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Semler O, Cormier-Daire V, Lausch E, Bober MB, Carroll R, Sousa SB, Deyle D, Faden M, Hartmann G, Huser AJ, Legare JM, Mohnike K, Rohrer TR, Rutsch F, Smith P, Travessa AM, Verardo A, White KK, Wilcox WR, Hoover-Fong J. Vosoritide Therapy in Children with Achondroplasia: Early Experience and Practical Considerations for Clinical Practice. Adv Ther 2024; 41:198-214. [PMID: 37882884 PMCID: PMC10796712 DOI: 10.1007/s12325-023-02705-9] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2023] [Accepted: 10/03/2023] [Indexed: 10/27/2023]
Abstract
INTRODUCTION Vosoritide is the first precision medical therapy approved to increase growth velocity in children with achondroplasia. Sharing early prescribing experiences across different regions could provide a framework for developing practical guidance for the real-world use of vosoritide. METHODS Two meetings were held to gather insight and early experience from experts in Europe, the Middle East, and the USA. The group comprised geneticists, pediatric endocrinologists, pediatricians, and orthopedic surgeons. Current practices and considerations for vosoritide were discussed, including administration practicalities, assessments, and how to manage expectations. RESULTS A crucial step in the management of achondroplasia is to determine if adequate multidisciplinary support is in place. Training for families is essential, including practical information on administration of vosoritide, and how to recognize and manage injection-site reactions. Advocated techniques include establishing a routine, empowering patients by allowing them to choose injection sites, and managing pain. Patients may discontinue vosoritide if they cannot tolerate daily injections or are invited to participate in a clinical trial. Clinicians in Europe and the Middle East emphasized the importance of assessing adherence to daily injections, as non-adherence may impact response and reimbursement. Protocols for monitoring patients receiving vosoritide may be influenced by regional differences in reimbursement and healthcare systems. Core assessments may include pubertal staging, anthropometry, radiography to confirm open physes, the review of adverse events, and discussion of concomitant or new medications-but timing of these assessments may also differ regionally and vary across institutions. Patients and families should be informed that response to vosoritide can vary in both magnitude and timing. Keeping families informed regarding vosoritide clinical trial data is encouraged. CONCLUSION The early real-world experience with vosoritide is generally positive. Sharing these insights is important to increase understanding of the practicalities of treatment with vosoritide in the clinical setting.
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Affiliation(s)
- Oliver Semler
- Faculty of Medicine, Center for Rare Diseases, University Hospital Cologne, University of Cologne, Cologne, Germany.
| | - Valérie Cormier-Daire
- Centre of Reference for Constitutional Bone Diseases (MOC), Department of Clinical Genetics, Paris Centre University, INSERM UMR 1163, Imagine Institute, Necker-Enfants Malades Hospital, Paris, France
| | - Ekkehart Lausch
- Pediatric Genetics, Center for Pediatric and Adolescent Medicine, University Hospital Freiburg, Freiburg, Germany
| | - Michael B Bober
- Nemours Skeletal Dysplasia Program, Nemours Children's Hospital, Delaware, Wilmington, DE, USA
| | - Ricki Carroll
- Nemours Skeletal Dysplasia Program, Nemours Children's Hospital, Delaware, Wilmington, DE, USA
| | - Sérgio B Sousa
- Medical Genetics Unit, Hospital Pediátrico, Centro Hospitalar e Universitário de Coimbra, Coimbra, Portugal
- University Clinic of Genetics, Faculty of Medicine, Universidade de Coimbra, Coimbra, Portugal
| | - David Deyle
- Department of Clinical Genomics, Mayo Clinic, Rochester, MN, USA
| | - Maha Faden
- Medical Genetic Unit, Children's Hospital, King Saud Medical City, Riyadh, Saudi Arabia
| | - Gabriele Hartmann
- Vienna Bone and Growth Center, Department of Pediatrics and Adolescent Medicine, Medical University of Vienna, Vienna, Austria
| | - Aaron J Huser
- Paley Advanced Limb Lengthening Institute, West Palm Beach, FL, USA
| | - Janet M Legare
- Department of Pediatrics, School of Medicine and Public Health, University of Wisconsin, Madison, WI, USA
| | - Klaus Mohnike
- Universitätskinderklinik, Otto-Von-Guericke Universität, Magdeburg, Germany
| | - Tilman R Rohrer
- Department of General Pediatrics and Neonatology, Saarland University Medical Centre, Homburg, Germany
| | - Frank Rutsch
- Department of General Pediatrics, Münster University Children's Hospital, Münster, Germany
| | - Pamela Smith
- Division of Endocrinology, Phoenix Children's Hospital, Phoenix, AZ, USA
| | - Andre M Travessa
- Department of Medical Genetics, Hospital de Santa Maria, Centro Hospitalar Universitário Lisboa Norte, Faculty of Medicine, University of Lisbon, Lisbon, Portugal
| | - Angela Verardo
- Division of Pediatric Endocrinology, Children's Hospital of New Jersey at Newark Beth Israel Medical Center, Newark, NJ, USA
| | | | - William R Wilcox
- Department of Human Genetics, Emory University School of Medicine, Atlanta, GA, USA
| | - Julie Hoover-Fong
- Department of Genetic Medicine, Johns Hopkins University, Baltimore, MD, USA
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Backeljauw P, Blair JC, Ferran JM, Kelepouris N, Miller BS, Pietropoli A, Polak M, Sävendahl L, Verlinde F, Rohrer TR. Early GH Treatment Is Effective and Well Tolerated in Children With Turner Syndrome: NordiNet® IOS and Answer Program. J Clin Endocrinol Metab 2023; 108:2653-2665. [PMID: 36947589 PMCID: PMC10505549 DOI: 10.1210/clinem/dgad159] [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] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/16/2022] [Revised: 02/24/2023] [Accepted: 03/03/2023] [Indexed: 03/24/2023]
Abstract
CONTEXT Despite having normal growth hormone (GH) secretion, individuals with Turner syndrome (TS) have short stature. Treatment with recombinant human GH is recommended for TS girls with short stature. OBJECTIVE This work aimed to evaluate the effectiveness and safety of Norditropin (somatropin, Novo Nordisk) with up to 10 years of follow-up in children with TS. METHODS Secondary analysis was conducted of Norditropin data from 2 non-interventional studies: NordiNet® IOS (NCT00960128) and the ANSWER program (NCT01009905). RESULTS A total of 2377 girls with TS were included in the safety analysis set (SAS), with 1513 in the treatment-naive effectiveness analysis set (EAS). At the start of treatment, 1273 (84%) participants were prepubertal (EAS); mean (SD) age was 8.8 (3.9) years. Mean (SD) dose received at the start of GH treatment was 0.045 (0.011) mg/kg/day (EAS). Mean (SD) baseline insulin-like growth factor-1 (IGF-I) SD score (SDS) was -0.86 (1.52), and mean (SD) duration of GH treatment (SAS) was 3.8 (2.8) years.Height SDS (HSDS) increased throughout follow-up, with near-adult HSDS reached by 264 (17%) participants (mean [SD] -1.99 [0.94]; change from baseline +0.90 [0.85]). During the study, 695 (46%) participants (EAS) entered puberty at a mean (SD) age of 12.7 (1.9) years (whether puberty was spontaneous or induced was unknown). Within the SAS, mean IGF-I SDS (SD) at year 10 was 0.91 (1.69); change from baseline +1.48 (1.70). Serious adverse reactions were reported in 10 participants (epiphysiolysis [n = 3]). CONCLUSION GH-treated participants with TS responded well, without new safety concerns. Our real-world data are in agreement with previous studies.
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Affiliation(s)
- Philippe Backeljauw
- Division of Pediatric Endocrinology, Cincinnati Children's Hospital Medical Center, University of Cincinnati College of Medicine, Cincinnati, OH 45229-3039, USA
| | - Joanne C Blair
- Department of Endocrinology, Alder Hey Children's NHS Foundation Trust, Liverpool L14 5AB, UK
| | | | | | - Bradley S Miller
- Division of Pediatric Endocrinology, M Health Fairview Masonic Children's Hospital, Minneapolis, MN 55454, USA
| | | | - Michel Polak
- Université de Paris Cité, Hôpital Universitaire Necker Enfants Malades, Assistance Publique Hôpitaux de Paris, 75015 Paris, France
| | - Lars Sävendahl
- Karolinska Institutet, Karolinska University Hospital, 171 64 Solna, Sweden
| | - Franciska Verlinde
- Belgian Society for Pediatric Endocrinology and Diabetology, 1090 Brussels, Belgium
| | - Tilman R Rohrer
- University Children’s Hospital, Saarland University Medical Center, 66421 Homburg, Germany
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Ross J, Fridman M, Kelepouris N, Murray K, Krone N, Polak M, Rohrer TR, Pietropoli A, Lawrence N, Backeljauw P. Factors Associated With Response to Growth Hormone in Pediatric Growth Disorders: Results of a 5-year Registry Analysis. J Endocr Soc 2023; 7:bvad026. [PMID: 36936713 PMCID: PMC10016032 DOI: 10.1210/jendso/bvad026] [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] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/30/2022] [Indexed: 02/18/2023] Open
Abstract
Context Growth hormone (GH) therapy can increase linear growth in patients with growth hormone deficiency (GHD), Turner syndrome (TS), Noonan syndrome (NS), and Prader-Willi syndrome (PWS), although outcomes vary by disease state. Objective To assess growth and identify factors associated with growth response with long-term GH therapy. Methods Data from pediatric patients with GHD, TS, NS, and PWS obtained at GH treatment initiation (baseline) and annually for 5 years in the ANSWER Program and NordiNet® IOS were analyzed retrospectively. Height standard deviation score (HSDS) was assessed over time, and multivariate analyses determined variables with significant positive effects on growth outcomes in each patient cohort. Results Data from patients with GHD (n = 12 683), TS (n = 1307), NS (n = 203), and PWS (n = 102) were analyzed. HSDS increased over time during GH treatment in all cohorts. Factors with significant positive effects on ΔHSDS were younger age at GH initiation and lower HSDS at baseline (all cohorts) and higher GH dose (GHD and TS only); sex had no effect in any cohort. The modeling analysis showed that ΔHSDS was greatest in year 1 and attenuated over consecutive years through year 5. Estimated least-squares mean ΔHSDS values at year 5 by cohort were 1.702 (females) and 1.586 (males) in GHD, 1.033 in TS, 1.153 in NS, and 1.392 in PWS. Conclusion Long-term GH therapy results in large increases in HSDS in patients with GHD, TS, NS, and PWS. Greater gains in HSDS can be obtained with higher GH doses and earlier initiation of treatment.
