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Özbek MN, Demiral M, Unal E, Karaşin ND, Baran RT, Demirbilek H. A rare and preventable aetiology of neurodevelopmental delay and epilepsy: familial glucocorticoid deficiency. J Pediatr Endocrinol Metab 2021; 34:1463-1468. [PMID: 34271604 DOI: 10.1515/jpem-2021-0150] [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: 03/09/2021] [Accepted: 06/20/2021] [Indexed: 11/15/2022]
Abstract
OBJECTIVES Familial glucocorticoid deficiency (FGD) is a rare autosomal recessive disorder characterised by isolated glucocorticoid deficiency. Melanocortin receptor 2 (MC2R) mediates the functions of adrenocorticotropic hormone (ACTH) in the adrenal cortex. MC2R accessory protein (MRAP) is a transmembrane protein involved in the trafficking of MC2R to the cell surface. Mutations in MC2R and MRAP genes cause FGD type 1 and 2. In the present case series, we evaluate the clinical characteristics and long-term follow-up of six cases with FGD due to mutations in MC2R and MRAP. CASE PRESENTATION Data of six cases with FGD (five with mutations in MC2R and one with a mutation in MRAP) who were being followed at our paediatric endocrine centre was evaluated. Diagnosis of FGD was considered in case of elevated ACTH and inappropriately low cortisol level, and exclusion of other aetiologies. The main presenting complaints were hyperpigmentation and hypoglycaemic convulsion in all cases. During a follow-up period of 26-115 months, one patient with homozygous 560delT mutation in MC2R, one female with G226R mutation in MC2R and one female with IVS3ds+1delG mutation in MRAP had a neurodevelopmental delay (NDD), while the other three patients had normal neurodevelopment. CONCLUSIONS FGD patients due to MC2R and MRAP mutations with early diagnosis and compliance to the hydrocortisone therapy had normal neurodevelopment, while delay in diagnosis and poor compliance was associated with severe hypoglycaemic convulsions and subsequent complications NDD.
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Affiliation(s)
- Mehmet Nuri Özbek
- Department of Paediatric Endocrinology, Gazi Yasargil Training and Research Hospital, Diyarbakır, Turkey
| | - Meliha Demiral
- Department of Paediatric Endocrinology, Gazi Yasargil Training and Research Hospital, Diyarbakır, Turkey
| | - Edip Unal
- Department of Paediatric Endocrinology, Gazi Yasargil Training and Research Hospital, Diyarbakır, Turkey
| | - Nezahat Doğan Karaşin
- Department of Paediatrics, Gazi Yasargil Training and Research Hospital, Diyarbakır, Turkey
| | - Rıza Taner Baran
- Department of Paediatric Endocrinology, Antalya Training and Research Hospital, Antalya, Turkey
| | - Huseyin Demirbilek
- Department of Paediatric Endocrinology, Faculty of Medicine, Hacettepe University, Ankara, Turkey
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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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Demiral M, Unal E, Baysal B, Baran RT, Demirbilek H, Özbek MN. Evaluation of the Final Adult Height and Its Determinants in Patients with Growth Hormone Deficiency: A Single-centre Experience from the South-Eastern Region of Turkey. J Clin Res Pediatr Endocrinol 2020; 12:295-302. [PMID: 32157854 PMCID: PMC7499137 DOI: 10.4274/jcrpe.galenos.2020.2019.0218] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/01/2022] Open
Abstract
OBJECTIVE The aim was to determine the final adult height (FAH) achieved by recombinant human growth hormone (rhGH) treatment, the factors affecting FAH and the success of attaining the genetic potential. METHODS Data of 133 patients treated with rhGH therapy were reviewed retrospectively. Patients were grouped according to diagnosis, either isolated GH deficiency (IGHD) or multiple pituitary hormone deficiency (MPHD), and by sex, and pubertal status at the beginning of treatment. RESULTS The mean age of initiation of treatment was 12.3±2.18 years, and the mean duration of rhGH treatment was 3.65±1.5 years. The mean height standard deviation score (SDS) at diagnosis was -3.11±0.75 SD. All patients received a standardized GH dose of 0.033 mg/kg/day. Mean FAH-SDS was -1.8±0.77 and delta height-SDS (the change in height SDS between the beginning and end of treatment) was 1.28±0.94 SD. FAH-SDS was -1.79±0.86 SD in males; -1.82±0.64 in females (p=0.857); -1.94±0.71 at the beginning of treatment in pubertal patients and -1.68±0.81 in prepubertal patients (p=0.056); -1.84±0.89 in patients with IGHD and -0.47±0.2 in patients with MPHD (p˃0.05). In multiple regression analysis, First year delta height-SDS was the most predictive factor for both FAH-SDS and delta height-SDS. CONCLUSION The majority of our patients achieved a final height compatible with their genetic potential as well as population standards when treated with rhGH even having started at a relatively late age. First year delta height-SDS was a predictive factor for FAH.
