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Cassio A, Marescotti G, Aversa T, Salerno M, Tornese G, Stancampiano M, Tuli G, Faienza MF, Cavarzere P, Fava D, Parpagnoli M, Bruzzi P, Ibba A, Calcaterra V, Mameli C, Grandone A, Cherubini V, Assirelli V, Franchina F, Capalbo D, Mase RD, Tamaro G, Cavasin J, Munarin J, Russo G, Wasniewska M. Central Precocious Puberty in Italian Boys: Data From a Large Nationwide Cohort. J Clin Endocrinol Metab 2024:dgae035. [PMID: 38308814 DOI: 10.1210/clinem/dgae035] [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: 09/08/2023] [Indexed: 02/05/2024]
Abstract
CONTEXT There are only a few nationwide studies on boys with central precocious puberty (CPP) and the last Italian study is a case series of 45 boys that dates back to 2000. OBJECTIVE We aimed to evaluate the causes of CPP in boys diagnosed during the last 2 decades in Italy and the relative frequency of forms with associated central nervous system (CNS) abnormalities on magnetic resonance imaging (MRI) compared to idiopathic ones. METHODS We performed a national multicenter retrospective study collecting data from 193 otherwise normal healthy boys with a diagnosis of CPP. Based on MRI findings, the patients were divided into: Group 1, no CNS abnormalities; Group 2, mild abnormalities (incidental findings) unrelated to CPP; and Group 3, causal pathological CNS abnormalities. RESULTS The MRI findings show normal findings in 86%, mild abnormalities (incidental findings) in 8.3%, and causal pathological CNS abnormalities in 5.7% of the cases. In Group 3, we found a higher proportion of patients with chronological age at diagnosis < 7 years (P = .00001) and body mass index greater than +2 SDS (P < .01). Gonadotropin-releasing hormone analogue therapy was started in 183/193 subjects. The final height appeared in the range of the target height in all groups and in 9 patients in whom the therapy was not started. CONCLUSION In our study on a large nationwide cohort of boys referred for precocious puberty signs, the percentage of forms associated with CNS abnormalities was one of the lowest reported in the literature.
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Affiliation(s)
- Alessandra Cassio
- Pediatric Unit, IRCCS Azienda Ospedaliero-Universitaria di Bologna, 40138 Bologna, Italy
- Department of Medical and Surgery Sciences, University of Bologna, 40138 Bologna, Italy
| | - Gloria Marescotti
- Pediatric Unit, IRCCS Azienda Ospedaliero-Universitaria di Bologna, 40138 Bologna, Italy
| | - Tommaso Aversa
- Department of Human Pathology of Adulthood and Childhood, University of Messina, 98125 Messina, Italy
- Pediatric Unit, University Hospital, 98122 Messina, Italy
| | - Mariacarolina Salerno
- Pediatric Endocrinology Unit, Department of Translational Medical Sciences, University Federico II, 80131 Naples, Italy
| | - Gianluca Tornese
- Institute for Maternal and Child Health IRCCS "Burlo Garofolo", 34137 Trieste, Italy
- Department of Medicine, Surgery and Health Sciences, University of Trieste, 34129 Trieste, Italy
| | - Marianna Stancampiano
- Department of Pediatrics, Endocrine Unit, IRCCS San Raffaele Scientific Institute, 20132 Milan, Italy
| | - Gerdi Tuli
- Department of Pediatric Endocrinology, Regina Margherita Children's Hospital, Department of Pediatric Sciences, University of Turin, 10126 Torino, Italy
| | - Maria Felicia Faienza
- Pediatric Unit, Department of Precision and Regenerative Medicine and Ionian Area, University of Bari "A. Moro", 70124 Bari, Italy
| | - Paolo Cavarzere
- Pediatric Division, Department of Pediatrics, University Hospital of Verona, 37126 Verona, Italy
| | - Daniela Fava
- Department of Pediatrics, IRCCS Istituto Giannina Gaslini, Genoa 16147, Italy
- Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health, University of Genoa, Genoa 16142, Italy
| | - Maria Parpagnoli
- Department of Diabetology and Endocrinology, Meyer Children Hospital IRCCS, 50139 Florence, Italy
| | - Patrizia Bruzzi
- Pediatric Unit Department of Medical and Surgical Sciences of Mothers, Children and Adults, University of Modena and Reggio Emilia, 41124 Modena, Italy
| | - Anastasia Ibba
- Pediatric Endocrinology Unit and Newborn Screening Center, Pediatric Microcitemic Hospital, ASL Cagliari, 09121 Cagliari, Italy
| | - Valeria Calcaterra
- Child and Adolescent Unit, Department of internal Medicine and Therapeutics, University of Pavia, 27100 Pavia, Italy
| | - Chiara Mameli
- Department of Biomedical and Clinical Sciences, University of Milan, 20157 Milan, Italy
| | - Anna Grandone
- Department of Woman, Child and of General and Specialized Surgery, Università degli Studi della Campania "Luigi Vanvitelli", 80138, Napoli, Italy
| | - Valentino Cherubini
- Department of Women's and Children's Health, Salesi Hospital, 60126 Ancona, Italy
| | - Valentina Assirelli
- Pediatric Unit, IRCCS Azienda Ospedaliero-Universitaria di Bologna, 40138 Bologna, Italy
- Department of Medical and Surgery Sciences, University of Bologna, 40138 Bologna, Italy
| | - Francesca Franchina
- Department of Human Pathology of Adulthood and Childhood, University of Messina, 98125 Messina, Italy
- Pediatric Unit, University Hospital, 98122 Messina, Italy
| | - Donatella Capalbo
- Pediatric Endocrinology Unit, Department of Mother and Child University Hospital Federico II Naples, 80131 Naples, Italy
| | - Raffaella Di Mase
- Pediatric Endocrinology Unit, Department of Mother and Child University Hospital Federico II Naples, 80131 Naples, Italy
| | - Gianluca Tamaro
- Institute for Maternal and Child Health IRCCS "Burlo Garofolo", 34137 Trieste, Italy
| | - Julia Cavasin
- Department of Medicine, Surgery and Health Sciences, University of Trieste, 34129 Trieste, Italy
| | - Jessica Munarin
- Department of Pediatric Endocrinology, Regina Margherita Children's Hospital, Department of Pediatric Sciences, University of Turin, 10126 Torino, Italy
| | - Gianni Russo
- Department of Pediatrics, Endocrine Unit, IRCCS San Raffaele Scientific Institute, 20132 Milan, Italy
| | - Malgorzata Wasniewska
- Department of Human Pathology of Adulthood and Childhood, University of Messina, 98125 Messina, Italy
- Pediatric Unit, University Hospital, 98122 Messina, Italy
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Di Mase R. [A case of congenital hypothyroidism and Turner syndrome.]. Recenti Prog Med 2023; 114:3e-5e. [PMID: 38031864 DOI: 10.1701/4142.41400] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 12/01/2023]
Abstract
When properly treated, congenital hypothyroidism (CH) allows normal growth. We describe the case of a girl followed-up for CH diagnosed upon newborn screening, with good adherence to L-T4 therapy, who had an impaired linear growth starting from 4 years of age. Diagnostic work-up allowed exclusion of inflammatory diseases and/or malabsorption and led to the diagnosis of Turner syndrome (TS). Recombinant GH (rGH) therapy was undertaken with satisfactory growth recovery. At the age of 8, a condition of autoimmune thyroiditis was detected, due to an increased risk in the context of her syndrome. Except for small adjustments in the dose of L-T4, hypothyroidism remained well-controlled even after starting rGH therapy.
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Affiliation(s)
- Raffaella Di Mase
- UOS di Endocrinologia pediatrica-DAI materno-infantile, Azienda Ospedaliera Universitaria Federico II di Napoli
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Santamaria F, Scandurra C, Mezzalira S, Bochicchio V, Salerno M, Di Mase R, Capalbo D. Unmet Needs of Pediatricians in Transgender-Specific Care: Results of a Short-Term Training. Horm Res Paediatr 2023:1-7. [PMID: 37748459 DOI: 10.1159/000533551] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/28/2023] [Accepted: 08/09/2023] [Indexed: 09/27/2023] Open
Abstract
INTRODUCTION The aim of this study was to evaluate (i) the knowledge about different dimensions of sexual identity in a group of family pediatricians and (ii) the efficacy of a training program to improve knowledge and reduce genderism and heteronormativity. METHODS A pre-post-follow-up study was conducted with 96 Italian pediatricians (48 men and 48 women) who participated in a 6-h training program and divided into 2 sections. The first section was theoretical and focused on the conceptual foundations of sexual identity, the depathologizing approach to gender diversity, and the role of pediatricians as the first contacts of children's or adolescents' family. The second part was experiential and included the presentation of a clinical case and the activation of a group reflection on the management of gender-diverse youth. Knowledge about sexual identity, genderism, and heteronormativity was measured. RESULTS Pre-training questionnaires revealed that the mean score of knowledge about sexual identity was 7.13 ± 3.21. One-way within-subject ANOVA revealed significant effects from pre- to post-training and from pre- to follow-up assessment but not from post-training to follow-up assessment, suggesting that significant changes in the knowledge about sexual identity (F = 39.75, p < 0.001), in personal biases related to genderism (F = 7.46, p < 0.01), and in heteronormative attitudes (F = 44.99, p < 0.001) and behaviors (F = 79.29, p < 0.001) were achieved through the training and maintained at follow-up. CONCLUSION These findings indicate the importance of training pediatricians to work with gender-diverse youth and provide them with the best clinical interventions.