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Affiliation(s)
- Judith Ross
- Nemours duPont Hospital for Children, Thomas Jefferson University, Philadelphia, PA 19107, USA
| | | | - Nicky Kelepouris
- Correspondence: Nicky Kelepouris, MD, Novo Nordisk Inc., 800 Scudders Mill Rd, Plainsboro Township, NJ 08536.
| | | | - Nils Krone
- Department of Oncology and Metabolism, University of Sheffield, Western Bank, Sheffield S10 2TN, UK
| | - Michel Polak
- Hôpital Universitaire Necker Enfants Malades, Université de Paris Cité, Paris 75015, France
| | - Tilman R Rohrer
- University Children's Hospital, Saarland University Medical Center, Homburg 66421, Germany
| | | | - Neil Lawrence
- Department of Oncology and Metabolism, University of Sheffield, Western Bank, Sheffield S10 2TN, UK
| | - Philippe Backeljauw
- Cincinnati Children's Hospital Medical Center, University of Cincinnati College of Medicine, Cincinnati, OH 45229, USA
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Levin J, Hasan A, Alba Alejandre I, Lorenzi I, Mall V, R. Rohrer T. Diseases Affecting Middle-Aged and Elderly Individuals With Trisomy 21. Dtsch Arztebl Int 2023; 120:14-24. [PMID: 36468261 PMCID: PMC10035343 DOI: 10.3238/arztebl.m2022.0371] [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] [Received: 05/24/2022] [Revised: 05/24/2022] [Accepted: 03/11/2022] [Indexed: 03/25/2023]
Abstract
BACKGROUND The life expectancy of individuals with trisomy 21 (Down syndrome, DS) has risen to more than 60 years over the past few decades. As a result, diseases arising in mid and later life have become an issue of major concern in the care of individuals with DS. This article discusses and summarizes, from a multidisciplinary perspective, the diseases commonly affecting this population. METHODS This narrative review is based on publications identified by a selective literature search, extrapolation of the available evidence, and the authors' personal experience. RESULTS Robust epidemiological evidence indicates that many different diseases, which are dealt with by many different medical specialties, are more common in individuals with DS. The genetic background of some of these diseases is now understood down to the molecular level, e.g., primary hypothyroidism or Alzheimer's disease in DS. Recent gains in epidemiological and pathophysiological understanding contrast with a dearth of evidence on treatment for most of these disorders. CONCLUSION In view of the complexity of DS-associated morbidity, it would be desirable for DS-specific multidisciplinary care to be made available to patients with DS.
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Affiliation(s)
- Johannes Levin
- Department of Neurology, Klinikum der Ludwig-Maximilians-Universität München, Munich, Germany
- German Center for Neurodegenerative Diseases e. V. (DZNE) Munich, Germany
- Munich Cluster of Systems Neurology (SyNergy)
| | - Alkomiet Hasan
- Department of Psychiatry, Psychotherapy, and Psychosomatics, Faculty of Medicine, University of Augsburg, District Hospital Augsburg, Germany
| | - Irene Alba Alejandre
- Department of Neurology, Klinikum der Ludwig-Maximilians-Universität München, Munich, Germany
| | - Irene Lorenzi
- Department of Gynecology and Obstetrics, Klinikum der Ludwig-Maximilians-Universität München, Munich, Germany
- Hamburg Epilepsy Center, Protestant Hospital Alsterdorf, Department of Neurology and Epileptology, Hamburg, Germany
| | - Volker Mall
- KBO Kinderzentrum München and Department of Sociopaediatrics at Munich Technical University (TMU), Munich, Germany
| | - Tilman R. Rohrer
- Division of Pediatric Endocrinology, University Children‘s Hospital, Saarland University Medical Center, Homburg, Germany
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Levin J, Hasan A, Alejandre IA, Lorenzi I, Mall V, Rohrer TR. Diseases affecting middle-aged and elderly individuals with trisomy 21. Deutsches Ärzteblatt international 2023. [DOI: 10.3238/arztebl.m2022.03711] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
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Büttner BR, Tittel SR, Kamrath C, Karges B, Köstner K, Melmer A, Müller‐Roßberg E, Richter F, Rohrer TR, Holl RW. Type 1 diabetes mellitus and SARS-CoV-2 in pediatric and adult patients - Data from the DPV network. J Diabetes 2022; 14:758-766. [PMID: 36443963 PMCID: PMC9705805 DOI: 10.1111/1753-0407.13332] [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] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/08/2022] [Revised: 10/21/2022] [Accepted: 10/25/2022] [Indexed: 11/30/2022] Open
Abstract
BACKGROUND Data on patients with type 1 diabetes mellitus (T1DM) and severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infections are sparse. This study aimed to investigate the association between SARS-CoV-2 infection and T1DM. METHODS Data from the Prospective Diabetes Follow-up (DPV) Registry were analyzed for diabetes patients tested for SARS-CoV-2 by polymerase chain reaction (PCR) in Germany, Austria, Switzerland, and Luxembourg during January 2020-June 2021, using Wilcoxon rank-sum and chi-square tests for continuous and dichotomous variables, adjusted for multiple testing. RESULTS Data analysis of 1855 pediatric T1DM patients revealed no differences between asymptomatic/symptomatic infected and SARS-CoV-2 negative/positive patients regarding age, new-onset diabetes, diabetes duration, and body mass index. Glycated hemoglobin A1c (HbA1c) and diabetic ketoacidosis (DKA) rate were not elevated in SARS-CoV-2-positive vs. -negative patients. The COVID-19 manifestation index was 37.5% in individuals with known T1DM, but 57.1% in individuals with new-onset diabetes. 68.8% of positively tested patients were managed as outpatients/telemedically. Data analysis of 240 adult T1MD patients revealed no differences between positively and negatively tested patients except lower HbA1c. Of these patients, 83.3% had symptomatic infections; 35.7% of positively tested patients were hospitalized. CONCLUSIONS Our results indicate low morbidity in SARS-CoV-2-infected pediatric T1DM patients. Most patients with known T1DM and SARS-CoV-2 infections could be managed as outpatients. However, SARS-CoV-2 infection was usually symptomatic if it coincided with new-onset diabetes. In adult patients, symptomatic SARS-CoV-2 infection and hospitalization were associated with age.
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Affiliation(s)
| | - Sascha René Tittel
- Institute for Epidemiology and Medical Biometry, Zentralinstitut für Biomedizinische Technik (ZIBMT)Ulm UniversityUlmGermany
- German Center for Diabetes Research (DZD)Munich‐NeuherbergGermany
| | - Clemens Kamrath
- Center of Child and Adolescent MedicineJustus Liebig UniversityGiessenGermany
| | - Beate Karges
- Division of Endocrinology and Diabetes, Medical FacultyRWTH Aachen UniversityAachenGermany
| | - Katharina Köstner
- German Center for Pediatric and Adolescent RheumatologyGarmisch‐PartenkirchenGermany
| | - Andreas Melmer
- Department of Diabetes, Endocrinology, Clinical Nutrition and Metabolism, Inselspital, Bern University HospitalUniversity of BernBernSwitzerland
| | - Elke Müller‐Roßberg
- Department of Pediatric Endocrinology and DiabetesChildren's HospitalEsslingenGermany
| | - Friederike Richter
- Department of PediatricsGarmisch‐Partenkirchen Medical CenterGarmisch‐PartenkirchenGermany
| | - Tilman R. Rohrer
- Department of PediatricsSaarland University Medical CenterHomburgSaarGermany
| | - Reinhard W. Holl
- Institute for Epidemiology and Medical Biometry, Zentralinstitut für Biomedizinische Technik (ZIBMT)Ulm UniversityUlmGermany
- German Center for Diabetes Research (DZD)Munich‐NeuherbergGermany
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Gund MP, Bucher M, Hannig M, Rohrer TR, Rupf S. Oral hygiene knowledge versus behavior in children: A questionnaire‐based, interview‐style analysis and on‐site assessment of toothbrushing practices. Clin Exp Dent Res 2022; 8:1167-1174. [PMID: 35713561 PMCID: PMC9562490 DOI: 10.1002/cre2.607] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2021] [Revised: 05/27/2022] [Accepted: 05/28/2022] [Indexed: 11/08/2022] Open
Abstract
Objectives Oral hygiene plays an important role in eliminating biofilms and preventing dental caries. However, the implementation of oral health knowledge that children learn from their parents and through school dental health programmes remains poorly studied. This study aimed to investigate oral hygiene knowledge and its practical utilization in children and young adolescents (CYAs) aged 2–15 years. Material and methods This was a questionnaire‐based, interview‐style community survey and on‐site practical assessment of CYAs' toothbrushing skills conducted during two 1‐day public science‐promoting events held at a major German university hospital in consecutive years. CYAs first answered questions on toothbrushing frequency, dental aids used, and dental care. They subsequently underwent diagnostic staining and demonstrated their brushing technique and method. CYAs' responses (percentages) to questionnaire items addressing oral hygiene knowledge and practice, and on‐site assessment of toothbrushing skills served as the main outcome measures. Results Of 244 participating CYAs, 178 (73%) CYAs had no caries experience, the percentage increasing with age from 5% in 2–5‐year‐olds to 40% in those aged > 10 years. Of 117/244 (48%) indicating that teeth should be brushed three times daily, 80/117 (68%) self‐reported twice‐daily brushing, 32/117 (27%) reported brushing three times, and 4/117 (3%) stated doing so only once. Although 131/244 (54%) considered that teeth should be brushed for 3 min, 77/131 (59%) self‐reported actually doing so and 41/131 (31%) reported brushing for 2min. Seventeen of 42 (40%) participants aged > 10 years showed no systematic brushing method, with 21/42 (50%) failing to clean their teeth completely. Participants aged 6–10 years exhibited the highest proportion (97/134, 72%) of complete cleaning. One hundred and forty‐six of 244 (60%) of CYAs knew about floss; 63/134 (43%) reported using it. Good adherence to oral health recommendations (i.e., brushing ≥ 2/day for ≥2min) was observed in 212/244 (87%) CYAs, the remaining 32/244 (13%) exhibiting poor adherence. Conclusion CYAs knew about the importance of oral hygiene and cleaned their teeth frequently. However, translation of their knowledge into practice showed deficiencies. Repeated encouragement to put oral health knowledge into practice is important.