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Affiliation(s)
- Meliha Demiral
- Gazi Yaşargil Training and Research Hospital, Clinic of Paediatric Endocrinology, Diyarbakır, Turkey,* Address for Correspondence: Gazi Yaşargil Training and Research Hospital, Clinic of Paediatric Endocrinology, Diyarbakır, Turkey Phone: +90 535 588 56 49 E-mail:
| | - Edip Unal
- Gazi Yaşargil Training and Research Hospital, Clinic of Paediatric Endocrinology, Diyarbakır, Turkey
| | - Birsen Baysal
- Gazi Yaşargil Training and Research Hospital, Clinic of Paediatrics, Diyarbakır, Turkey
| | - Rıza Taner Baran
- Antalya Training and Research Hospital, Clinic of Paediatric Endocrinology, Antalya, Turkey
| | - Hüseyin Demirbilek
- Hacettepe University Faculty of Medicine, Department of Paediatric Endocrinology, Ankara, Turkey
| | - Mehmet Nuri Özbek
- Gazi Yaşargil Training and Research Hospital, Clinic of Paediatric Endocrinology, Diyarbakır, Turkey
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Demiral M, Salih Karaca M, Unal E, Baysal B, Taner Baran R, Demirbilek H, Nuri Ozbek M. A novel diagnostic tool for the evaluation of hypothalamic-pituitary region and diagnosis of growth hormone deficiency: pons ratio. J Pediatr Endocrinol Metab 2020; 33:735-742. [PMID: 32436858 DOI: 10.1515/jpem-2019-0321] [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: 07/12/2019] [Accepted: 03/21/2020] [Indexed: 11/15/2022]
Abstract
Backgrounds Limitations in the evaluation of the pituitary size and changes according to pubertal status make its validity questionable. Recently, in a small-scale study, pons ratio (PR) has been suggested as a more sensitive tool for diagnosis and etiological evaluation of growth hormone deficiency (GHD). The aim of the study is to evaluate the diagnostic value of PR in the diagnosis of GHD. Methods We retrospectively evaluated the pituitary magnetic resonance imaging (MRI) of 133 patients with a diagnosis of GHD. Primary axis (PA) was assigned as a line crossing the mid-sagittal dorsum sella and fourth ventricle. PR was defined as the pons height above the PA divided by total pons height. The PR of patients with GHD was compared to subjects without GHD. Results Study included 133 patients with GHD and 47 controls. In total, 121 (91%) patients had isolated GHD and 12 (9%) patients had multiple pituitary hormone deficiency. The PR of the patient group (mean: 0.32 ± 0.89; range: 0.14-0.63) was significantly higher than controls (mean: 0.26 ± 0.067; range 0.19-0.44) (p: 0.000). The optimal cut-off value of PR for GHD diagnosis was 0.27 (sensitivity 71% specificity 56%). There was a negative correlation between anterior pituitary height (APH)-SDS and PR (p: 0.002; r: -0.27). APH was increased, but PR remained unchanged in pubertal patients (p: 0.089). Conclusions PR measurement is a noninvasive, practical method with a cost-benefit clinical value. As it is not affected by pubertal status, PR is potentially a more sensitive tool for evaluation of pituitary gland in GHD patients compared to APH.