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Affiliation(s)
- Fabiana Santamaria
- Department of Mother and Child, Paediatric Endocrinology Unit/University Hospital Federico II, Naples, Italy
| | - Cristiano Scandurra
- Department of Neuroscience, Reproductive Sciences and Dentistry, University of Naples Federico II, Naples, Italy
| | - Selene Mezzalira
- Department of Humanistic Studies, University of Calabria, Rende, Italy
| | | | - Mariacarolina Salerno
- Department of Translational Medical Sciences, Paediatric Endocrinology Unit, University of Naples Federico II, Naples, Italy
| | - Raffaella Di Mase
- Department of Mother and Child, Paediatric Endocrinology Unit/University Hospital Federico II, Naples, Italy
| | - Donatella Capalbo
- Department of Mother and Child, Paediatric Endocrinology Unit/University Hospital Federico II, Naples, Italy
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Improda N, Moracas C, Mattace Raso G, Valente V, Crisci G, Lorello P, Di Mase R, Salerno M, Capalbo D. Vascular Function and Intima-Media Thickness in Children and Adolescents with Growth Hormone Deficiency: Results from a Prospective Case-Control Study. Horm Res Paediatr 2023; 97:140-147. [PMID: 37290420 DOI: 10.1159/000531473] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/01/2023] [Accepted: 05/19/2023] [Indexed: 06/10/2023] Open
Abstract
INTRODUCTION Growth hormone deficiency (GHD) may be associated with subtle cardiovascular abnormalities, reversible upon starting GH treatment. Data on vascular morphology and function in GHD children are scanty and inconclusive. The aim of our study was to evaluate the effects of GHD and GH treatment on endothelial function and intima-media thickness (IMT) in children and adolescents. METHODS We enrolled 24 children with GHD (10.85 ± 2.71 years) and 24 age-, sex-, and BMI-matched controls. We evaluated anthropometry, lipid profile, asymmetric dimethylarginine (ADMA), brachial flow-mediated dilatation (FMD), and IMT of common (cIMT) and internal (iIMT) carotid artery at study entry in all subjects and after 12 months of treatment in GHD children. RESULTS At baseline GHD, children had higher total cholesterol (163.17 ± 18.66 vs. 149.83 ± 20.68 mg/dL, p = 0.03), LDL cholesterol (91.18 ± 20.41 vs. 77.08 ± 19.73 mg/dL, p = 0.019), atherogenic index (AI) (2.94 ± 0.71 vs. 2.56 ± 0.4, p = 0.028), and ADMA (215.87 ± 109.15 vs. 164.10 ± 49.15 ng/mL, p < 0.001), compared to controls. GHD patients also exhibited increased higher waist-to-height ratio (WHtR) compared to controls (0.48 ± 0.05 vs. 0.45 ± 0.02 cm, p = 0.03). GH therapy resulted in a decrease in WHtR (0.44 ± 0.03 cm, p = 0.001), total (151.60 ± 15.23 mg/dL, p = 0.001) and LDL cholesterol (69.94 ± 14.40 mg/dL, p < 0.0001), AI (2.28 ± 0.35, p = 0.001), and ADMA (148.47 ± 102.43 ng/mL, p < 0.0001). GHD showed lower baseline FMD than controls (8.75 ± 2.44 vs. 11.85 ± 5.98%, p = 0.001), which improved after 1-year GH treatment (10.60 ± 1.69%, p = 0.001). Baseline cIMT and iIMT were comparable between the two groups, but slightly reduced in GHD patients after treatment. CONCLUSION GHD children may exhibit endothelial dysfunction in addition to other early atherosclerotic markers like visceral adiposity, and altered lipids, which can be restored by GH treatment.
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Affiliation(s)
- Nicola Improda
- Paediatric Endocrinology Unit, Department of Translational Medical Sciences, "Federico II" University, Naples, Italy
- Emergency Unit, Department of Emergency, Santobono-Pausilipon Children's Hospital, Naples, Italy
| | - Cristina Moracas
- Paediatric Endocrinology Unit, Department of Mother and Child, University Hospital "Federico II", Naples, Italy
| | | | - Valeria Valente
- Department of Translational Medical Sciences, "Federico II" University, Naples, Italy
| | - Giulia Crisci
- Department of Translational Medical Sciences, "Federico II" University, Naples, Italy
| | - Paola Lorello
- Paediatric Endocrinology Unit, Department of Translational Medical Sciences, "Federico II" University, Naples, Italy
| | - Raffaella Di Mase
- Paediatric Endocrinology Unit, Department of Mother and Child, University Hospital "Federico II", Naples, Italy
| | - Mariacarolina Salerno
- Paediatric Endocrinology Unit, Department of Translational Medical Sciences, "Federico II" University, Naples, Italy
| | - Donatella Capalbo
- Paediatric Endocrinology Unit, Department of Mother and Child, University Hospital "Federico II", Naples, Italy
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Zucchini S, Di Iorgi N, Pozzobon G, Pedicelli S, Parpagnoli M, Driul D, Matarazzo P, Baronio F, Crocco M, Iudica G, Partenope C, Nardini B, Ubertini G, Menardi R, Guzzetti C, Iughetti L, Aversa T, Di Mase R, Cassio A. Management of Childhood-onset Craniopharyngioma in Italy: A Multicenter, 7-Year Follow-up Study of 145 Patients. J Clin Endocrinol Metab 2022; 107:e1020-e1031. [PMID: 34718649 DOI: 10.1210/clinem/dgab784] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/18/2021] [Indexed: 11/19/2022]
Abstract
CONTEXT Nationwide data on children diagnosed with craniopharyngioma (CP) are not available in Italy. OBJECTIVE This work aimed to identify patients' characteristics, type of surgical approach, complications and recurrences, number of pituitary deficits, and number of patients starting growth hormone (GH) treatment. METHODS A retrospective multicenter collection took place of 145 patients aged 0 to 18 years who underwent surgery for CP between 2000 and 2018, and followed up in 17 Italian centers of pediatric endocrinology. RESULTS Age at diagnosis was 8.4 ± 4.1 years. Duration of symptoms was 10.8 ± 12.5 months and headache was most frequent (54%), followed by impaired growth (48%) and visual disturbances (44%). Most lesions were suprasellar (85%), and histology was adamantinomatous in all cases but two. Surgical approach was transcranial (TC) in 67.5% of cases and transsphenoidal (TS) in 31.%. The TC approach was prevalent in all age groups. Postsurgery complications occurred in 53% of cases, with water-electrolyte disturbances most frequent. Radiotherapy was used in 39% of cases. All patients but one presented with at least one hormone pituitary deficiency, with thyrotropin deficiency most frequent (98.3%), followed by adrenocorticotropin (96.8%), arginine vasopressin (91.1%), and GH (77.4%). Body mass index (BMI) significantly increased over time. A hypothalamic disturbance was present in 55% of cases. GH therapy was started during follow-up in 112 patients at a mean age of 10.6 years, and 54 developed a recurrence or regrowth of the residual lesion. CONCLUSION CP is often diagnosed late in Italy, with TC more frequent than the TS surgical approach. Postsurgery complications were not rare, and hypopituitarism developed almost in all cases. BMI shows a tendency to increase overtime.