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Affiliation(s)
- Madline P. Gund
- Clinic Department of Operative Dentistry, Periodontology and Preventive Dentistry Saarland University Homburg Germany
| | - Marina Bucher
- Clinic Department of Operative Dentistry, Periodontology and Preventive Dentistry Saarland University Homburg Germany
| | - Matthias Hannig
- Clinic Department of Operative Dentistry, Periodontology and Preventive Dentistry Saarland University Homburg Germany
| | - Tilman R. Rohrer
- University Children's Hospital, Saarland University Medical Centre Homburg Germany
| | - Stefan Rupf
- Clinic Department of Operative Dentistry, Periodontology and Preventive Dentistry Saarland University Homburg Germany
- Department of Synoptic Dentistry Saarland University Homburg Germany
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Hammersen J, Reschke F, Tittel SR, Pappa A, Dost A, Köstner K, Rosenbauer J, Kapellen TM, Rohrer TR, Holl RW. Metabolic control during the SARS-CoV-2 lockdown in a large German cohort of pediatric patients with type 1 diabetes: Results from the DPV initiative. Pediatr Diabetes 2022; 23:351-361. [PMID: 35084805 DOI: 10.1111/pedi.13319] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [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: 12/07/2021] [Accepted: 01/17/2022] [Indexed: 12/15/2022] Open
Abstract
OBJECTIVE To assess if metabolic control worsened during the SARS-CoV2 lockdown in spring 2020 in youth with type 1 diabetes (T1D) in Germany. METHODS Data from 19,729 pediatric T1D patients from the diabetes prospective follow-up (DPV) registry were available. Data sets from four time-periods between January 1 and June 30, 2020, were compared with data from the whole year 2019 in the same patient; differences were adjusted for seasonality, increasing age, and longer diabetes duration. HbA1c values from laboratory measurements and estimates derived from continuous glucose monitoring (CGM) were aggregated into a combined glucose indicator (CGI), expressed in analogy to HbA1c. RESULTS Based on regression models adjusted for differences of sex, age, diabetes duration, and migratory background between the four time-periods, CGI values in 2020 were slightly higher than in 2019, for example, by 0.044% (0.042-0.046) (median [95% CI]) in the second lockdown month, time-period 3. Insulin dose and BMI-SDS were also marginally higher. In 2020, there were fewer hospitalizations (e.g., incidence risk ratio in time-period 3 compared with 2019: 0.52 [95% CI: 0.46-0.58]). In a subgroup of patients reporting CGM data in both years, metrics in 2020 improved: time in target increased, and mean sensor glucose fell, for example, by 2.8% (2.7-2.9), and by 4.4 mg/dl (4.3-4.6) in time-period 3. CONCLUSION Before, during, and after the lockdown in spring 2020, metabolic control in youth with T1D in Germany did not differ significantly from the preceding year. Further effects of the ongoing pandemic on pediatric T1D patients need to be evaluated.
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Affiliation(s)
- Johanna Hammersen
- Department of Pediatrics, University Hospital Erlangen, Erlangen, Germany
| | - Felix Reschke
- Diabetes Center for Children and Adolescents, Children's Hospital Auf der Bult, Hannover, Germany
| | - Sascha R Tittel
- Institute of Epidemiology and Medical Biometry, ZIBMT, Ulm University, Ulm, Germany.,German Center for Diabetes Research (DZD), Munich-Neuherberg, Germany
| | - Angeliki Pappa
- Department of Pediatrics, University Hospital RWTH Aachen, Aachen, Germany
| | - Axel Dost
- Department of Pediatrics, University Hospital Jena, Jena, Germany
| | - Katharina Köstner
- German Center for Pediatric and Adolescent Rheumatology, Garmisch-Partenkirchen, Germany
| | - Joachim Rosenbauer
- German Center for Diabetes Research (DZD), Munich-Neuherberg, Germany.,Institute for Biometrics and Epidemiology, German Diabetes Center, Leibniz Center for Diabetes Research, Heinrich-Heine University Düsseldorf, Düsseldorf, Germany
| | - Thomas M Kapellen
- Hospital for Children and Adolescents, University of Leipzig, Leipzig, Germany.,Median Children's Hospital "Am Nicolausholz", Bad Kösen, Germany
| | - Tilman R Rohrer
- Department of Pediatrics, Saarland University Medical Center, Homburg, Germany
| | - Reinhard W Holl
- Institute of Epidemiology and Medical Biometry, ZIBMT, Ulm University, Ulm, Germany.,German Center for Diabetes Research (DZD), Munich-Neuherberg, Germany
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Hüls A, Feany PT, Zisman SI, Costa ACS, Dierssen M, Balogh R, Bargagna S, Baumer NT, Brandão AC, Carfi A, Chicoine BA, Ghosh S, Lakhanpaul M, Levin J, Lunsky Y, Manso C, Okun E, Real de Asua D, Rebillat AS, Rohrer TR, Sgandurra G, Valentini D, Sherman SL, Strydom A. COVID-19 Vaccination of Individuals with Down Syndrome-Data from the Trisomy 21 Research Society Survey on Safety, Efficacy, and Factors Associated with the Decision to Be Vaccinated. Vaccines (Basel) 2022; 10:530. [PMID: 35455279 PMCID: PMC9030605 DOI: 10.3390/vaccines10040530] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2022] [Revised: 03/20/2022] [Accepted: 03/23/2022] [Indexed: 01/27/2023] Open
Abstract
Individuals with Down syndrome (DS) are among the groups with the highest risk for severe COVID-19. Better understanding of the efficacy and risks of COVID-19 vaccines for individuals with DS may help improve uptake of vaccination. The T21RS COVID-19 Initiative launched an international survey to obtain information on safety and efficacy of COVID-19 vaccines for individuals with DS. De-identified survey data collected between March and December 2021 were analyzed. Of 2172 individuals with DS, 1973 (91%) had received at least one vaccine dose (57% BNT162b2), 107 (5%) were unvaccinated by choice, and 92 (4%) were unvaccinated for other reasons. Most participants had either no side effects (54%) or mild ones such as pain at the injection site (29%), fatigue (12%), and fever (7%). Severe side effects occurred in <0.5% of participants. About 1% of the vaccinated individuals with DS contracted COVID-19 after vaccination, and all recovered. Individuals with DS who were unvaccinated by choice were more likely to be younger, previously recovered from COVID-19, and also unvaccinated against other recommended vaccines. COVID-19 vaccines have been shown to be safe for individuals with DS and effective in terms of resulting in minimal breakthrough infections and milder disease outcomes among fully vaccinated individuals with DS.
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Affiliation(s)
- Anke Hüls
- Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, GA 30322, USA;
- Gangarosa Department of Environmental Health, Rollins School of Public Health, Emory University, Atlanta, GA 30322, USA
| | - Patrick T. Feany
- Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, GA 30322, USA;
| | | | - Alberto C. S. Costa
- Department of Psychiatry, Case Western Reserve University, Cleveland, OH 44106, USA;
- Department of Macromolecular Science and Engineering, Case Western Reserve University, Cleveland, OH 44106, USA
| | - Mara Dierssen
- Centre for Genomic Regulation (CRG), The Barcelona Institute of Science and Technology, Universitat Pompeu Fabra, 08016 Barcelona, Spain;
- Universitat Pompeu Fabra (UPF), 08016 Barcelona, Spain
- Centrode Investigación Biomédica en Red de Enfermedades Raras (CIBERER), 08016 Barcelona, Spain
| | - Robert Balogh
- Faculty of Health Sciences, Ontario Tech University, Oshawa, ON L1G 0C5, Canada;
| | - Stefania Bargagna
- Department of Developmental Neuroscience, IRCCS Fondazione Stella Maris, 56128 Calambrone, Italy; (S.B.); (G.S.)
| | - Nicole T. Baumer
- Department of Neurology, Division of Developmental Medicine, Department of Pediatrics, Boston Children’s Hospital, Harvard Medical School, Boston, MA 02115, USA;
| | | | - Angelo Carfi
- Policlinico Universitario Agostino Gemelli IRCCS, 00100 Rome, Italy;
| | | | - Sujay Ghosh
- Cytogenetics and Genomics Research Unit, Department of Zoology, University of Calcutta, Kolkata 700073, India;
| | - Monica Lakhanpaul
- Department of Population Policy and Practice, UCL Great Ormond Street Institute of Child Health, University College, London WC1N 1EH, UK;
- Community Paediatrics, Whittington Health NHS, London N19 5NF, UK
| | - Johannes Levin
- Department of Neurology, Ludwig-Maximilians-Universität München, 80539 Munich, Germany;
- German Center for Neurodegenerative Diseases, Site Munich, 53127 Munich, Germany
- Munich Cluster for Systems Neurology (SyNergy), 81377 Munich, Germany
| | - Yona Lunsky
- Azrieli Adult Neurodevelopmental Centre, CAMH, Temerty Faculty of Medicine, University of Toronto, Toronto, ON M5S 1A1, Canada;
| | | | - Eitan Okun
- The Paul Feder Laboratory on Alzheimer’s Disease Research, Bar Ilan University, Ramat Gan 5290002, Israel;
- The Gonda Brain Research Center, Bar Ilan University, Ramat Gan 5290002, Israel
- The Mina and Everard Goodman Faculty of Life Sciences, Bar Ilan University, Ramat Gan 5290002, Israel
| | - Diego Real de Asua
- Department of Internal Medicine and Instituto de Investigación Biomédica-La Princesa, Hospital Universitario de La Princesa, 28001 Madrid, Spain;
| | | | - Tilman R. Rohrer
- Division of Pediatric Endocrinology, Department of Pediatrics and Neonatology, Saarland University Medical Center, 66424 Homburg, Germany;
| | - Giuseppina Sgandurra
- Department of Developmental Neuroscience, IRCCS Fondazione Stella Maris, 56128 Calambrone, Italy; (S.B.); (G.S.)