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Affiliation(s)
- Meliha Demiral
- Gazi Yasargil Training and Research Hospital Clinics of Paediatric Endocrinology, Diyarbakır, Turkey
| | - Mehmet Salih Karaca
- Gazi Yasargil Training and Research Hospital Clinics of Radiology, Diyarbakir, Turkey
| | - Edip Unal
- Gazi Yasargil Training and Research Hospital Clinics of Paediatric Endocrinology, Diyarbakır, Turkey
| | - Birsen Baysal
- Gazi Yasargil Training and Research Hospital Clinics of Paediatrics, Diyarbakır, Turkey
| | - Rıza Taner Baran
- Antalya Training and Research Hospital Clinics of Paediatric Endocrinology, Antalya, Turkey
| | - Huseyin Demirbilek
- Hacettepe University, Faculty of Medicine, Department of Paediatric Endocrinology, Ankara, Turkey
| | - Mehmet Nuri Ozbek
- Gazi Yasargil Training and Research Hospital Clinics of Paediatric Endocrinology, Diyarbakır, Turkey
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Filiz S, Selçuk ÖT, Baran RT. Evaluation of Pediatric Voice Handicap Index in Children With Allergic Rhinitis. J Voice 2019; 33:801.e17-801.e20. [DOI: 10.1016/j.jvoice.2018.02.021] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2017] [Accepted: 02/20/2018] [Indexed: 01/30/2023]
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Baran RT, Baran SO, Toraman NF, Filiz S, Demirbilek H. Evaluation of intraocular pressure and retinal nerve fiber layer, retinal ganglion cell, central macular thickness, and choroidal thickness using optical coherence tomography in obese children and healthy controls. Niger J Clin Pract 2019; 22:539-545. [DOI: 10.4103/njcp.njcp_471_18] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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Abstract
OBJECTIVE Adult epidemiological studies suggest that the rate of Restless Legs syndrome (RLS) in the general population may range from 5% to 15%. The aim of this study was to investigate the frequency of RLS in a community sample of obese adolescents aged 10-16 years and to assess the association with sleep quality and health-related glucose metabolism markers. METHODS The study group comprised 144 obese and overweight children aged 10-16 yearsand the control group consisted of 66 age-matched healthy children. The RLS Questionnaire devised by the International RLS Study and the Pittsburgh Sleep Quality Index (PSQI), where a score >5 indicates poor sleep quality, was used to assess sleep quality. RESULTS Mean body mass index (BMI) of the overweight/obese and control groups were 30.5±0.5 and 18.7±0.2, respectively. The frequency of RLS was higher in the obese group (21.7%) than the overweight (3.4%) and control (1.5%) (p<0.001) groups. The frequency of a poor PSQI score was significantly higher (p<0.001) in the obese group (37.3%) than the control group (24.2%). The obese with RLS group also had poorer sleep quality scores than the non-RLS obese group. Many symptoms of sleep disruption were more common in obese patients with RLS and RLS was independently correlated with a high PSQI score [odds ratio (OR): 2.25, confidence interval (Cl): 0.96-5.28, p<0.001)] and an increased BMI z-score (OR: 8.87, Cl: 2.04-38.61, p<0.001). CONCLUSION RLS is common in obese children and may be associated with altered sleep quality. Obese children with RLS need to be assessed since they may need support to improve their sleep quality.