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Affiliation(s)
- Stefano Zucchini
- Pediatric Endocrine Unit, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Endo-ERN Center for Rare Endocrine Conditions, 40138 Bologna, Italy
| | - Natascia Di Iorgi
- Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health (DINOGMI), University of Genova, 16147 Genoa, Italy
- Department of Pediatrics, IRCCS Istituto Giannina Gaslini, 16147 Genoa, Italy
| | - Gabriella Pozzobon
- Department of Paediatrics, IRCCS San Raffaele Scientific Institute, Vita Salute San Raffaele University, Endo-ERN Center for Rare Endocrine Conditions, 20132 Milan, Italy
| | - Stefania Pedicelli
- Dipartimento Pediatrico Universitario Ospedaliero, IRCCS "Bambino Gesù" Children's Hospital, 00165 Rome, Italy
| | - Maria Parpagnoli
- Auxo-Endocrinology and Gynecology Meyer Children's University Hospital, 50139 Florence, Italy
| | - Daniela Driul
- Division of Pediatrics, University Hospital Santa Maria della Misericordia, ASUFC, 33100 Udine, Italy
| | - Patrizia Matarazzo
- Department of Pediatric Endocrinology, Regina Margherita Children's Hospital, University of Turin, 10126 Turin, Italy
| | - Federico Baronio
- Pediatric Endocrine Unit, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Endo-ERN Center for Rare Endocrine Conditions, 40138 Bologna, Italy
| | - Marco Crocco
- Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health (DINOGMI), University of Genova, 16147 Genoa, Italy
- Neuro-Oncology Unit, IRCCS Istituto Giannina Gaslini, 16147 Genoa, Italy
| | - Giovanna Iudica
- Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health (DINOGMI), University of Genova, 16147 Genoa, Italy
| | - Cristina Partenope
- Department of Paediatrics, IRCCS San Raffaele Scientific Institute, Vita Salute San Raffaele University, Endo-ERN Center for Rare Endocrine Conditions, 20132 Milan, Italy
| | - Beatrice Nardini
- Auxo-Endocrinology and Gynecology Meyer Children's University Hospital, 50139 Florence, Italy
| | - Graziamaria Ubertini
- Dipartimento Pediatrico Universitario Ospedaliero, IRCCS "Bambino Gesù" Children's Hospital, 00165 Rome, Italy
| | - Rachele Menardi
- Division of Paediatrics, Department of Medicine (DAME) University of Udine, 33100 Udine, Italy
| | - Chiara Guzzetti
- Pediatric Endocrine Unit, Pediatric Hospital Microcitemico Antonio Cao, AO Brotzu, 09121 Cagliari, Italy
| | - Lorenzo Iughetti
- Pediatric Unit, Department of Medical and Surgical Sciences for Mothers, Children and Adults, University of Modena and Reggio Emilia, 41124 Modena, Italy
| | - Tommaso Aversa
- Unit of Paediatrics, Department of Human Pathology of Adulthood and Childhood, University of Messina, 98124 Messina, Italy
| | - Raffaella Di Mase
- University Federico II, Department of Translational Medical Sciences, 80131 Naples, Italy
| | - Alessandra Cassio
- Pediatric Endocrine Unit, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Endo-ERN Center for Rare Endocrine Conditions, 40138 Bologna, Italy
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Esposito A, Vigone MC, Polizzi M, Wasniewska MG, Cassio A, Mussa A, Gastaldi R, Di Mase R, Vincenzi G, Pozzi C, Peroni E, Bravaccio C, Capalbo D, Bruzzese D, Salerno M. Effect of initial levothyroxine dose on neurodevelopmental and growth outcomes in children with congenital hypothyroidism. Front Endocrinol (Lausanne) 2022; 13:923448. [PMID: 36133316 PMCID: PMC9484273 DOI: 10.3389/fendo.2022.923448] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/19/2022] [Accepted: 08/02/2022] [Indexed: 11/13/2022] Open
Abstract
OBJECTIVES We designed a multicentre open prospective randomized trial to evaluate the risk-benefit profile of two different initial treatment schemes with levothyroxine (L-T4), 10-12.5 μg/kg/day vs 12.6-15 μg/kg/day, on growth and neurodevelopmental outcomes in children with congenital hypothyroidism (CH) detected by neonatal screening to identify the best range dose to achieve optimal neurocognitive development. DESIGN PATIENTS AND METHODS Children detected by neonatal screening were randomly assigned to receive an initial L-T4 dose of 10-12.5 μg/kg/day (Low) or 12.6-15 μg/kg/day (High). All patients underwent periodical clinical examination with measurement of growth parameters and measurement of TSH and FT4. Neurocognitive development was evaluated at the age of 24 months using Griffiths Mental Development Scales (GMDS) and cognitive and behavioral assessment was performed at 48 months of age using Wechsler Preschool and Primary scale of Intelligence (WIPPSI-III). The study was registered with clinicaltrials.gov (NCT05371262). RESULTS Treatment schemes below or above 12.5 μg/kg/day were both associated with rapid normalization of TSH and thyroid hormone levels in most patients with no differences in the risk of over- and under-treatment episodes in the first months of life. Growth parameters were normal and comparable between the two groups. Developmental quotients at 24 months of age were normal in both groups (Low 100.6 ± 15.5 vs High 96.9 ± 16.6). Likewise, at 4 years of age IQ and subtest scores were comparable between patients from Low and High (Total IQ 104.2 ± 11.4 vs 101.0 ± 20.3, Verbal IQ 103.9 ± 11.5 vs 98.7 ± 15.1, Performance IQ 105.3 ± 10.4 vs 100.3 ± 19.8). 6/45 CH patients (13.3%) showed a total IQ below 85 (73.7 ± 5.9) regardless of age at diagnosis, L-T4 starting dose, time of FT4 and TSH normalization and episodes of over and undertreatment. Worse socioeconomic status and delayed bone age at diagnosis were the only predictors of an increased risk of having suboptimal IQ at 24 and IQ at 48 months. CONCLUSIONS Our results indicate that initial treatment with L-T4, 10-12.5 μg/kg/day vs 12.6-15 μg/kg/day, are both associated with normal growth and neurodevelopmental outcomes in children with CH detected by neonatal screening. Further studies with a long-term follow-up on a larger number of patients are needed to confirm these results. CLINICAL TRIAL REGISTRATION https://clinicaltrials.gov/ct2/show/NCT05371262?term=NCT05371262&draw=2&rank=1 identifer NCT05371262.
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Affiliation(s)
- Andrea Esposito
- Pediatric Endocrinology Unit, Department of Translational Medical Sciences, University of Naples Federico II, Naples, Italy
| | | | - Miriam Polizzi
- Pediatric Endocrinology Unit, Department of Mother and Child, University Hospital Federico II, Naples, Italy
| | | | | | - Alessandro Mussa
- Pediatric Clinical Genetics Unit, Department of Public Health and Pediatrics, Regina Margherita Children Hospital, Torino, Italy
| | - Roberto Gastaldi
- Department of Pediatrics, IRCCS Istituto Giannina Gaslini, Genova, Italy
| | - Raffaella Di Mase
- Pediatric Endocrinology Unit, Department of Mother and Child, University Hospital Federico II, Naples, Italy
| | - Gaia Vincenzi
- Endocrine Unit, Department of Pediatrics, IRCCS San Raffaele Hospital, Milan, Italy
| | - Clara Pozzi
- Endocrine Unit, Department of Pediatrics, IRCCS San Raffaele Hospital, Milan, Italy
| | - Elena Peroni
- Department of Pediatrics, Ospedale di Legnano, ASST Ovest milanese, Legnano, Italy
| | - Carmela Bravaccio
- Pediatric Endocrinology Unit, Department of Translational Medical Sciences, University of Naples Federico II, Naples, Italy
| | - Donatella Capalbo
- Pediatric Endocrinology Unit, Department of Mother and Child, University Hospital Federico II, Naples, Italy
| | - Dario Bruzzese
- Department of Public Health, University of Naples Federico II, Naples, Italy
| | - Mariacarolina Salerno
- Pediatric Endocrinology Unit, Department of Translational Medical Sciences, University of Naples Federico II, Naples, Italy
- *Correspondence: Mariacarolina Salerno,
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Vigone MC, Ortolano R, Vincenzi G, Pozzi C, Ratti M, Assirelli V, Vissani S, Cavarzere P, Mussa A, Gastaldi R, Di Mase R, Salerno M, Street ME, Trombatore J, Weber G, Cassio A. Treatment of congenital hypothyroidism: comparison between L-thyroxine oral solution and tablet formulations up to 3 years of age. Eur J Endocrinol 2021; 186:45-52. [PMID: 34714772 DOI: 10.1530/eje-20-1444] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/14/2021] [Accepted: 10/28/2021] [Indexed: 11/08/2022]
Abstract
OBJECTIVE Oral solution and tablet formulations of levothyroxine (L-T4) are both used in the treatment of congenital hypothyroidism (CH). However, few studies and with a limited follow-up period have been published comparing these two formulations in children. DESIGN The aim of this multicenter study was to compare the effectiveness of L-T4 oral solution (with ethanol as excipient) and tablet formulation in children with CH up to 3 years of age. METHODS Children diagnosed with CH between 2006 and 2015 were enrolled and divided into two groups according to the L-T4 formulation used: solution in drops (group D) or tablets (group T). Auxological parameters, thyroid-stimulating hormone (TSH) and free thyroxine (FT4) values and L-T4 dose were collected at diagnosis and at 15 days, 1, 3, 6, 12, 24 and 36 months of treatment. The developmental quotient (DQ) at 1 and 3 years of age was evaluated using Griffiths' Scale. RESULTS In this study, 254 children were enrolled among which 117 were treated with solution and 137 with tablets. Auxological parameters, dose and thyroid function values at diagnosis, 3, 6, 12, 24, 36 months were not significantly different. TSH at 15 days (P = 0.002) and 1 month (P = 0.009) was significantly reduced in group D. At 2-year follow-up, median TSH was significantly lower in group T (P = 0.03). No statistical difference was detected between the median DQ; however, group D showed lower values in the language subscale at 12 months and in eye-hand coordination at 36 months. CONCLUSIONS Both therapeutic strategies are effective in the treatment of CH. A higher risk of overtreatment in the first months of therapy seems to be associated with oral solution L-T4; therefore, a different strategy should be considered when starting and adjusting the dose. No negative effects on cognitive development were observed. The data obtained are encouraging but long-term follow-up is needed.