- Department of Clinical and Experimental Medicine, University of Pisa, 56126 Pisa, Italy
| | - Diletta Valentini
- Pediatric Unit, Pediatric Emergency Department, Bambino Gesù Children’s Hospital, IRCCS, 00165 Rome, Italy;
| | - Stephanie L. Sherman
- Department of Human Genetics, School of Medicine, Emory University, Atlanta, GA 30322, USA;
| | - Andre Strydom
- South London and Maudsley NHS Foundation Trust, London SE5 8AZ, UK; (S.I.Z.); (A.S.)
- Department of Forensic and Neurodevelopmental Sciences, Institute of Psychiatry, Psychology, and Neuroscience, King’s College London, London SE5 8AB, UK
- The London Down Syndrome (LonDownS) Consortium, London SE5 8AB, UK
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10
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Romano A, Kaski JP, Dahlgren J, Kelepouris N, Pietropoli A, Rohrer TR, Polak M. Cardiovascular safety of growth hormone treatment in Noonan syndrome: real-world evidence. Endocr Connect 2022; 11:EC-21-0549.R1. [PMID: 34939937 PMCID: PMC8859970 DOI: 10.1530/ec-21-0549] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [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: 12/17/2021] [Accepted: 12/22/2021] [Indexed: 11/08/2022]
Abstract
OBJECTIVE The study aims to assess the cardiovascular safety of growth hormone (GH) treatment in patients with Noonan syndrome (NS) in clinical practice. DESIGN The study design involves two observational, multicentre studies (NordiNet® IOS and the ANSWER Program) evaluating the long-term effectiveness and safety of GH in >38,000 paediatric patients, of which 421 had NS. METHODS Serious adverse events, serious adverse reactions (SARs) and non-serious adverse reactions (NSARs) were reported by the treating physicians. Cardiovascular comorbidities at baseline and throughout the studies were also recorded. RESULTS The safety analysis set comprised 412 children with NS (29.1% females), with a mean (s.d.) baseline age of 9.29 (3.88) years, treated with an average GH dose of 0.047 (0.014) mg/kg/day during childhood. Cardiovascular comorbidities at baseline were reported in 48 (11.7%), most commonly pulmonary valve stenosis (PVS) and atrial septal defects. Overall, 22 (5.3%) patients experienced 34 safety events. The most common were the NSARs: headache (eight events in seven patients) and arthralgia (five events in three patients). Two SARs occurred in one patient (brain neoplasm and metastases to spine). No cardiovascular safety events were recorded in patients with NS. Five cardiovascular comorbidities in five patients were reported after initiation of GH treatment: three cases of unspecified cardiovascular disease, one ruptured abdominal aortic aneurysm and one PVS. CONCLUSIONS GH treatment had a favourable safety profile in patients with NS, including those with cardiovascular comorbidities. Prospective studies are warranted to systematically assess the safety of GH treatment in patients with NS and cardiovascular disease.
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Affiliation(s)
- Alicia Romano
- Department of Pediatrics, New York Medical College, Valhalla, New York, USA
| | - Juan Pablo Kaski
- Centre for Inherited Cardiovascular Diseases, Great Ormond Street Hospital & UCL Institute of Cardiovascular Science, London, UK
- Correspondence should be addressed to J P Kaski:
| | - Jovanna Dahlgren
- Department of Paediatrics, Region Västra Götaland, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Nicky Kelepouris
- US Medical Affairs, Novo Nordisk Inc., Plainsboro, New Jersey, USA
| | - Alberto Pietropoli
- Global Medical Affairs, Novo Nordisk Health Care AG, Zurich, Switzerland
| | - Tilman R Rohrer
- Department of Pediatric Endocrinology, University Children’s Hospital, Saarland University Medical Center, Homburg, Germany
| | - Michel Polak
- Paediatric Endocrinology, Diabetology and Gynaecology Department, Hôpital Universitaire Necker Enfants-Malades, AP-HP, Université de Paris, Imagine Institute, Paris, France
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11
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Redlich A, Luster M, Lorenz K, Lessel L, Rohrer TR, Schmid KW, Frühwald MC, Vorwerk P, Kuhlen M. Age, American Thyroid Association Risk Group, and Response to Therapy Are Prognostic Factors in Children With Differentiated Thyroid Cancer. J Clin Endocrinol Metab 2022; 107:e165-e177. [PMID: 34415989 DOI: 10.1210/clinem/dgab622] [Citation(s) in RCA: 15] [Impact Index Per Article: 7.5] [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: 07/02/2021] [Indexed: 12/27/2022]
Abstract
CONTEXT Against the background of increasing incidence, pediatric differentiated thyroid carcinoma (DTC) frequently presents with advanced disease and high recurrence rates while prognosis remains excellent. BACKGROUND We investigated the use of a pediatric classification and an adult response to therapy risk stratification for pediatric DTC patients and their implications for adaptation of treatment and follow-up. METHODS Data from patients aged <18 years with a diagnosis of primary DTC, registered with the German Pediatric Oncology Hematology-Malignant Endocrine Tumor registry since 1995, were analyzed. For risk prediction, patients were retrospectively assigned to the American Thyroid Association (ATA) risk groups and evaluated for response to therapy. RESULTS By October 2019, 354 patients with DTC had been reported (median age at diagnosis 13.7 years, range 3.6-17.9) with lymph node and distant metastases in 74.3% and 24.5%. Mean follow-up was 4.1 years (range 0-20.6). Ten-year overall and event-free survival (EFS) rates were 98.9% and 78.1%. EFS was impaired for patients with lymph node and distant metastases (P < .001), positive postoperative thyroglobulin (P = .006), incomplete resection (P = .002), sequential surgeries to achieve total thyroidectomy (P = .042), invasion of capsule (P < .001) and lymph vessels (P = .005), infiltration of surrounding soft tissues (P < .001), tumor multifocality (P < .001), ATA intermediate- and high-risk group (P < .001), and age <10 years (P < .001). Multivariate analysis revealed age <10 years at diagnosis, ATA high-risk level, and poor response to therapy as significant negative prognostic factors for EFS. CONCLUSION Age, ATA risk group, and response to therapy emerged as significant prognostic factors for EFS in pediatric patients with DTC, requiring risk-adapted individualized therapy and follow-up.
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Affiliation(s)
- Antje Redlich
- Pediatric Oncology Department, Otto von Guericke University Children's Hospital, Magdeburg, Germany
| | - Markus Luster
- Department of Nuclear Medicine, University Hospital Marburg, Marburg, Germany
| | - Kerstin Lorenz
- Department of Visceral, Vascular and Endocrine Surgery, Martin Luther University Halle-Wittenberg, Halle (Saale), Germany
| | - Lienhard Lessel
- Pediatric Oncology Department, Otto von Guericke University Children´s Hospital, Magdeburg, Germany
| | - Tilman R Rohrer
- Department of Pediatric Endocrinology, University Children's Hospital, Saarland University Medical Center, Homburg, Germany
| | - Kurt W Schmid
- Institute of Pathology, University Hospital Essen, University of Duisburg-Essen, Essen, Germany
| | - Michael C Frühwald
- Paediatric and Adolescent Medicine, University Medical Center Augsburg, Germany
| | - Peter Vorwerk
- Pediatric Oncology Department, Otto von Guericke University Children´s Hospital, Magdeburg, Germany
| | - Michaela Kuhlen
- Paediatric and Adolescent Medicine, University Medical Center Augsburg, Germany
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12
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Emes D, Hüls A, Baumer N, Dierssen M, Puri S, Russell L, Sherman SL, Strydom A, Bargagna S, Brandão AC, Costa ACS, Feany PT, Chicoine BA, Ghosh S, Rebillat AS, Sgandurra G, Valentini D, Rohrer TR, Levin J, Lakhanpaul M. COVID-19 in Children with Down Syndrome: Data from the Trisomy 21 Research Society Survey. J Clin Med 2021; 10:5125. [PMID: 34768645 PMCID: PMC8584980 DOI: 10.3390/jcm10215125] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2021] [Revised: 10/21/2021] [Accepted: 10/27/2021] [Indexed: 12/31/2022] Open
Abstract
Adults with Down Syndrome (DS) are at higher risk for severe outcomes of coronavirus disease 2019 (COVID-19) than the general population, but evidence is required to understand the risks for children with DS, which is necessary to inform COVID-19 shielding advice and vaccination priorities. We aimed to determine the epidemiological and clinical characteristics of COVID-19 in children with DS. Using data from an international survey obtained from a range of countries and control data from the United States, we compared the prevalence of symptoms and medical complications and risk factors for severe outcomes between DS and non-DS paediatric populations with COVID-19. Hospitalised COVID-19 patients <18 years with DS had a higher incidence of respiratory symptoms, fever, and several medical complications from COVID-19 than control patients without DS <18 years. Older age, obesity, and epilepsy were significant risk factors for hospitalisation among paediatric COVID-19 patients with DS, and age and thyroid disorder were significant risk factors for acute respiratory distress syndrome. Mortality rates were low in all paediatric COVID-19 patients (with and without DS), contrasting with previous findings in adults with DS (who exhibit higher mortality than those without DS). Children with DS are at increased risk for more severe presentations of COVID-19. Efforts should be made to ensure the comprehensive and early detection of COVID-19 in this population and to identify children with DS who present comorbidities that pose a risk for a severe course of COVID-19. Our results emphasize the importance of vaccinating children with DS as soon as they become eligible.
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Affiliation(s)
- David Emes
- Department of Infectious Disease Epidemiology, Faculty of Epidemiology and Public Health, London School of Hygiene and Tropical Medicine, London WC1E 7HT, UK;
| | - Anke Hüls
- Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, GA 30322, USA; (A.H.); (L.R.); (P.T.F.)