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Affiliation(s)
- Rıza Taner Baran
- University of Health Sciences, Antalya Training and Research Hospital, Clinic of Pediatric Endocrinology and Diabetes, Antalya, Turkey
| | - Müge Atar
- Süleyman Demirel University Faculty of Medicine, Department of Pediatric Endocrinology and Diabetes, Isparta, Turkey,* Address for Correspondence: Süleyman Demirel University Faculty of Medicine, Department of Pediatric Endocrinology and Diabetes, Isparta, Turkey Phone: +90 246 211 93 02 E-mail:
| | - Özgür Pirgon
- Süleyman Demirel University Faculty of Medicine, Department of Pediatric Endocrinology and Diabetes, Isparta, Turkey
| | - Serkan Filiz
- University of Health Sciences, Antalya Training and Research Hospital, Department of Pediatric Allergy, Antalya, Turkey
| | - Meral Filiz
- University of Health Sciences, Antalya Training and Research Hospital, Department of Physical Therapy and Rehabilitation, Antalya, Turkey
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Baran RT, Demirbilek H,, Baran S, Parlak M, Parlak E. Çocukluk çağında nadir görülen idiyopatik hipoparatiroidizm ve bazal gangliyon kalsifikasyonu birlikteliği: Fahr hastalığı. Cukurova Medical Journal 2018. [DOI: 10.17826/cumj.341260] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
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Baran RT, Sürer-Adanır A, Karakurt MN, Dündar M, Aydın M, Özbek MN, Demirbilek H. Evaluation of psychological characteristics of Turkish children with type 1 diabetes mellitus from two demographically and geographically distinct regions. Turk J Pediatr 2018; 60:554-561. [PMID: 30968638 DOI: 10.24953/turkjped.2018.05.013] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Baran RT, Sürer-Adanır A, Karakurt MN, Dündar M, Aydın M, Özbek MN, Demirbilek H. Evaluation of psychological characteristics of Turkish children with type 1 diabetes mellitus from two demographically and geographically distinct regions. Turk J Pediatr 2018; 60: 554-561. Type 1 diabetes mellitus (T1DM), patients have an increased risk of psychiatric morbidity compared to their healthy counterparts. The aim of the present study is to evaluate the demographic and laboratory data and psychological characteristics of children with T1DM from two geographical regions of Turkey. The study included 98 pediatric T1DM patients followed in pediatric endocrinology clinics from Diyarbakir (n=50), an eastern city and Antalya (n=48) a western city, and 43 healthy subjects from Diyarbakir (n=20) and Antalya (n=23). The sociodemographic data, duration of diabetes and the glycated hemoglobin levels (HbA1c) were also noted. For the evaluation of emotional and behavioral problems in children, Turkish version of The Child Behavior Checklist (CBCL) 6-18, and for depression, Child depression inventory (CDI) was used. Patients from the Diyarbakır Diabetes Mellitus (DDM) group had a longer duration of diabetes compared to those of the Antalya Diabetes Mellitus (ADM) group, while HbA1c levels were not statistically different. Children with T1DM from Diyarbakır reported higher problem scores in CBCL in majority of domains and both internalizing and externalizing subscores compared to the controls and in all domains compared to the patients from Antalya. The CDI scores of the DDM group were also significantly higher than those of the ADM group. In conclusion, diabetic children from Diyarbakır had more problems in emotional, social and behavioral domains compared to the healthy peers and patients from Antalya, indicating that T1DM brought more psychosocial burden to these patients independently from the metabolic control. Pediatric specialists working in the eastern region should be more precautious with diabetic patients in terms of comorbid psychiatric conditions and psychiatric referral when needed.
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Affiliation(s)
| | | | - Melih Nuri Karakurt
- Children's State Hospital, Clinics of Pediatric and Adolescent Psychiatry, Diyarbakir, Turkey
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Abstract
OBJECTIVE Deficiency of sex steroids has a negative impact on bone mineral content. In studies conducted on postmenopausal women and animal studies, elevated follicle-stimulating hormone (FSH) levels were found to be correlated with a decrease in bone mineralization and osteoporosis. The aim of the present study was to evaluate bone mineral density (BMD) in adolescent girls with hypogonadotropic and hypergonadotropic hypogonadism and also to investigate the correlation between FSH level and BMD. METHODS The study group included 33 adolescent girls with hypogonadism (14 with hypogonadotropic hypogonadism and 19 with hypergonadotropic hypogonadism). FSH, luteinizing hormone, estradiol levels, and BMD (using dual energy x-ray absorptiometry) were measured. RESULTS There were no statistically significant differences between the chronological age and bone age of the two patient groups, namely, with hypogonadotropic and hypergonadotropic hypogonadism. There was also no significant difference between BMD z-score values obtained from measurements from the spine and the femur neck of patients in the two groups (p-values were 0.841 and 0.281, respectively). In the hypergonadotropic group, a moderately negative correlation was detected between FSH level and BMD z-score measured from the femur neck (ρ=-0.69, p=0.001), whilst no correlation was observed between FSH levels and height adjusted BMD-z scores measured from the spine (ρ=0.17, p=0.493). FSH level was not found to be an independent variable affecting BMD z-score. CONCLUSION BMD z-scores were detected to be similar in adolescent girls with hypogonadotropic and hypergonadotropic hypogonadism, and FSH levels were not found to have a clinically relevant impact on BMD.