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Affiliation(s)
- Maria Cristina Vigone
- Department of Pediatrics, Endocrine Unit, Vita-Salute San Raffaele University, IRCSS San Raffaele, Milan, Italy
| | - Rita Ortolano
- Sant'Orsola-Malpighi University Hospital, Pediatric Unit, Program of Pediatric Endocrinology, Bologna, Italy
| | - Gaia Vincenzi
- Department of Pediatrics, Endocrine Unit, Vita-Salute San Raffaele University, IRCSS San Raffaele, Milan, Italy
| | - Clara Pozzi
- Department of Pediatrics, Endocrine Unit, Vita-Salute San Raffaele University, IRCSS San Raffaele, Milan, Italy
| | - Micol Ratti
- Department of Pediatrics, Endocrine Unit, Vita-Salute San Raffaele University, IRCSS San Raffaele, Milan, Italy
| | - Valentina Assirelli
- Sant'Orsola-Malpighi University Hospital, Pediatric Unit, Program of Pediatric Endocrinology, Bologna, Italy
| | - Sofia Vissani
- Sant'Orsola-Malpighi University Hospital, Pediatric Unit, Program of Pediatric Endocrinology, Bologna, Italy
| | - Paolo Cavarzere
- Pediatric Department, Universitary Hospital of Verona, Verona, Italy
| | - Alessandro Mussa
- Department of Public Health and Pediatrics, University of Torino, Torino, Italy
| | | | | | | | | | | | - Giovanna Weber
- Department of Pediatrics, Endocrine Unit, Vita-Salute San Raffaele University, IRCSS San Raffaele, Milan, Italy
| | - Alessandra Cassio
- Sant'Orsola-Malpighi University Hospital, Pediatric Unit, Program of Pediatric Endocrinology, Bologna, Italy
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8
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Aiello F, Cirillo G, Cassio A, Di Mase R, Tornese G, Umano GR, Miraglia Del Giudice E, Grandone A. Molecular screening of PROKR2 gene in girls with idiopathic central precocious puberty. Ital J Pediatr 2021; 47:5. [PMID: 33413516 PMCID: PMC7792053 DOI: 10.1186/s13052-020-00951-z] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/10/2020] [Accepted: 12/14/2020] [Indexed: 11/17/2022] Open
Abstract
Background Prokineticin receptor 2 (PROKR2) loss of function mutations have been described as cause of hypogonadotropic hypogonadism. In 2017, a first case of central precocious puberty (CPP) caused by PROKR2 heterozygous gain of function mutation was described in a 3.5 years-old girl. No other cases have been reported yet. This study performs a molecular screening in girls with early onset CPP (breast budding before 6 years of age) to identify possible alterations in PROKR2. Methods We analysed DNA of 31 girls with idiopathic CPP diagnosed via basal LH levels > 0.3 IU/L or peak-LH > 5 IU/L after stimulation, without any MKRN3 mutations. The Fisher exact test was used to compare polymorphism allele frequency to corresponding ones in genome aggregation database (gnomAD). Results No rare variants were identified. Five polymorphisms were found (rs6076809, rs8116897, rS3746684, rs3746682, rs3746683). All except one (i.e. rs3746682) had a minor allele frequency (MAF) similar to that reported in literature. rs3746682 presented a MAF higher than that described in the gnomAD (0.84 in our cohort vs 0.25 from gnomAD). Conclusions As for other G protein-coupled receptors (i.e. GPR54), mutations in PROKR2 do not seem to be a frequent cause of CPP in girls.
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Affiliation(s)
- Francesca Aiello
- Department of Child, Woman, General and Specialized Surgery, University of Campania "L. Vanvitelli", Naples, Italy
| | - Grazia Cirillo
- Department of Child, Woman, General and Specialized Surgery, University of Campania "L. Vanvitelli", Naples, Italy
| | | | - Raffaella Di Mase
- Pediatric Section-Department of Translational Medical Sciences, University of Naples Federico II, Naples, Italy
| | - Gianluca Tornese
- Institute for Maternal and Child Health, IRCCS "Burlo Garofolo", Trieste, Italy
| | - Giuseppina R Umano
- Department of Child, Woman, General and Specialized Surgery, University of Campania "L. Vanvitelli", Naples, Italy
| | | | - Anna Grandone
- Department of Child, Woman, General and Specialized Surgery, University of Campania "L. Vanvitelli", Naples, Italy.
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Capalbo D, Alfano S, Polizzi M, Di Mase R, Improda N, Esposito A, Bravaccio C, Salerno M. Cognitive Function in Children With Idiopathic Subclinical Hypothyroidism: Effects of 2 Years of Levothyroxine Therapy. J Clin Endocrinol Metab 2020; 105:5718305. [PMID: 32002552 DOI: 10.1210/clinem/dgaa046] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [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: 11/13/2019] [Accepted: 01/28/2020] [Indexed: 12/13/2022]
Abstract
BACKGROUND Long-term consequences of mild subclinical hypothyroidism (SH) in children are still unclear, and the need for levothyroxine (L-T4) supplementation remains controversial. We designed a 2-year, case-control, prospective study of a cohort of children with SH to evaluate the effects of L-T4 therapy on neurocognitive outcome. METHODS Thirty-four children, age 9.1 ± 2.6 years, with long-lasting, idiopathic, and mild SH, and 34 healthy matched controls, were enrolled. Twenty SH children underwent a 2-year L-T4 treatment (group A), whereas 14 refused treatment and were reevaluated after a 2-year-follow-up (group B). IQ and specific cognitive domains were evaluated in all children at study entry and after 2 years of therapy (group A) or observation (group B) in SH individuals. RESULTS In SH children baseline IQ scores were normal and comparable to controls (full-scale IQ [FSIQ] 100.4 ± 11.3 vs 101.8 ± 14.2, verbal IQ [VIQ] 99.7 ± 13.7 vs 98.3 ± 14.9 and performance IQ [PIQ] 101.2 ± 10.4 vs 105 ± 10.4).In group A, L-T4 treatment was associated with normalization of thyrotropin (6.3 ± 1.0 mIU/L at baseline vs 2.8 ± 1.4 mIU/L at 2 years, P < .001). However, 2-year L-T4 therapy was not associated with a change in IQ scores (FSIQ 104.4 ± 13.8 vs 102.7 ± 11.0; VIQ 101.8 ± 14.9 vs 102.3 ± 11.9; and PIQ 106.5 ± 13.9 vs 102.7 ± 10.7) or in verbal or performance subtest scores. No significant differences were found in IQ scores after 2 years of treatment in group A compared to group B after a 2-year follow-up. CONCLUSIONS Our data suggest neurocognitive function in children is not impaired by persistent, mild, untreated SH and is not significantly modified by 2-year L-T4 supplementation.