- Gangarosa Department of Environmental Health, Rollins School of Public Health, Emory University, Atlanta, GA 30322, USA
| | - Nicole Baumer
- Boston Children’s Hospital, Harvard Medical School, Boston, MA 02115, USA;
| | - Mara Dierssen
- Centre for Genomic Regulation (CRG), The Barcelona Institute of Science and Technology, 08003 Barcelona, Spain;
- Universitat Pompeu Fabra (UPF), 08002 Barcelona, Spain
- Centro de Investigación Biomédica en Red de Enfermedades Raras (CIBERER), 28029 Madrid, Spain
| | - Shiela Puri
- Down Syndrome Medical Interest Group UK, Leeds Community Healthcare NHS Trust, Teddington TW11 9PS, UK;
| | - Lauren Russell
- Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, GA 30322, USA; (A.H.); (L.R.); (P.T.F.)
| | - Stephanie L. Sherman
- Department of Human Genetics, School of Medicine, Emory University, Atlanta, GA 30322, USA;
| | - Andre Strydom
- Department of Forensic and Neurodevelopmental Sciences, Institute of Psychiatry, Psychology, and Neuroscience, King’s College London, London WC2R 2LS, UK;
- The London Down Syndrome (LonDownS) Consortium, London WC2R 2LS, UK
- South London and the Maudsley NHS Foundation Trust, London WC2R 2LS, UK
| | - Stefania Bargagna
- Department of Developmental Neuroscience, IRCCS Fondazione Stella Maris, 56128 Pisa, Italy; (S.B.); (G.S.)
| | | | - Alberto C. S. Costa
- Departments of Pediatrics and of Psychiatry, School of Medicine, Case Western Reserve University, ACSC, Cleveland, OH 44106, USA;
| | - Patrick T. Feany
- Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, GA 30322, USA; (A.H.); (L.R.); (P.T.F.)
| | | | - Sujay Ghosh
- Cytogenetics and Genomics Research Unit, Department of Zoology, University of Calcutta, Kolkata 700 073, West Bengal, India;
| | | | - Giuseppina Sgandurra
- Department of Developmental Neuroscience, IRCCS Fondazione Stella Maris, 56128 Pisa, Italy; (S.B.); (G.S.)
- Department of Clinical and Experimental Medicine, University of Pisa, 56126 Pisa, Italy
| | - Diletta Valentini
- Pediatric Unit, Bambino Gesù Children’s Hospital, IRCCS, 00146 Rome, Italy;
| | - Tilman R. Rohrer
- Division of Pediatric Endocrinology, Saarland University Medical Center, 66421 Homburg/Saar, Germany;
| | - Johannes Levin
- Department of Neurology, Ludwig-Maximilians-Universität München, 80539 Munich, Germany;
- German Center for Neurodegenerative Diseases, Site Munich, 81377 Munich, Germany
- Munich Cluster for Systems Neurology (SyNergy), 81377 Munich, Germany
| | - Monica Lakhanpaul
- Population, Policy and Practice Department, Great Ormond Street Institute of Child Health, UCL, London WC1N 1EH, UK
- Whittington NHS Trust, London N19 5NF, UK
- Down Syndrome Medical Interest Group, Teddington TW11 9PS, UK
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13
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Rohrer TR, Abuzzahab J, Backeljauw P, Birkegård AC, Blair J, Dahlgren J, Júlíusson PB, Ostrow V, Pietropoli A, Polak M, Romano A, Ross J, Sävendahl L, Miller BS. Long-Term Effectiveness and Safety of Childhood Growth Hormone Treatment in Noonan Syndrome. Horm Res Paediatr 2021; 93:380-395. [PMID: 33440388 DOI: 10.1159/000512429] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [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: 12/24/2019] [Accepted: 09/25/2020] [Indexed: 11/19/2022] Open
Abstract
INTRODUCTION Few data exist on long-term growth hormone (GH) treatment in patients with Noonan syndrome (NS). OBJECTIVE To evaluate the effectiveness and safety of GH treatment in NS in clinical practice. METHODS Height gain, near-adult height (NAH), and safety were assessed in 2 complementary non-interventional studies: NordiNet® IOS and ANSWER. The safety analysis included 412 patients, and the effectiveness analysis included 84 GH-treated patients (male, n = 67) with ≥4 years' height standard deviation score (HSDS) data. HSDS was determined using national reference (NR) and NS-specific (NSS) data. RESULTS The mean (SD) baseline age was 8.38 (3.57) years; HSDS, -2.76 (1.03); GH dose, 41.6 (11.1) µg/kg/day. The mean (SD) HSDS increase from baseline (ΔHSDS) was 0.49 (0.37) (first year), 0.79 (0.58) (second year), and 1.01 (0.60) (third year) (NR). The mean (SD) HSDS at year 3 was -1.66 (1.00) (NR; 1.06 [1.12] [NSS]). Twenty-four patients achieved NAH. The mean (SD) NAH SDS (NR) was -1.51 (0.60) (154.90 [3.21] cm) in females and -1.79 (1.09) (165.61 [7.19] cm) in males; 70.8% (17/24) had NAH SDS ≥ -2. Adverse drug reactions and GH-unrelated serious adverse events (n = 34) were reported in 22/412 (5.3%) patients. Four neoplasms and 3 cases of scoliosis were reported; no cardiovascular adverse events occurred. CONCLUSIONS GH-treated children with NS achieved substantial height gain during the first 3 years of follow-up. Overall, 24 patients achieved NAH, with 70.8% having NAH SDS ≥ -2. There was no evidence to support a higher prevalence of neoplasm, or cardiac or other comorbidities.
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Affiliation(s)
- Tilman R Rohrer
- Department of Pediatric Endocrinology, University Children's Hospital, Saarland University Medical Center, Homburg, Germany,
| | - Jennifer Abuzzahab
- Diabetes and Endocrine Center, Children's Hospital & Clinics of Minnesota, Saint Paul, Minnesota, USA
| | - Philippe Backeljauw
- Cincinnati Children's Hospital Medical Center, University of Cincinnati College of Medicine, Cincinnati, Ohio, USA
| | | | - Joanne Blair
- Department of Paediatric Endocrinology, Alder Hey Children's NHS Foundation Trust, Liverpool, United Kingdom
| | - Jovanna Dahlgren
- Department of Paediatrics, Region Västra Götaland, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Pétur Benedikt Júlíusson
- Department of Paediatrics, Haukeland University Hospital, Bergen, Norway.,Department of Health Registry Research and Development, National Institute of Public Health, Bergen, Norway.,Department of Clinical Science, University of Bergen, Bergen, Norway
| | - Vlady Ostrow
- Medical Affairs, Novo Nordisk Inc., Princeton, New Jersey, USA
| | - Alberto Pietropoli
- Global Medical Affairs, Novo Nordisk Health Care AG, Zurich, Switzerland
| | - Michel Polak
- Paediatric Endocrinology, Diabetology and Gynaecology Department, Necker Children's University Hospital, Imagine Institute, Paris, France
| | - Alicia Romano
- Department of Pediatrics, New York Medical College, Valhalla, New York, USA
| | - Judith Ross
- Nemours DuPont Hospital for Children and Department of Pediatrics, Thomas Jefferson University, Philadelphia, Pennsylvania, USA
| | - Lars Sävendahl
- Pediatric Endocrinology, Karolinska University Hospital and Department of Women´s and Children´s Health, Karolinska Institutet, Solna, Sweden
| | - Bradley S Miller
- Pediatric Endocrinology, University of Minnesota Masonic Children's Hospital, Minneapolis, Minnesota, USA
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14
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Gund MP, Boros G, Hannig M, Thieme-Ruffing S, Gärtner B, Rohrer TR, Simon A, Rupf S. Bacterial contamination of forehead skin and surgical mask in aerosol-producing dental treatment. J Oral Microbiol 2021; 13:1978731. [PMID: 34567438 PMCID: PMC8462870 DOI: 10.1080/20002297.2021.1978731] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
Background Bacterial contamination of dental professionals’ facial skin and protective equipment from treatment-related aerosols and droplets are poorly studied. Methods This prospective study analyzed samples from 67 consecutive aerosol-producing dental treatments. Sterile nylon swabs served to collect samples from dental professionals’ foreheads before and after exposure. Contact samples were obtained from used surgical masks. Samples were incubated on agar under aerobic and anaerobic conditions. Bacteria were classified by MALDI-TOF mass spectrometry. We determined the frequencies of obligate and facultative oral bacteria and scored bacterial growth (0: none; 1: < 100 colonies; 2: >100 colonies; 3: dense). Results Bacteria were detected in 95% of skin-swab and 76% of mask samples. Median bacterial scores were 2 for forehead samples before and after treatment, and 1 for masks. Obligate and facultative oral bacteria were more frequent (6% and 30%) in samples from exposed forehead skin, which also showed increased bacterial scores (28%). 5% of samples contained methicillin-sensitive Staphylococcus aureus; 3% contained obligate anaerobes. Conclusion Exposed forehead skin was significantly less contaminated with obligate oral bacteria than expected based on surgical mask findings. Exposed forehead skin showed increased contamination attributable to aerosol-producing procedures. The forehead’s physiological skin microbiota may offer some protection against bacterial contamination.