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Affiliation(s)
- Mehmet Nuri Özbek
- Diyarbakır Children State Hospital, Clinic of Pediatric Endocrinology, Diyarbakır, Turkey
| | - Hüseyin Demirbilek
- Diyarbakır Children State Hospital, Clinic of Pediatric Endocrinology, Diyarbakır, Turkey; Present position: Hacettepe University Faculty of Medicine, Department of Pediatric Endocrinology, Ankara, Turkey, Phone: +90 543 370 54 91 E-mail:
| | - Rıza Taner Baran
- Diyarbakır Children State Hospital, Clinic of Pediatric Endocrinology, Diyarbakır, Turkey
| | - Ahmet Baran
- Diyarbakır Children State Hospital, Clinic of Radiology, Diyarbakır, Turkey
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Kasapkara ÇS, Akar M, Özbek MN, Tüzün H, Aldudak B, Baran RT, Tanyalçın T. Mutations in BTD gene causing biotinidase deficiency: a regional report. J Pediatr Endocrinol Metab 2015; 28:421-4. [PMID: 25423671 DOI: 10.1515/jpem-2014-0056] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/12/2014] [Accepted: 10/22/2014] [Indexed: 11/15/2022]
Abstract
Biotinidase deficiency is an autosomal recessive inborn error of biotin metabolism. Children with biotinidase deficiency cannot cleave biocytin and, therefore, cannot recycle biotin. Untreated individuals become secondarily biotin deficient, which in turn results in decreased activities of the biotin-dependent carboxylases and the subsequent accumulation of toxic metabolites causing clinical symptoms. Biotinidase deficiency is characterized by neurological, cutaneous manifestations and metabolic abnormalities. The worldwide incidence of profound biotinidase deficiency has been estimated at 1:112,271. The human biotinidase gene is located on chromosome 3p25 and consists of four exons with a total length of 1629 base pairs. To date, more than 100 mutations in the biotinidase gene known to cause biotinidase deficiency have been reported. The vast majority of mutations are homozygous or compound heterozygous. Finding known mutations can be correlated with the biochemical enzymatic results. This report summarizes the demographic features of patients identified as biotinidase deficient from August of 2012 through August of 2013 and mutation analysis results for 20 cases in the southeast region of Turkey.
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Abstract
Prepubertal unilateral gynecomastia is an extremely rare condition. At present, its etiology and management strategy are not well known. Two unrelated prepubertal boys of ages 8 and 9 who presented with complaints of unilateral enlargement of breast tissue are reported. Physical examination, biochemical, hormonal and oncologic work-up findings were normal. Both patients were treated with peripheral liposuction successfully. Histopathological and immunohistochemical examinations showed benign fibroglandular gynecomastia and intensive (3+) estrogen receptor expression in 100% of periductal epithelial cells. Although an extremely rare and generally benign condition, patients with prepubertal unilateral gynecomastia should have a full endocrine and oncologic work-up.