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Affiliation(s)
- Donatella Capalbo
- Pediatric Endocrinology Unit, Department of Mother and Child, University Hospital Federico II, Naples, Italy
| | - Sara Alfano
- Pediatric Endocrinology Unit, Department of Translational Medical Sciences, University Federico II, Naples, Italy
| | - Miriam Polizzi
- Pediatric Endocrinology Unit, Department of Mother and Child, University Hospital Federico II, Naples, Italy
| | - Raffaella Di Mase
- Pediatric Endocrinology Unit, Department of Mother and Child, University Hospital Federico II, Naples, Italy
| | - Nicola Improda
- Pediatric Endocrinology Unit, Department of Translational Medical Sciences, University Federico II, Naples, Italy
| | - Andrea Esposito
- Pediatric Endocrinology Unit, Department of Translational Medical Sciences, University Federico II, Naples, Italy
| | - Carmela Bravaccio
- Pediatric Endocrinology Unit, Department of Translational Medical Sciences, University Federico II, Naples, Italy
| | - Mariacarolina Salerno
- Pediatric Endocrinology Unit, Department of Translational Medical Sciences, University Federico II, Naples, Italy
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10
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Capalbo D, Esposito A, Improda N, Wasniewska MG, Di Mase R, De Luca F, Bruzzese D, Salerno M. Glucose homeostasis in GHD children during long-term replacement therapy: a case-control study. Endocrine 2018; 59:643-650. [PMID: 28875423 DOI: 10.1007/s12020-017-1408-0] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [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: 06/16/2017] [Accepted: 08/22/2017] [Indexed: 11/28/2022]
Abstract
PURPOSE To evaluate glucose homeostasis in children with growth hormone (GH) deficiency (GHD) receiving long-term replacement therapy. METHODS We evaluated glucose, insulin, HOmeostasis Model Assessment (HOMA-IR), and HbA1c in 100 GHD children at diagnosis and during 5 years of therapy. One hundred healthy children comparable to patients were evaluated at baseline and after 1 and 5 years. RESULTS No difference was detected at baseline between GHD patients and controls in glucose (79.58 ± 9.96 vs. 77.18 ± 8.20 mg/dl), insulin (4.50 ± 3.24 vs. 4.30 ± 2.60 µU/ml), HbA1c (5.20 ± 0.31 vs. 5.25 ± 0.33%) levels, and HOMA-IR (0.93 ± 0.72 vs. 0.86 ± 0.61). One year of GH was associated with a significant increase in insulin (7.21 ± 4.84, p < 0.001) and HOMA-IR (1.32 ± 0.98, p < 0.001) in GHD children, which became different from controls (p < 0.001 and p = 0.004). These parameters did not change further during the following years of treatment in GHD subjects. In contrast, controls did not show significant changes in insulin (4.40 ± 2.60) and HOMA-IR (0.82 ± 0.60) during the first year; however, at the fifth year of the study a significant increase in insulin (6.50 ± 3.50, p = 0.004) and HOMA-IR (1.29 ± 0.54, p < 0.001) was documented, making these parameters comparable between patients and controls. CONCLUSIONS Our results suggest that growth hormone (GH) treatment is not associated with significant impairment of insulin sensitivity in GHD children. The slight impairment observed in GHD adolescents after long-term GH is comparable to that physiologically occurring in healthy pubertal subjects.
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Affiliation(s)
- Donatella Capalbo
- Department of Pediatrics, University "Federico II" of Naples, Naples, Italy
| | - Andrea Esposito
- Department of Translational Medical Sciences Pediatric Endocrinology Section, University "Federico II" of Naples, Naples, Italy
| | - Nicola Improda
- Department of Pediatrics, University "Federico II" of Naples, Naples, Italy
| | | | - Raffaella Di Mase
- Department of Pediatrics, University "Federico II" of Naples, Naples, Italy
| | - Filippo De Luca
- Department of Pediatric Gynecological, Microbiological and Biomedical Sciences, University of Messina, Messina, Italy
| | - Dario Bruzzese
- Department of Public Health, University "Federico II" of Naples, Naples, Italy
| | - Mariacarolina Salerno
- Department of Translational Medical Sciences Pediatric Endocrinology Section, University "Federico II" of Naples, Naples, Italy.
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11
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Capalbo D, Barbieri F, Improda N, Giallauria F, Di Pietro E, Rapacciuolo A, Di Mase R, Vigorito C, Salerno M. Growth Hormone Improves Cardiopulmonary Capacity and Body Composition in Children With Growth Hormone Deficiency. J Clin Endocrinol Metab 2017; 102:4080-4088. [PMID: 28938456 DOI: 10.1210/jc.2017-00871] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [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: 04/12/2017] [Accepted: 08/24/2017] [Indexed: 01/22/2023]
Abstract
CONTEXT Growth hormone deficiency (GHD) in children may be associated with early cardiovascular risk factors and alterations in left ventricular (LV) structure and function; data on cardiopulmonary functional capacity are lacking. OBJECTIVES Aim of the study was to evaluate the effect of GHD and growth hormone (GH) therapy on cardiopulmonary functional capacity, left and right cardiac structure and function, and body composition in children and adolescents. DESIGN Prospective, case-control study. PATIENTS AND METHODS Twenty-one untrained GHD children (11.3 ± 0.8 years) underwent cardiopulmonary exercise testing, echocardiography and dual-energy x-ray absorptiometry, before and after 12 months of GH therapy. Twenty-one controls matched for sex, pubertal status, body mass index, and physical activity (PA) were evaluated at baseline and after 1 year. RESULTS At baseline, GHD patients showed reduced LV mass (LVM; 63.32 ± 7.80 vs 80.44 ± 26.29 g/m2, P = 0.006), peak oxygen consumption (VO2peak; 22.92 ± 4.80 vs 27.48 ± 6.71 mL/Kg/min, P = 0.02), peak workload (80.62 ± 29.32 vs 103.76 ± 36.20 W, P = 0.02), and O2 pulse (4.93 ± 1.30 vs 7.67 ± 2.93 mL/beat, P = 0.0003), compared with controls. GHD patients also exhibited lower lean body mass (LBM 65.36 ± 7.84% vs 76.13 ± 8.23%, P < 0.001), and higher fat mass (FM 30.84 ± 7.92% vs 22.19 ± 8.18%, P = 0.001) than controls. GH therapy resulted in a significant increase of LVM (72.01 ± 15.88, P = 0.03), VO2peak (26.80 ± 4.97; P = 0.01), peak workload (103.67 ± 32.24, P = 0.001), O2 pulse (6.64 ± 1.68, P = 0.0007), and LBM (75.36 ± 7.59%, P = 0.0001), with a reduction in FM (22.62 ± 7.73%, P = 0.001). No difference was found in either left or right ventricular function. CONCLUSION Our results suggest that cardiac structure, body composition and cardiopulmonary functional capacity are impaired in children with untreated GHD and can be restored after short-term GH replacement therapy.
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Affiliation(s)
- Donatella Capalbo
- Department of Translational Medical Sciences, Pediatric Section, Federico II University of Naples, 80131 Naples, Italy
| | - Flavia Barbieri
- Department of Translational Medical Sciences, Pediatric Section, Federico II University of Naples, 80131 Naples, Italy
| | - Nicola Improda
- Department of Translational Medical Sciences, Pediatric Section, Federico II University of Naples, 80131 Naples, Italy
| | - Francesco Giallauria
- Department of Translational Medical Sciences, Division of Internal Medicine and Cardiac Rehabilitation, Federico II University of Naples, 80131 Naples, Italy
| | - Elisa Di Pietro
- Department of Advanced Biomedical Science, Federico II University of Naples, 80131 Naples, Italy
| | - Antonio Rapacciuolo
- Department of Advanced Biomedical Science, Federico II University of Naples, 80131 Naples, Italy
| | - Raffaella Di Mase
- Department of Translational Medical Sciences, Pediatric Section, Federico II University of Naples, 80131 Naples, Italy
| | - Carlo Vigorito
- Department of Translational Medical Sciences, Division of Internal Medicine and Cardiac Rehabilitation, Federico II University of Naples, 80131 Naples, Italy
| | - Mariacarolina Salerno
- Department of Translational Medical Sciences, Pediatric Section, Federico II University of Naples, 80131 Naples, Italy
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12
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Grandone A, Del Vecchio Blanco F, Torella A, Caruso M, De Luca F, Di Mase R, Messina MF, Salerno MC, Sallemi A, Perone L, Marzuillo P, Miraglia Del Giudice E, Nigro V, Perrone L. Multiplex Ligation-Dependent Probe Amplification Accurately Detects Turner Syndrome in Girls with Short Stature. Horm Res Paediatr 2017; 86:330-336. [PMID: 27784012 DOI: 10.1159/000452219] [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] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/20/2016] [Accepted: 10/03/2016] [Indexed: 11/19/2022] Open
Abstract
AIMS We aimed at evaluating a standard multiplex ligation-dependent probe amplification (MLPA) probe set for the detection of aneuploidy to diagnose Turner syndrome (TS). We first fixed an MLPA ratio cutoff able to detect all cases of TS in a pilot TS group. We then tested this value on a second group of TS patients and a short-stature population to measure specificity and sensitivity. METHODS 15 TS patients with X mosaicism or X structural abnormalities (Pilot TS Group), 45 TS karyotype-assessed patients (TS Group), and 74 prepubertal female patients with apparent idiopathic short stature (Short-Stature Group) were enrolled. All subjects underwent MLPA and karyotype analysis. In the TS and Short-Stature Groups, MLPA testing was performed in blind. RESULTS The choice of an MLPA threshold ratio of 0.76 for at least 1 probe allowed us to detect all TS cases, including mosaicisms. Sensitivity and specificity were 100% (CI 95%, 0.92-1) and 88.89% (CI 95%, 0.79-0.94), respectively. The positive predictive value was 88.5%, and the negative predictive value was 100%. MLPA detected the presence of Y chromosome material in 2 patients. CONCLUSION MLPA is an accurate and inexpensive tool to screen for TS in girls with short stature. A customized MLPA kit may be useful for the screening of an even larger population.