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Affiliation(s)
- Madline P Gund
- Clinic Department of Operative Dentistry, Periodontology and Preventive Dentistry, Saarland University, Homburg, Germany.,Oral Surgery Clinic, German Armed Forces Central Hospital; Koblenz, Germany
| | - Gabor Boros
- Oral Surgery Clinic, German Armed Forces Central Hospital; Koblenz, Germany
| | - Matthias Hannig
- Clinic Department of Operative Dentistry, Periodontology and Preventive Dentistry, Saarland University, Homburg, Germany
| | - Sigrid Thieme-Ruffing
- Institute of Medical Microbiology and Hygiene, Department of Hospital Hygiene, Saarland University, Homburg, Germany
| | - Barbara Gärtner
- Institute of Medical Microbiology and Hygiene, Department of Hospital Hygiene, Saarland University, Homburg, Germany
| | - Tilman R Rohrer
- University Children's Hospital, Saarland University Medical Center, Homburg, Germany
| | - Arne Simon
- University Children's Hospital, Saarland University Medical Center, Homburg, Germany
| | - Stefan Rupf
- Clinic Department of Operative Dentistry, Periodontology and Preventive Dentistry, Saarland University, Homburg, Germany.,Chair of Synoptic Dentistry, Saarland University, Homburg, Germany
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15
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Kamrath C, Rosenbauer J, Eckert AJ, Pappa A, Reschke F, Rohrer TR, Mönkemöller K, Wurm M, Hake K, Raile K, Holl RW. Incidence of COVID-19 and Risk of Diabetic Ketoacidosis in New-Onset Type 1 Diabetes. Pediatrics 2021; 148:peds.2021-050856. [PMID: 34011636 DOI: 10.1542/peds.2021-050856] [Citation(s) in RCA: 24] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 05/13/2021] [Indexed: 11/24/2022] Open
Abstract
OBJECTIVES With this study, our aim was to quantify the relative risk (RR) of diabetic ketoacidosis at diagnosis of type 1 diabetes during the year 2020 and to assess whether it was associated with the regional incidence of coronavirus disease 2019 (COVID-19) cases and deaths. METHODS Multicenter cohort study based on data from the German Diabetes Prospective Follow-up Registry. The monthly RR for ketoacidosis in 2020 was estimated from observed and expected rates in 3238 children with new-onset type 1 diabetes. Expected rates were derived from data from 2000 to 2019 by using a multivariable logistic trend regression model. The association between the regional incidence of COVID-19 and the rate of ketoacidosis was investigated by applying a log-binomial mixed-effects model to weekly data with Germany divided into 5 regions. RESULTS The observed versus expected frequency of diabetic ketoacidosis was significantly higher from April to September and in December (mean adjusted RRs, 1.48-1.96). During the first half of 2020, each increase in the regional weekly incidence of COVID-19 by 50 cases or 1 death per 100 000 population was associated with an increase in the RR of diabetic ketoacidosis of 1.40 (95% confidence interval, 1.10-1.77; P = .006) and 1.23 (1.14-1.32; P < .001), respectively. This association was no longer evident during the second half of 2020. CONCLUSIONS These findings suggest that the local severity of the pandemic rather than health policy measures appear to be the main reason for the increase in diabetic ketoacidosis and thus the delayed use of health care during the pandemic.
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Affiliation(s)
- Clemens Kamrath
- Division of Pediatric Endocrinology and Diabetology, Centre of Child and Adolescent Medicine, Justus Liebig University, Giessen, Germany
| | - Joachim Rosenbauer
- Institute for Biometrics and Epidemiology, German Diabetes Centre, Leibniz Centre for Diabetes Research at Heinrich Heine University Dusseldorf, Dusseldorf, Germany.,German Centre for Diabetes Research, Munich-Neuherberg, Germany
| | - Alexander J Eckert
- German Centre for Diabetes Research, Munich-Neuherberg, Germany.,Institute of Epidemiology and Medical Biometry, Ulm University, Ulm, Germany
| | - Angeliki Pappa
- Department of Pediatrics, University Hospital Rheinisch-Westfaelische Technische Hochschule Aachen, Aachen, Germany
| | - Felix Reschke
- Diabetes Centre for Children and Adolescents, Children's Hospital Auf der Bult, Hannover, Germany
| | - Tilman R Rohrer
- Department of Pediatrics, Saarland University, Homburg, Saarland, Germany
| | - Kirsten Mönkemöller
- Department of Pediatrics, Kinderkrankenhaus Amsterdamer Strasse, Cologne, Germany
| | - Michael Wurm
- Department of Pediatrics, Klinik St. Hedwig, University Hospital Regensburg, Krankenhaus Barmherzige Brüder, Regensburg, Germany
| | - Kathrin Hake
- Department of Pediatrics, Müritz Klinikum, Waren, Germany
| | - Klemens Raile
- Department of Pediatric Endocrinology and Diabetology, Charité, University Medicine Berlin, Germany
| | - Reinhard W Holl
- German Centre for Diabetes Research, Munich-Neuherberg, Germany.,Institute of Epidemiology and Medical Biometry, Ulm University, Ulm, Germany
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16
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Sävendahl L, Polak M, Backeljauw P, Blair JC, Miller BS, Rohrer TR, Hokken-Koelega A, Pietropoli A, Kelepouris N, Ross J. Long-Term Safety of Growth Hormone Treatment in Childhood: Two Large Observational Studies: NordiNet IOS and ANSWER. J Clin Endocrinol Metab 2021; 106:1728-1741. [PMID: 33571362 PMCID: PMC8118578 DOI: 10.1210/clinem/dgab080] [Citation(s) in RCA: 20] [Impact Index Per Article: 6.7] [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: 12/16/2020] [Indexed: 02/06/2023]
Abstract
CONTEXT Growth hormone (GH) treatment has a generally good safety profile; however, concerns about increased mortality risk in adulthood have been raised. OBJECTIVE This work aims to assess the long-term safety of GH treatment in clinical practice. METHODS Data were collected from 676 clinics participating in 2 multicenter longitudinal observational studies: the NordiNet International Outcome Study (2006-2016, Europe) and ANSWER Program (2002-2016, USA). Pediatric patients treated with GH were classified into 3 risk groups based on diagnosis. Intervention consisted of daily GH treatment, and main outcome measures included incidence rates (events/1000 patient-years) of adverse drug reactions (ADRs), serious adverse events (SAEs), and serious ADRs, and their relationship to GH dose. RESULTS The combined studies comprised 37 702 patients (68.4% in low-risk, 27.5% in intermediate-risk, and 4.1% in high-risk groups) and 130 476 patient-years of exposure. The low-risk group included children born small for gestational age (SGA; 20.7%) and non-SGA children (eg, with GH deficiency; 79.3%). Average GH dose up to the first adverse event (AE) decreased with increasing risk category. Patients without AEs received higher average GH doses than patients with more than one AE across all groups. A significant inverse relationship with GH dose was shown for ADR and SAE incidence rates in the low-risk group (P = .003 and P = .001, respectively) and the non-SGA subgroup (both P = .002), and for SAEs in the intermediate- and high-risk groups (P = .002 and P = .05, respectively). CONCLUSIONS We observed no indication of increased mortality risk nor AE incidence related to GH dose in any risk group. A short visual summary of our work is available (1).
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Affiliation(s)
- Lars Sävendahl
- Karolinska Institutet, Karolinska University Hospital, Solna, Sweden
- Correspondence: Lars Sävendahl, MD, PhD, Karolinska University Hospital J9:30, Visionsgatan 4, SE-171 64, Solna, Sweden.
| | - Michel Polak
- Université de Paris, Hôpital Universitaire Necker Enfants Malades, Paris, France
| | - Philippe Backeljauw
- Cincinnati Children’s Hospital Medical Center, University of Cincinnati College of Medicine, Cincinnati, Ohio, USA
| | - Joanne C Blair
- Alder Hey Children’s NHS Foundation Trust, Liverpool, UK
| | - Bradley S Miller
- University of Minnesota Masonic Children’s Hospital, Minneapolis, Minnesota, USA
| | - Tilman R Rohrer
- University Children’s Hospital, Saarland University Medical Center, Homburg, Germany
| | - Anita Hokken-Koelega
- Department of Pediatrics, Division of Endocrinology, Erasmus University Medical Center/Sophia Children’s Hospital, Rotterdam, the Netherlands
| | | | | | - Judith Ross
- Thomas Jefferson University, Philadelphia, Pennsylvania, USA
- Nemours/DuPont Hospital for Children, Wilmington, Delaware, USA
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Abd El Rahman M, Jung AM, Zemlin M, Rohrer TR, Schuck R, Oberhoffer FS, Abdul-Khaliq H. Left atrial remodelling among Turner syndrome patients: novel insights from non-invasive 3D echocardiography. Quant Imaging Med Surg 2021; 12:2634-2648. [DOI: 10.21037/qims-21-515] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2021] [Accepted: 11/23/2021] [Indexed: 11/06/2022]
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18
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Kamrath C, Mönkemöller K, Biester T, Rohrer TR, Warncke K, Hammersen J, Holl RW. Ketoacidosis in Children and Adolescents With Newly Diagnosed Type 1 Diabetes During the COVID-19 Pandemic in Germany. JAMA 2020; 324:801-804. [PMID: 32702751 PMCID: PMC7372511 DOI: 10.1001/jama.2020.13445] [Citation(s) in RCA: 207] [Impact Index Per Article: 51.8] [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: 12/11/2022]
Abstract
This study uses diabetes registry data to compare the frequency of diabetic ketoacidosis (DKA) in children and adolescents at time of type 1 diabetes diagnosis in Germany during the first 2 months of the coronavirus disease 2019 (COVID-19) pandemic vs the same time period in 2018 and 2019.
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Affiliation(s)
- Clemens Kamrath
- Center of Child and Adolescent Medicine, Justus Liebig University, Giessen, Germany
| | - Kirsten Mönkemöller
- Department of Pediatrics, Kinderkrankenhaus Amsterdamer Strasse, Cologne, Germany
| | - Torben Biester
- Diabetes Center for Children and Adolescents, Children’s Hospital Auf der Bult, Hannover, Germany
| | - Tilman R. Rohrer
- Department of Pediatrics, Saarland University Medical Center, Homburg/Saar, Germany
| | - Katharina Warncke
- Department of Pediatrics, Technical University of Munich School of Medicine, Munich, Germany
| | - Johanna Hammersen
- Department of Pediatrics, University Hospital Erlangen, Erlangen, Germany
| | - Reinhard W. Holl
- Institute of Epidemiology and Medical Biometry (ZIBMT), Ulm University, Ulm, Germany
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19
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Abu-Halima M, Oberhoffer FS, El Rahman MA, Jung AM, Zemlin M, Rohrer TR, Kahraman M, Keller A, Meese E, Abdul-Khaliq H. Insights from circulating microRNAs in cardiovascular entities in turner syndrome patients. PLoS One 2020; 15:e0231402. [PMID: 32271829 PMCID: PMC7145016 DOI: 10.1371/journal.pone.0231402] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2020] [Accepted: 03/23/2020] [Indexed: 12/15/2022] Open
Abstract
Background Turner syndrome (TS) is a chromosomal disorder, in which a female is partially or entirely missing one of the two X chromosomes, with a prevalence of 1:2500 live female births. The present study aims to identify a circulating microRNA (miRNA) signature for TS patients with and without congenital heart disease (CHD). Methods Microarray platform interrogating 2549 miRNAs were used to detect the miRNA abundance levels in the blood of 33 TS patients and 14 age-matched healthy volunteer controls (HVs). The differentially abundant miRNAs between the two groups were further validated by RT-qPCR. Results We identified 60 differentially abundant miRNA in the blood of TS patients compared to HVs, from which, 41 and 19 miRNAs showed a higher and a lower abundance levels in TS patients compared to HVs, respectively. RT-qPCR confirmed the significantly higher abundance levels of eight miRNAs namely miR-374b-5p, miR-199a-5p, miR-340-3p, miR-125b-5p, miR-30e-3p, miR-126-3p, miR-5695, and miR-26b-5p in TS patients as compared with the HVs. The abundance level of miR-5695 was higher in TS patients displaying CHD as compared to TS patients without CHD (p = 0.0265; log2-fold change 1.99); whereas, the abundance level of miR-126-3p was lower in TS patients with congenital aortic valve disease (AVD) compared to TS patients without BAV (p = 0.0139, log2-fold change 1.52). The clinical feature statistics revealed that miR-126-3p had a significant correlation with sinotubular junction Z-score (r = 0.42; p = 0.0154). Conclusion The identified circulating miRNAs signature for TS patients with manifestations associated with cardiovascular diseases provide new insights into the molecular mechanism of TS that may guide the development of novel diagnostic approaches.