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Affiliation(s)
- Hüseyin Demirbilek
- Diyarbakır Children State Hospital, Clinic of Pediatric Endocrinology, Diyarbakır, Turkey. E-mail:
| | - Gökhan Bacak
- Great Ormond Street Hospital for Children, Clinic of Pediatric Endocrinology, London, United Kingdom
| | - Rıza Taner Baran
- Diyarbakır Children State Hospital, Clinic of Pediatric Endocrinology, Diyarbakır, Turkey
| | - Yahya Avcı
- University College, Institute of Child Health, London, United Kingdom
| | - Ahmet Baran
- Diyarbakır Training and Research Hospital, Clinic of Plastic and Reconstructive Surgery, Diyarbakır, Turkey
| | - Ayşenur Keleş
- University College, Institute of Child Health, London, United Kingdom
| | - Mehmet Nuri Özbek
- Diyarbakır Children State Hospital, Clinic of Pediatric Endocrinology, Diyarbakır, Turkey
| | - Yasemin Alanay
- Dicle University Faculty of Medicine, Department of Pathology, Diyarbakır, Turkey
| | - Khalid Hussain
- Great Ormond Street Hospital for Children, Clinic of Pediatric Endocrinology, London, United Kingdom
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University College, Institute of Child Health, London, United Kingdom
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Abstract
Gunshot injuries (GSI) of the cranial area have an extremely high mortality rate. Herein, we present a girl who has been living with a bullet in the posterior sellar region. A 6-year-old girl was admitted with complaints of headache, polyuria and polydypsia, which started after a GSI. At the time of admission the patient's anthropometric, physical and neurological examinations were normal. Urine output was 5.5 L/m2/24h. A water deprivation test suggested central diabetes insipidus, which responded to treatment. Evaluation of other pituitary hormones revealed central hypothyroidism and growth hormone deficiency. Pituitary hormone deficiency must be kept in mind in patients injured by a gunshot to the sellar/parasellar region.
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Affiliation(s)
- Hüseyin Demirbilek
- Diyarbakır Children's State Hospital, Pediatric Endocrinology, Diyarbakır, Turkey. E-mail:
| | - Mehmet Nuri Özbek
- Diyarbakır Children’s State Hospital, Pediatric Endo crinology, Diyarbakır, Turkey
| | - Rıza Taner Baran
- Diyarbakır Children’s State Hospital, Pediatric Endo crinology, Diyarbakır, Turkey
| | - Ahmet Baran
- Diyarbakır Children’s State Hospital, Radiology, Diyarbakır, Turkey
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Demirbilek H, Özbek MN, Baran RT. Incidence of type 1 diabetes mellitus in Turkish children from the southeastern region of the country: a regional report. J Clin Res Pediatr Endocrinol 2013; 5:98-103. [PMID: 23748062 PMCID: PMC3701930 DOI: 10.4274/jcrpe.954] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/19/2013] [Accepted: 03/10/2013] [Indexed: 01/15/2023] Open
Abstract
OBJECTIVE Variability in the incidence of type 1 diabetes mellitus (T1DM) related to geographical region, ethnic background, gender, and age indicates a need for further epidemiological studies. To date, there are no reported studies on the incidence of T1DM in the pediatric age group from the Southeastern region of Turkey. To define the incidence, demographic and clinical characteristics of T1DM in children 0-14 years of age in Diyarbakir, one of the largest cities in the Southeast region of Turkey. METHODS Hospital files of patients with the diagnosis of T1DM were reviewed. Data of all patients diagnosed between 1 June 2010 and 31 May 2011 were evaluated. Population data on the 0-14 age group were obtained from the Turkish Statistical Institute (TSI) reports. RESULTS From a total of 41 T1DM patients, 24 (58.5%) were female (male: 41.5%) with a male/female ratio of 1.4. The overall annual incidence of T1DM was 7.2/10(5), being 8.7/10(5) in females and 5.7/10(5) in males. The peak incidence was found to occur at age 5-9 years in the girls and 10-14 years in the boys. Mean age at diagnosis was 8.1±3.8 years. Rate of presentation with diabetic ketoacidosis was 65.9%. Patients applied most frequently in spring and winter months. CONCLUSIONS In this first T1DM incidence study on the pediatric age group in Diyarbakir, Turkey, T1DM incidence was found to be similar to that in countries with low-middle incidence.
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Affiliation(s)
- Hüseyin Demirbilek
- Diyarbakır Children State Hospital, Division of Pediatric Endocrinology, Diyarbakır, Turkey.
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