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Affiliation(s)
- Anna Grandone
- Dipartimento della Donna, del Bambino, di Chirurgia Generale e Specialistica, Seconda Università degli Studi di Napoli, Naples, Italy
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13
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Aversa T, Corrias A, Salerno M, Tessaris D, Di Mase R, Valenzise M, Corica D, De Luca F, Wasniewska M. Five-Year Prospective Evaluation of Thyroid Function Test Evolution in Children with Hashimoto's Thyroiditis Presenting with Either Euthyroidism or Subclinical Hypothyroidism. Thyroid 2016; 26:1450-1456. [PMID: 27541075 DOI: 10.1089/thy.2016.0080] [Citation(s) in RCA: 24] [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: 01/22/2023]
Abstract
BACKGROUND Whether the course of thyroid function in Hashimoto's thyroiditis (HT) differs in children who present with either euthyroidism or subclinical hypothyroidism (SH) has been incompletely investigated. AIM Using a five-year prospective evaluation of 234 children with HT and no prognostic risk factors, this study investigated whether the evolution of the thyroid status is influenced by the biochemical pattern at initial diagnosis. RESULTS In the entire series, thyrotropin values significantly increased during follow-up, while free thyroxine values decreased and the proportion of children with a thyroid dysfunction increased from 27.3% to 47.4% (p = 0.0001). An increasing proportion of cases with severe thyroid dysfunction was identified, especially among the 64 patients presenting with SH (group B), but also among the 170 children presenting with euthyroidism (group A) at initial diagnosis. At the end of follow-up, the prevalence of children with overt hypothyroidism was 12.3% in group A compared with 31.2% in group B (p = 0.0007). In the overall population, however, the majority of patients (52.6%) exhibited biochemical euthyroidism at the end of follow-up. CONCLUSIONS Children with HT may develop a deterioration of thyroid status during the first five years of disease. Such a trend may be observed, even in the patients who initially present with a mild biochemical picture (either SH or euthyroidism). A total of 57.1% of initially euthyroid children remain euthyroid, and 40.6% of patients with initial SH normalize thyroid function within five years after HT diagnosis. The patients presenting with SH are more prone to the risk of developing severe thyroid dysfunction over time.
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Affiliation(s)
- Tommaso Aversa
- 1 Department of Pediatrics, University of Messina , Messina, Italy
| | - Andrea Corrias
- 2 Department of Pediatrics, University of Turin , Regina Margherita Children's Hospital, Turin, Italy
| | | | - Daniele Tessaris
- 2 Department of Pediatrics, University of Turin , Regina Margherita Children's Hospital, Turin, Italy
| | - Raffaella Di Mase
- 3 Department of Pediatrics, University "Federico II ," Naples, Italy
| | | | - Domenico Corica
- 1 Department of Pediatrics, University of Messina , Messina, Italy
| | - Filippo De Luca
- 1 Department of Pediatrics, University of Messina , Messina, Italy
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14
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Esposito A, Capalbo D, De Martino L, Rezzuto M, Di Mase R, Pignata C, Salerno M. Long-term effects of growth hormone (GH) replacement therapy on hematopoiesis in a large cohort of children with GH deficiency. Endocrine 2016; 53:192-8. [PMID: 26511947 DOI: 10.1007/s12020-015-0781-9] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [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: 07/20/2015] [Accepted: 10/19/2015] [Indexed: 10/22/2022]
Abstract
The aim of our prospective case-control study was to evaluate long-term effects of GH replacement therapy on erythrocytes parameters, leukocytes, and platelets numbers in a large cohort of children with isolated GH deficiency (GHD). Hemoglobin (Hb) concentration, hematocrit (Hct), mean corpuscular volume, mean corpuscular hemoglobin, red cell distribution width, number of erythrocytes, leukocytes, neutrophils, lymphocytes, monocytes and platelets, ferritin, and C-reactive protein were evaluated in 85 children with isolated GHD (10.20 ± 3.50 years) before and annually during the first 5 years of GH replacement therapy and in 85 healthy children age and sex comparable to patients during 5 years of follow-up. Compared with controls, GHD children at study entry showed lower Hb (-1.18 ± 0.87 vs. -0.40 ± 0.90 SDS, p < 0.0001), red cells number (-0.24 ± 0.81 vs. 0.25 ± 1.14 SDS, p < 0.0001), and Hct (-1.18 ± 0.86 vs. -0.68 ± 0.99 SDS, p < 0.0001). Twelve GHD patients (14 %) showed a normocytic anemia. GH therapy was associated with a significant increase in Hb, Hct, and red cells number which became all comparable to controls within the first 2 years of treatment. Moreover, hemoglobin levels normalized in all anemic GHD patients after 5 years of therapy. No difference between patients and controls was found in leukocytes and platelets numbers neither at baseline nor during the study. GHD in childhood is associated with an impairment of erythropoiesis which causes a normocytic anemia in a considerable percentage of patients. GH replacement therapy exerts a beneficial effect leading to a significant increase of erythrocytes parameters and recovery from anemia. Neither GHD nor GH replacement treatment exerts effects on leukocytes or platelets numbers.
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Affiliation(s)
- Andrea Esposito
- Pediatric Endocrinology Unit, Department of Translational Medical Sciences, University of Naples "Federico II", via Sergio Pansini 5, 80131, Naples, Italy
| | - Donatella Capalbo
- Pediatric Endocrinology Unit, Department of Translational Medical Sciences, University of Naples "Federico II", via Sergio Pansini 5, 80131, Naples, Italy
| | - Lucia De Martino
- Pediatric Endocrinology Unit, Department of Translational Medical Sciences, University of Naples "Federico II", via Sergio Pansini 5, 80131, Naples, Italy
| | - Martina Rezzuto
- Pediatric Endocrinology Unit, Department of Translational Medical Sciences, University of Naples "Federico II", via Sergio Pansini 5, 80131, Naples, Italy
| | - Raffaella Di Mase
- Pediatric Endocrinology Unit, Department of Translational Medical Sciences, University of Naples "Federico II", via Sergio Pansini 5, 80131, Naples, Italy
| | - Claudio Pignata
- Pediatric Immunology Unit, Department of Translational Medical Sciences, University of Naples "Federico II", via Sergio Pansini 5, 80131, Naples, Italy
| | - Mariacarolina Salerno
- Pediatric Endocrinology Unit, Department of Translational Medical Sciences, University of Naples "Federico II", via Sergio Pansini 5, 80131, Naples, Italy.
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15
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De Martino L, Capalbo D, Improda N, Lorello P, Ungaro C, Di Mase R, Cirillo E, Pignata C, Salerno M. Novel Findings into AIRE Genetics and Functioning: Clinical Implications. Front Pediatr 2016; 4:86. [PMID: 27597936 PMCID: PMC4992815 DOI: 10.3389/fped.2016.00086] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/14/2016] [Accepted: 08/02/2016] [Indexed: 01/22/2023] Open
Abstract
Autoimmune polyendocrinopathy candidiasis ectodermal dystrophy (APECED), formerly known as autoimmune polyendocrine syndrome type 1, is a paradigm of a monogenic autoimmune disease caused by mutations of a gene, named autoimmune regulator (AIRE). AIRE acts as a transcription regulator that promotes immunological central tolerance by inducing the ectopic thymic expression of many tissue-specific antigens. Although the syndrome is a monogenic disease, it is characterized by a wide variability of the clinical expression with no significant correlation between genotype and phenotype. Indeed, many aspects regarding the exact role of AIRE and APECED pathogenesis still remain unraveled. In the last decades, several studies in APECED and in its mouse experimental counterpart have revealed new insights on how immune system learns self-tolerance. Moreover, novel interesting findings have extended our understanding of AIRE's function and regulation thus improving our knowledge on the pathogenesis of APECED. In this review, we will summarize recent novelties on molecular mechanisms underlying the development of APECED and their clinical implications.