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Affiliation(s)
- Masood Abu-Halima
- Institute of Human Genetics, Saarland University, Homburg/Saar, Germany
- * E-mail:
| | | | - Mohammed Abd El Rahman
- Department of Pediatric Cardiology, Saarland University Medical Center, Homburg/Saar, Germany
| | - Anna-Maria Jung
- Department of Pediatric Endocrinology, Saarland University Medical Center, Homburg/Saar, Germany
| | - Michael Zemlin
- Department of Pediatric Endocrinology, Saarland University Medical Center, Homburg/Saar, Germany
| | - Tilman R. Rohrer
- Department of Pediatric Endocrinology, Saarland University Medical Center, Homburg/Saar, Germany
| | - Mustafa Kahraman
- Chair for Clinical Bioinformatics, Saarland University, Saarbruecken, Germany
| | - Andreas Keller
- Chair for Clinical Bioinformatics, Saarland University, Saarbruecken, Germany
| | - Eckart Meese
- Institute of Human Genetics, Saarland University, Homburg/Saar, Germany
| | - Hashim Abdul-Khaliq
- Department of Pediatric Cardiology, Saarland University Medical Center, Homburg/Saar, Germany
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20
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Oberhoffer FS, Abdul-Khaliq H, Jung AM, Zemlin M, Rohrer TR, Abd El Rahman M. Assessment of left ventricular myocardial work in Turner syndrome patients: insights from the novel non-invasive pressure-strain loop analysis method. Quant Imaging Med Surg 2020; 10:15-25. [PMID: 31956525 DOI: 10.21037/qims.2019.09.19] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2023]
Abstract
Background Turner syndrome (TS), a relatively rare chromosomal disease, is associated with multiple cardiovascular risk factors that possibly lead to increased left ventricular afterload and functional impairment. The aim of this study was to investigate whether alterations in myocardial work and work efficiency can be found in TS patients through left ventricular pressure-strain loop analysis (PSL). Methods Thirty-eight patients with TS and 19 healthy, age-matched controls were recruited for this study. Global peak systolic strain (GLPS) and PSL of the left ventricle was assessed in study participants. TS patients whose history included coarctation of the aorta or prior cardiac surgery were excluded from GLPS and PSL analyses (n=5). Results Median age was 16.00 years in the TS group and 16.35 years in the control group (P=0.236). GLPS did not show significant differences between both groups (P=0.524). TS patients demonstrated, compared to controls, a significantly higher global myocardial work index (BSA) (mean ± SD: 1,497±505 vs. 1,214±245 mmHg*%/m2; P=0.027). Heart rate was significantly increased in TS patients, compared to controls (mean ± SD: 90.08±14.79 vs. 73.95±15.05 bpm; P<0.001), and correlated significantly with global myocardial work index [body surface area (BSA)] within the TS cohort (r=0.558, P=0.001). Conclusions TS patients showed signs of increased myocardial workload that were only detectable through the novel PSL analysis method and not through GLPS. Moreover, elevated resting heart rate was linked with increased myocardial workload in TS patients. Further studies will have to investigate whether TS patients may develop advanced left ventricular systolic dysfunction later in life.
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Affiliation(s)
| | - Hashim Abdul-Khaliq
- Department of Pediatric Cardiology, Saarland University Hospital, Homburg (Saar), Germany
| | - Anna-Maria Jung
- Department of Pediatric Endocrinology, Saarland University Hospital, Homburg (Saar), Germany
| | - Michael Zemlin
- Department of Pediatric Endocrinology, Saarland University Hospital, Homburg (Saar), Germany
| | - Tilman R Rohrer
- Department of Pediatric Endocrinology, Saarland University Hospital, Homburg (Saar), Germany
| | - Mohamed Abd El Rahman
- Department of Pediatric Cardiology, Saarland University Hospital, Homburg (Saar), Germany.,Department of Pediatrics and Pediatric Cardiology, Cairo University, Cairo, Egypt
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21
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Sävendahl L, Polak M, Backeljauw P, Blair J, Miller BS, Rohrer TR, Pietropoli A, Ostrow V, Ross J. Treatment of Children With GH in the United States and Europe: Long-Term Follow-Up From NordiNet® IOS and ANSWER Program. J Clin Endocrinol Metab 2019; 104:4730-4742. [PMID: 31305924 PMCID: PMC6812718 DOI: 10.1210/jc.2019-00775] [Citation(s) in RCA: 30] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/02/2019] [Accepted: 07/08/2019] [Indexed: 11/19/2022]
Abstract
CONTEXT Understanding real-world prescribing of GH may help improve treatment of eligible patients. OBJECTIVE Overall: to assess real-world effectiveness and safety of GH (Norditropin). This analysis: to compare clinical characteristics of GH-treated children in the United States and Europe. DESIGN The American Norditropin Studies: Web-Enabled Research Program (ANSWER; 2002 to 2016, United States) and the NordiNet International Outcome Study (NordiNet IOS; 2006 to 2016, Europe) were multicenter longitudinal observational cohort studies. SETTING Data were recorded in 207 (United States) and 469 (Europe) clinics. PARTICIPANTS Patients with GH deficiency, Turner syndrome, Noonan syndrome, idiopathic short stature, Prader-Willi syndrome, or born small for gestational age, who commenced GH treatment aged <18 years. INTERVENTION GH was prescribed by treating physicians according to local practice. MAIN OUTCOMES MEASURES Baseline data and drug doses were recorded. Data on effectiveness and safety were collected. RESULTS ANSWER had 19,847 patients in the full analysis set (FAS; patients with birthdate information and one or more GH prescription) and 12,660 in the effectiveness analysis set (EAS; GH-naive patients with valid baseline information). NordiNet IOS had 17,711 (FAS) and 11,967 (EAS). Boys accounted for 69% (ANSWER) and 57% (NordiNet IOS). Treatment start occurred later than optimal to improve growth. The proportion of boys treated was generally larger, children were older at treatment start, and GH doses were higher in the United States vs Europe. No new safety signals of concern were noted. CONCLUSIONS In most indications, more boys than girls were treated, and treatment started late. Earlier diagnosis of GH-related disorders is needed. The data support a favorable benefit-risk profile of GH therapy in children.
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Affiliation(s)
- Lars Sävendahl
- Karolinska Institutet, Karolinska University Hospital, Solna, Sweden
- Correspondence and Reprint Requests: Lars Sävendahl, MD, PhD, Karolinska University Hospital, J9:30, Visionsgatan 4, 171 64 Solna, Sweden. E-mail: ; or Michel Polak, MD, PhD, Hôpital Necker Enfants Malades, 149 rue de Sèvres, 75743 Paris, France. E-mail:
| | - Michel Polak
- Hôpital Necker Enfants Malades, Paris, France
- Correspondence and Reprint Requests: Lars Sävendahl, MD, PhD, Karolinska University Hospital, J9:30, Visionsgatan 4, 171 64 Solna, Sweden. E-mail: ; or Michel Polak, MD, PhD, Hôpital Necker Enfants Malades, 149 rue de Sèvres, 75743 Paris, France. E-mail:
| | - Philippe Backeljauw
- Cincinnati Center for Growth Disorders, Cincinnati Children’s Hospital Medical Center, University of Cincinnati College of Medicine, Cincinnati, Ohio
| | - Jo Blair
- Alder Hey Children’s NHS Foundation Trust, Liverpool, United Kingdom
| | - Bradley S Miller
- University of Minnesota Masonic Children’s Hospital, Minneapolis, Minnesota
| | - Tilman R Rohrer
- University Children’s Hospital, Saarland University Medical Center, Homburg, Germany
| | | | | | - Judith Ross
- Thomas Jefferson University, Philadelphia, Pennsylvania
- Nemours/DuPont Hospital for Children, Wilmington, Delaware
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22
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Oberhoffer FS, Abdul-Khaliq H, Jung AM, Rohrer TR, Abd El Rahman M. Two-dimensional speckle tracking of the abdominal aorta: a novel approach to evaluate arterial stiffness in patients with Turner syndrome. Cardiovasc Diagn Ther 2019; 9:S228-S237. [PMID: 31737531 DOI: 10.21037/cdt.2019.03.01] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
Background Turner syndrome (TS) is an X-chromosomal disease affecting one in 2,500-3,000 female newborns. Girls and women with TS show multiple cardiovascular risk factors that all have an impact on arteriosclerosis and thus arterial stiffness. An accurate and non-invasive screening of arterial stiffness is essential to improve the overall outcome in these patients. Methods Thirty-five TS patients and 19 healthy, age-matched controls were prospectively recruited for this study. Arterial stiffness was measured at the abdominal aorta in subxiphoid view using two-dimensional speckle tracking (2DST). Acquisition was performed at a frame rate of 60-90 fps. Mean peak circumferential strain (AAO-S, %) was measured offline for respective layers (inner layer = AAO-SENDO, %; middle layer = AAO-SMESO, %; outer layer = AAO-SEPI, %). Results Compared with the control group, patients with TS showed significantly lower peak circumferential strain values in each layer [AAO-SENDO (mean ± SD): 10.98%±4.73% vs. 15.32%±4.78%, P=0.002; AAO-SMESO (mean ± SD): 6.36%±2.22% vs. 9.18%±2.83%, P<0.001; AAO-SEPI (mean ± SD): 4.49%±1.76% vs. 6.31%±2.53%, P=0.003]. Abdominal aortic strain values correlated significantly with left ventricular diastolic function assessed by mitral early (E) and late (A) flow ratio (AAO-SENDO and E/A: r=0.475, P<0.001; AAO-SMESO and E/A: r=0.504, P<0.001; AAO-SEPI and E/A: r=0.393, P=0.003). Heart rate correlated significantly negative with 2DST assessed arterial distensibility (r=-0.366; P=0.007). Relative intra- and interobserver variability ranged between 8.67% and 21.03% for 2DST of the abdominal aorta. Conclusions 2DST of the abdominal aorta might provide additional diagnostic value to detect possible functional vascular impairments in patients with TS. Left ventricular diastolic function is coupled with increased arterial stiffness in TS patients. The relatively high intra- and interobserver variability of 2DST of the abdominal aorta requires further improvement of the speckle tracking algorithm.
