pituitary hormones may also be affected. All patients proved negative for pituitary autoantibodies and had no alteration in any of the genes tested. CONCLUSIONS The remarkable association of two rare disorders affecting two functionally related systems in four patients from three independent pedigrees including a familial case provides strong evidence of the existence of a disease association: deficit in anterior pituitary function and variable immune deficiency, or DAVID.
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Affiliation(s)
- Marie-Hélène Quentien
- Centre de Recherche en Neurobiologie et Neurophysiologie de Marseille, Aix-Marseille Université, 13344 Marseille, France
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15
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Sulmont V, Souchon PF, Gouillard-Darnaud C, Fartura A, Salmon-Musial AS, Lambrecht E, Mauran P, Abely M. Metabolic control in children with diabetes mellitus who are younger than 6 years at diagnosis: continuous subcutaneous insulin infusion as a first line treatment? J Pediatr 2010; 157:103-7. [PMID: 20227730 DOI: 10.1016/j.jpeds.2009.12.034] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/03/2009] [Revised: 11/03/2009] [Accepted: 12/17/2009] [Indexed: 10/19/2022]
Abstract
OBJECTIVE To assess long-term metabolic outcomes in children with diabetes mellitus that was diagnosed when they were <6 years old. STUDY DESIGN A cohort of 66 children with diabetes mellitus that had a duration of at least 5 years and was diagnosed before they were 6 years old. Thirty-four children were treated at diagnosis with multiple daily subcutaneous insulin injections (MDI), and all these children, except 3, were switched to continuous subcutaneous insulin infusion (CSII; group A). Thirty-two children received CSII as initial treatment (group B). RESULTS Hemoglobin A1c values were significantly lower in patients receiving CSII than MDI during all the 8 years of follow-up except one (year 1: 6.9%+/-0.9% versus 7.6%+/-1%, P=.011 ; year 4: 7.4%+/-0.8% versus 8.1%+/-0.9%, P=.006; year 7: 7.6%+/-0.5% versus 8.3%+/-0.8%, P=.001). The incidence of severe hypoglycemia was greatly decreased for the CSII group (9.8 versus 22.3 episodes/100 patient-years, P=.016). In group A, hemoglobin A1c values increased during the study period, and in group B, they increased only during the first 2 years and remained constant thereafter. Only 9.1% of patients did not use or abandoned CSII. CONCLUSION CSII in children<6 years of age enables better long-term metabolic control and lowers the risk of severe hypoglycemia better than MDI, especially when initiated at diagnosis.
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Affiliation(s)
- Veronique Sulmont
- Department of Pediatrics, American Memorial Hospital, University Hospital of Reims, Reims, France.
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16
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Hoizey G, Souchon PF, Trenque T, Frances C, Lamiable D, Nicolas A, Grossenbacher F, Sabouraud P, Bednarek N, Motte J, Millart H. An unusual case of methyl bromide poisoning. J Toxicol Clin Toxicol 2002; 40:817-21. [PMID: 12475194 DOI: 10.1081/clt-120015841] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
A nonlethal poisoning case by methyl bromide in a young woman due to leakage of old fire extinguishers is described. The patient developed major action and intention myoclonus the day following exposure. Inorganic bromide concentrations in plasma were determined by inductively coupled plasma mass spectrometry. The initial plasma bromide level was 202 mg/L, 40-fold in excess than the commonly accepted tolerance limit, and decreased slowly to normal levels within 2 months. Although plasma inorganic bromide concentration is known not to be directly correlated to the severity of organic bromide poisoning, its determination was, in the present case, particularly useful to confirm the diagnosis. One year post-exposure, the patient showed no sign of central nervous system toxicity. While such a case of poisoning is particularly rare today, it illustrates, however, that the danger still exists in France although the destruction
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Affiliation(s)
- Guillaume Hoizey
- Laboratoire de Pharmacologie et Toxicologie, Hĵpital Maison Blanche, CHU de Reims, France.
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Abstract
AIM/HYPOTHESIS To study the prevalence of hypercholesterolemia, hypertriglyceridemia and the relationship between metabolic control, pubertal status and plasma lipoprotein levels in children with diabetes mellitus. SUBJECTS AND METHODS A cross-sectional study was conducted on 126 subjects with type I diabetes followed at our institution. There were 57 boys and 69 girls (mean age: 13.4+/-3.4 yr; mean duration of diabetes: 7.3+/-2.1 yr), on whom fasting lipoprotein levels and pubertal status were determined. Mean glycated hemoglobin (HbA1c) of the preceding year was used in the analysis. Cholesterol (CT) and triglyceride (TG) levels were transformed into standard deviations (SD) using age dependent normal values. RESULTS 1) CT levels of DM children (mean level: +0.9+/-1.2 SD) are higher for both sexes and at each age. Sixteen percent of the cases had CT level > or =2 SD. Within the range of the HbA1c observed (9.1+/-1.2%), CT levels are not correlated with the degree of metabolic control. In contrast to non-diabetic children, CT levels of the diabetic children did not vary throughout pubertal stages. CT levels correlated highly with apolipoprotein B (r=0.79; p<0.00001 and r(2)=82%, in univariate and multivariate analysis, respectively. 2) Plasma TG levels are comparable in the diabetic children (mean level: -0.11+/-0.9 SD) and non-diabetic children. Only 5% of the diabetic children have a TG level > or =2 SD. The TG levels are significantly, but weakly, positively correlated with duration of diabetes and the degree of metabolic control (r(2)=12% and 16%, respectively, p<0.0001 for both). CONCLUSIONS Plasma CT levels of type I diabetic children are increased in comparison to non-diabetic children and do not follow the usual decreasing pattern during puberty.
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Affiliation(s)
- M Polak
- Department of Pediatric Endocrinology and Diabetes, Hôpital Robert Debré, 75019 Paris, France.
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