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Affiliation(s)
- Lucia De Martino
- Pediatric Section, Department of Translational Medical Sciences, Federico II University , Naples , Italy
| | | | - Nicola Improda
- Pediatric Section, Department of Translational Medical Sciences, Federico II University , Naples , Italy
| | - Paola Lorello
- Pediatric Section, Department of Translational Medical Sciences, Federico II University , Naples , Italy
| | - Carla Ungaro
- Department of Pediatrics, Federico II University , Naples , Italy
| | | | - Emilia Cirillo
- Pediatric Section, Department of Translational Medical Sciences, Federico II University , Naples , Italy
| | - Claudio Pignata
- Pediatric Section, Department of Translational Medical Sciences, Federico II University , Naples , Italy
| | - Mariacarolina Salerno
- Pediatric Section, Department of Translational Medical Sciences, Federico II University , Naples , Italy
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16
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Delvecchio M, Salerno M, Vigone MC, Wasniewska M, Popolo PP, Lapolla R, Mussa A, Tronconi GM, D'Acunzo I, Di Mase R, Falcone RM, Corrias A, De Luca F, Weber G, Cavallo L, Faienza MF. Levothyroxine requirement in congenital hypothyroidism: a 12-year longitudinal study. Endocrine 2015; 50:674-80. [PMID: 25762444 DOI: 10.1007/s12020-015-0574-1] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [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: 12/28/2014] [Accepted: 03/04/2015] [Indexed: 10/23/2022]
Abstract
The aim of the replacement therapy with levothyroxine in congenital hypothyroidism (CH) is to correct hypothyroidism and ensure normal growth and neuropsychological development. Few data are available about the appropriate dose during childhood and early adolescence; therefore, we performed a multicenter observational study in a large population of patients with CH to assess the required levothyroxine dose to obtain euthyroidism. We recruited 216 patients with permanent CH classified into three groups (agenesia, ectopia, and in situ gland) on the basis of the thyroid imaging. The levothyroxine dose was recorded at 6 and 12 months and then yearly until 12 years of age. The daily levothyroxine requirement progressively decreased during the follow-up, irrespective of etiology. It was significantly lower in patients with in situ gland than in patients with athyreosis during the entire study period and with ectopic gland from the age of 1 year. The levothyroxine requirement at 6 months of age was correlated with the requirement at each later time-point. The daily dose was modified less frequently in patients with in situ thyroid (36 %) than in patients with ectopic gland (41.4 %) or with athyreosis (43.6 %). Patients with in situ gland required a lower dose than the other two subgroups. The dose at 6 months seems predictive of the requirement until 12 years of age. Euthyroidism may be achieved in pre-school and in-school patients by 3-4 and 2-3 µg/kg/day (70-90 and 60-80 µg/m(2)/day) of levothyroxine, respectively.
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Affiliation(s)
- Maurizio Delvecchio
- Department of Biomedical Sciences and Human Oncology, University of Bari Aldo Moro, Bari, Italy.
| | - Mariacarolina Salerno
- Pediatric Section-Department of Translational Medical Sciences, University of Naples Federico II, Naples, Italy
| | - Maria Cristina Vigone
- Department of Pediatrics Endocrinology, IRCCS Vita-Salute San Raffaele University, Milan, Italy
| | | | | | - Rosa Lapolla
- Department of Pediatrics, University of Foggia, Foggia, Italy
| | - Alessandro Mussa
- Division of Pediatric Endocrinology, Department of Pediatrics, University of Turin, Turin, Italy
| | - Giulia Maria Tronconi
- Department of Pediatrics Endocrinology, IRCCS Vita-Salute San Raffaele University, Milan, Italy
| | - Ida D'Acunzo
- Pediatric Section-Department of Translational Medical Sciences, University of Naples Federico II, Naples, Italy
| | - Raffaella Di Mase
- Pediatric Section-Department of Translational Medical Sciences, University of Naples Federico II, Naples, Italy
| | - Rosa Maria Falcone
- Department of Biomedical Sciences and Human Oncology, University of Bari Aldo Moro, Bari, Italy
| | - Andrea Corrias
- Division of Pediatric Endocrinology, Department of Pediatrics, University of Turin, Turin, Italy
| | - Filippo De Luca
- Department of Pediatrics, University of Messina, Messina, Italy
| | - Giovanna Weber
- Department of Pediatrics Endocrinology, IRCCS Vita-Salute San Raffaele University, Milan, Italy
| | - Luciano Cavallo
- Department of Biomedical Sciences and Human Oncology, University of Bari Aldo Moro, Bari, Italy
| | - Maria Felicia Faienza
- Department of Biomedical Sciences and Human Oncology, University of Bari Aldo Moro, Bari, Italy
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17
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Capalbo D, Mattace Raso G, Esposito A, Di Mase R, Barbieri F, Meli R, Bruzzese D, Salerno M. Cluster of cardiometabolic risk factors in children with GH deficiency: a prospective, case-control study. Clin Endocrinol (Oxf) 2014; 80:856-62. [PMID: 24372071 DOI: 10.1111/cen.12393] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.4] [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: 06/12/2013] [Revised: 06/23/2013] [Accepted: 12/07/2013] [Indexed: 12/17/2022]
Abstract
OBJECTIVE Growth hormone (GH) deficiency (GHD) in adults is associated with increased cardiovascular (CV) risk. Although some authors have documented the presence of early CV risk factors in untreated GHD children, results are still inconsistent. Aim of this study was to evaluate the effects of GHD and GH therapy on early cardiometabolic risk factors in a large cohort of children. SUBJECTS AND METHODS Waist-to-height ratio (WHtR), triglycerides, total-, low-density lipoprotein (LDL), high-density lipoprotein (HDL) cholesterol, atherogenic index (AI = total /HDL cholesterol), homocysteine, leptin, adiponectin, high-sensitivity C-reactive protein (hsCRP) and fibrinogen were evaluated in seventy-one GHD children (9·8 ± 3·6 years) before and after 2 years of GH therapy. Seventy-one healthy controls comparable with patients for age, sex and body mass index (BMI) were enrolled. RESULTS Compared with controls, GHD children at study entry had higher WHtR (0·52 ± 0·05 vs 0·45 ± 0·19, P = 0·004), triglycerides (0·44 ± 0·98 vs -0·03 ± 0·73 SDS, P = 0·012), total cholesterol (0·28 ± 1·08 vs -0·46 ± 0·98 SDS, P < 0·001), LDL cholesterol (0·20 ± 0·90 vs -0·39 ± 1·06 SDS, P = 0·007), AI (3·19 ± 0·73 vs 2·77 ± 0·53, P = 0·001), homocysteine (8·45 ± 1·8 vs 7·72 ± 1·6 μm, P = 0·003), leptin (8·03 ± 4·2 vs 5·09 ± 1·9 ng/ml, P = 0·001) and fibrinogen (292·6 ± 33 vs 268 ± 31·4 mg/dl, P = 0·011). No differences were found in adiponectin or hsCRP. GH therapy was associated with a significant reduction in WHtR (P < 0·001), total cholesterol (P < 0·001), LDL cholesterol (P = 0·002), homocysteine (P = 0·044) leptin (P = 0·022) and fibrinogen (P = 0·001). Moreover, GH therapy was associated with a significant increase in adiponectin levels (P = 0·001). CONCLUSIONS Our data suggest that children with untreated GHD exhibit a cluster of early cardiovascular risk factors and that GH treatment exerts beneficial effects on these abnormalities.
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Affiliation(s)
- Donatella Capalbo
- Pediatric Endocrinology Unit, Department of Translational Medical Sciences, University "Federico II" of Naples, Naples, Italy
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18
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De Martino L, Capalbo D, Improda N, D'Elia F, Di Mase R, D'Assante R, D'Acunzo I, Pignata C, Salerno M. APECED: A Paradigm of Complex Interactions between Genetic Background and Susceptibility Factors. Front Immunol 2013; 4:331. [PMID: 24167503 PMCID: PMC3805967 DOI: 10.3389/fimmu.2013.00331] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2013] [Accepted: 09/30/2013] [Indexed: 01/08/2023] Open
Abstract
Autoimmune polyendocrinopathy-candidiasis-ectodermal dystrophy (APECED) is a rare autosomal recessive disease, caused by mutations of a single gene named Autoimmune regulator gene (AIRE) which results in a failure of T-cell tolerance. Central tolerance takes place within the thymus and represents the mechanism by which potentially auto-reactive T-cells are eliminated through the negative selection process. The expression of tissue-specific antigens (TSAs) by medullary thymic epithelial cells (mTECs) in the thymus is a key process in the central tolerance and is driven by the protein encoded by AIRE gene, the transcription factor autoimmune regulator (AIRE). A failure in this process caused by AIRE mutations is thought to be responsible of the systemic autoimmune reactions of APECED. APECED is characterized by several autoimmune endocrine and non-endocrine manifestations and the phenotype is often complex. Although APECED is the paradigm of a monogenic autoimmune disorder, it is characterized by a wide variability of the clinical expression even between siblings with the same genotype, thus implying that additional mechanisms, other than the failure of Aire function, are involved in the pathogenesis of the disease. Unraveling open issues of the molecular basis of APECED, will help improve diagnosis, management, and therapeutical strategies of this complex disease.
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Affiliation(s)
- Lucia De Martino
- Pediatric Section, Department of Translational Medical Sciences, "Federico II" University , Naples , Italy
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19
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Di Mase R, Cerbone M, Improda N, Esposito A, Capalbo D, Mainolfi C, Santamaria F, Pignata C, Salerno M. Bone health in children with long-term idiopathic subclinical hypothyroidism. Ital J Pediatr 2012; 38:56. [PMID: 23088718 PMCID: PMC3484064 DOI: 10.1186/1824-7288-38-56] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/14/2012] [Accepted: 10/18/2012] [Indexed: 02/02/2023] Open
Abstract
Background Subclinical hypothyroidism (SH) is a relatively common condition characterized by a mild persistent thyroid failure. The management of children with SH is still a controversial issue and the decision to treat with L-thyroxine represents a clinical dilemma. Thyroid hormone and TSH play an important role in skeletal growth and bone mineral homeostasis. Aim To evaluate whether untreated idiopathic SH may affect bone health in childhood and to compare two different diagnostic tools such as dual-energy X-ray densitometry (DXA) and quantitative ultrasound (QUS). Patients and Methods Twenty-five children and adolescents (11 males) aged 9.8 ± 3.5 years (range 4.2-18.7) with untreated idiopathic SH were enrolled in the study. SH was diagnosed on the basis of normal FT4 levels with TSH concentrations between 4.2 and 10 mU/l. Children have been followed for 3.3 ± 0.3 years from the time of SH diagnosis. Twenty-five healthy children, age- and sex-matched, were enrolled as controls. Patients and controls underwent DXA to evaluate lumbar spine bone mineral density (BMD) and QUS at proximal phalanges of the non-dominant hand to assess bone quality, measured as amplitude-dependent speed of sound (Ad-SoS) and bone transmission time (BTT). Results Mean BMD Z-score was −0.4 ± 1.36 in patients and −0.2 ± 1.2 in controls. Mean Ad-SoS Z-score was 0.01 ± 1.0 in patients and 0.1 ± 1.2 in controls and mean BTT Z-score was −0.03 ± 0.8 and 0.04 ± 1.1 respectively. All values were within the normal range, both in patients and in controls. There were no statistically significant differences between the two groups. Conclusion Bone health, evaluated by lumbar spine DXA and phalangeal QUS, is not impaired in our children, despite long-term duration of idiopathic SH. Data about bone status provided by QUS are comparable to those provided by DXA. Therefore, QUS may represent a good, cheaper and safe screening test for bone evaluation in children with SH.
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Affiliation(s)
- Raffaella Di Mase
- Department of Pediatrics, University of Naples, Federico II, Naples, Italy
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20
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Capalbo D, De Martino L, Giardino G, Di Mase R, Di Donato I, Parenti G, Vajro P, Pignata C, Salerno M. Autoimmune polyendocrinopathy candidiasis ectodermal dystrophy: insights into genotype-phenotype correlation. Int J Endocrinol 2012; 2012:353250. [PMID: 23133448 PMCID: PMC3485503 DOI: 10.1155/2012/353250] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/15/2012] [Revised: 09/17/2012] [Accepted: 09/17/2012] [Indexed: 12/21/2022] Open
Abstract
Autoimmune polyendocrinopathy candidiasis ectodermal dystrophy (APECED) is a rare autosomal recessive disease, caused by mutations of a single gene named autoimmune regulator gene (AIRE) which results in a failure of T cell tolerance within the thymus. Chronic mucocutaneous candidiasis, chronic hypoparathyroidism, and Addison's disease are the hallmarks of the syndrome. APECED is also characterized by several autoimmune endocrine and nonendocrine manifestations, and the phenotype is often complex. Moreover, even though APECED is a monogenic disease, its clinical picture is generally dominated by a wide heterogeneity both in the severity and in the number of components even among siblings with the same AIRE genotype. The variability of its clinical expression implies that diagnosis can be challenging, and a considerable delay often occurs between the appearance of symptoms and the diagnosis. Since a prompt diagnosis is essential to prevent severe complications, clinicians should be aware of all symptoms and signs of suspicion. The aim of this paper is to give an overview on the clinical presentation and diagnostic criteria of APECED and to focus on current knowledge on genotype-phenotype correlation.
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Affiliation(s)
- Donatella Capalbo
- Department of Pediatrics, University of Naples Federico II, 80131 Naples, Italy
| | - Lucia De Martino
- Department of Pediatrics, University of Naples Federico II, 80131 Naples, Italy
| | - Giuliana Giardino
- Department of Pediatrics, University of Naples Federico II, 80131 Naples, Italy
| | - Raffaella Di Mase
- Department of Pediatrics, University of Naples Federico II, 80131 Naples, Italy
| | - Iolanda Di Donato
- Department of Pediatrics, University of Naples Federico II, 80131 Naples, Italy
| | - Giancarlo Parenti
- Department of Pediatrics, University of Naples Federico II, 80131 Naples, Italy
| | - Pietro Vajro
- Department of Pediatrics, University of Salerno, 84081 Salerno, Italy
| | - Claudio Pignata
- Department of Pediatrics, University of Naples Federico II, 80131 Naples, Italy
| | - Mariacarolina Salerno
- Department of Pediatrics, University of Naples Federico II, 80131 Naples, Italy
- *Mariacarolina Salerno:
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21
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Greco L, Gobbetti M, Auricchio R, Di Mase R, Landolfo F, Paparo F, Di Cagno R, De Angelis M, Rizzello CG, Cassone A, Terrone G, Timpone L, D'Aniello M, Maglio M, Troncone R, Auricchio S. Safety for patients with celiac disease of baked goods made of wheat flour hydrolyzed during food processing. Clin Gastroenterol Hepatol 2011; 9:24-9. [PMID: 20951830 DOI: 10.1016/j.cgh.2010.09.025] [Citation(s) in RCA: 70] [Impact Index Per Article: 5.4] [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: 11/06/2009] [Revised: 09/21/2010] [Accepted: 09/27/2010] [Indexed: 02/07/2023]
Abstract
BACKGROUND & AIMS Celiac disease (CD) is characterized by an inflammatory response to wheat gluten, rye, and barley proteins. Fermentation of wheat flour with sourdough lactobacilli and fungal proteases decreases the concentration of gluten. We evaluated the safety of daily administration of baked goods made from this hydrolyzed form of wheat flour to patients with CD. METHODS Patients were randomly assigned to consumption of 200 g per day of natural flour baked goods (NFBG) (80,127 ppm gluten; n = 6), extensively hydrolyzed flour baked goods (S1BG) (2480 ppm residual gluten; n = 2), or fully hydrolyzed baked goods (S2BG) (8 ppm residual gluten; n = 5) for 60 days. RESULTS Two of the 6 patients who consumed NFBG discontinued the challenge because of symptoms; all had increased levels of anti-tissue transglutaminase (tTG) antibodies and small bowel deterioration. The 2 patients who ate the S1BG goods had no clinical complaints but developed subtotal atrophy. The 5 patients who ate the S2BG had no clinical complaints; their levels of anti-tTG antibodies did not increase, and their Marsh grades of small intestinal mucosa did not change. CONCLUSIONS A 60-day diet of baked goods made from hydrolyzed wheat flour, manufactured with sourdough lactobacilli and fungal proteases, was not toxic to patients with CD. A combined analysis of serologic, morphometric, and immunohistochemical parameters is the most accurate method to assess new therapies for this disorder.
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Affiliation(s)
- Luigi Greco
- Department of Pediatrics and European Laboratory for the Study of Food Induced Diseases, University of Naples, Federico II, Naples, Italy.
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