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Affiliation(s)
| | - Hashim Abdul-Khaliq
- Department of Pediatric Cardiology, Saarland University Hospital, Homburg, Saar, Germany
| | - Anna-Maria Jung
- Department of Pediatric Endocrinology, Saarland University Hospital, Homburg, Saar, Germany
| | - Tilman R Rohrer
- Department of Pediatric Endocrinology, Saarland University Hospital, Homburg, Saar, Germany
| | - Mohamed Abd El Rahman
- Department of Pediatric Cardiology, Saarland University Hospital, Homburg, Saar, Germany
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23
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Rohrer TR, Ceplis-Kastner S, Jorch N, Müller HL, Pfäffle R, Reinehr T, Richter-Unruh A, Weißenbacher C, Holterhus PM, Ferring Arzneimittel GmbH DSCK. Needle-Free and Needle-Based Growth Hormone Therapy in Children: A Pooled Analysis of Three Long-Term Observational Studies. Horm Res Paediatr 2019; 90:393-406. [PMID: 30836359 PMCID: PMC6561679 DOI: 10.1159/000496614] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [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: 12/14/2018] [Accepted: 01/04/2019] [Indexed: 12/27/2022] Open
Abstract
BACKGROUND Treatment with growth hormone (GH) is standard clinical practice in children with GH deficiency (GHD) or Turner syndrome (TS). Hitherto, no long-term data on auxological outcome and safety of Zomacton® have been published. Data comparing needle-free administration (NF) and needle injection (NI) of GH are very sparse. AIMS To analyse longitudinal auxological outcome and safety data of GH treatment-naïve patients diagnosed with GHD or TS and to compare NF and NI in a real-life setting. METHODS Pooled auxological data and safety information from three consecutive prospective observational Zomacton® studies covering 22 years of treatment were analysed and NF was compared to NI. RESULTS The safety cohort comprised 1,595 patients who received at least one GH dose. The auxological outcome cohort comprised 856 treatment-naïve patients with follow-up data ≥12 months. Height-SDS and height velocity improved significantly during the first 3 years of treatment. Documented choice of device was available for 658 patients (NF 69.1%, NI 30.9%). NF administration was non-inferior to NI. No previously unknown safety signals occurred. CONCLUSION Real-life data show that treatment with Zomacton® improves auxological outcome parameters without new safety concerns. NF administration of GH represents a useful alternative to NI in children with growth disorders.
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Affiliation(s)
- Tilman R. Rohrer
- Department of Paediatrics, Saarland University Medical Centre, Homburg/Saar, Germany
| | | | - Norbert Jorch
- Protestant Hospital of the Bethel Foundation, Children's Hospital, Bielefeld, Germany
| | - Hermann L. Müller
- Department of Paediatrics and Paediatric Haematology/Oncology, University Children's Hospital, Klinikum Oldenburg AöR, Oldenburg, Germany
| | - Roland Pfäffle
- Department of Paediatric Endocrinology, Children's Hospital, Leipzig, Germany
| | - Thomas Reinehr
- Department of Paediatric Endocrinology, Diabetes, and Nutrition Medicine, Vestische Kinder- und Jugendklinik, University of Witten/Herdecke, Datteln, Germany
| | - Annette Richter-Unruh
- Department of Paediatric Endocrinology and Diabetology, University Children's Hospital, Ruhr University Bochum, Bochum, Germany
| | - Claudia Weißenbacher
- Department of Endocrinology, Dr. von Haunersches Children's Hospital, LMU Munich, Munich, Germany
| | - Paul-Martin Holterhus
- Division of Paediatric Endocrinology and Diabetes, Christian-Albrechts University of Kiel (CAU) and University Hospital Schleswig-Holstein (UKSH), Campus Kiel, Kiel, Germany,
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24
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Hauer NN, Popp B, Taher L, Vogl C, Dhandapany PS, Büttner C, Uebe S, Sticht H, Ferrazzi F, Ekici AB, De Luca A, Klinger P, Kraus C, Zweier C, Wiesener A, Jamra RA, Kunstmann E, Rauch A, Wieczorek D, Jung AM, Rohrer TR, Zenker M, Doerr HG, Reis A, Thiel CT. Evolutionary conserved networks of human height identify multiple Mendelian causes of short stature. Eur J Hum Genet 2019; 27:1061-1071. [PMID: 30809043 PMCID: PMC6777496 DOI: 10.1038/s41431-019-0362-0] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2018] [Revised: 01/14/2019] [Accepted: 01/24/2019] [Indexed: 12/22/2022] Open
Abstract
Height is a heritable and highly heterogeneous trait. Short stature affects 3% of the population and in most cases is genetic in origin. After excluding known causes, 67% of affected individuals remain without diagnosis. To identify novel candidate genes for short stature, we performed exome sequencing in 254 unrelated families with short stature of unknown cause and identified variants in 63 candidate genes in 92 (36%) independent families. Based on systematic characterization of variants and functional analysis including expression in chondrocytes, we classified 13 genes as strong candidates. Whereas variants in at least two families were detected for all 13 candidates, two genes had variants in 6 (UBR4) and 8 (LAMA5) families, respectively. To facilitate their characterization, we established a clustered network of 1025 known growth and short stature genes, which yielded 29 significantly enriched clusters, including skeletal system development, appendage development, metabolic processes, and ciliopathy. Eleven of the candidate genes mapped to 21 of these clusters, including CPZ, EDEM3, FBRS, IFT81, KCND1, PLXNA3, RASA3, SLC7A8, UBR4, USP45, and ZFHX3. Fifty additional growth-related candidates we identified await confirmation in other affected families. Our study identifies Mendelian forms of growth retardation as an important component of idiopathic short stature.
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Affiliation(s)
- Nadine N Hauer
- Institute of Human Genetics, Friedrich-Alexander-Universität Erlangen-Nürnberg FAU, Erlangen, Germany
| | - Bernt Popp
- Institute of Human Genetics, Friedrich-Alexander-Universität Erlangen-Nürnberg FAU, Erlangen, Germany
| | - Leila Taher
- Bioinformatics, Department of Biology, Friedrich-Alexander-Universität Erlangen-Nürnberg, Erlangen, Germany
| | - Carina Vogl
- Institute of Human Genetics, Friedrich-Alexander-Universität Erlangen-Nürnberg FAU, Erlangen, Germany
| | - Perundurai S Dhandapany
- Centre for Cardiovascular Biology and Disease, Institute for Stem Cell Biology and Regenerative Medicine (inStem), Bangalore, India.,The Knight Cardiovascular Institute, Departments of Medicine, Molecular and Medical Genetics, Oregon Health and Science University, Portland, OR, USA
| | - Christian Büttner
- Institute of Human Genetics, Friedrich-Alexander-Universität Erlangen-Nürnberg FAU, Erlangen, Germany
| | - Steffen Uebe
- Institute of Human Genetics, Friedrich-Alexander-Universität Erlangen-Nürnberg FAU, Erlangen, Germany
| | - Heinrich Sticht
- Institute of Biochemistry, FAU Erlangen-Nürnberg, Erlangen, Germany
| | - Fulvia Ferrazzi
- Institute of Human Genetics, Friedrich-Alexander-Universität Erlangen-Nürnberg FAU, Erlangen, Germany
| | - Arif B Ekici
- Institute of Human Genetics, Friedrich-Alexander-Universität Erlangen-Nürnberg FAU, Erlangen, Germany
| | - Alessandro De Luca
- Molecular Genetics Unit, Casa Sollievo della Sofferenza Hospital, IRCCS, San Giovanni Rotondo, Italy
| | - Patrizia Klinger
- Department of Orthopedic Rheumatology, Friedrich-Alexander-Universität Erlangen-Nürnberg (FAU), Erlangen, Germany
| | - Cornelia Kraus
- Institute of Human Genetics, Friedrich-Alexander-Universität Erlangen-Nürnberg FAU, Erlangen, Germany
| | - Christiane Zweier
- Institute of Human Genetics, Friedrich-Alexander-Universität Erlangen-Nürnberg FAU, Erlangen, Germany
| | - Antje Wiesener
- Institute of Human Genetics, Friedrich-Alexander-Universität Erlangen-Nürnberg FAU, Erlangen, Germany
| | - Rami Abou Jamra
- Institute of Human Genetics, University of Leipzig, Leipzig, Germany
| | - Erdmute Kunstmann
- Institute of Human Genetics, University of Würzburg, Würzburg, Germany
| | - Anita Rauch
- Institute of Medical Genetics, University of Zurich, Zurich, Switzerland
| | - Dagmar Wieczorek
- Institute of Human Genetics, University of Duisburg-Essen, Essen, Germany.,Institute of Human-Genetics, Medical Faculty of University Düsseldorf, Düsseldorf, Germany
| | - Anna-Marie Jung
- Division of Pediatric Endocrinology, Department of General Pediatrics and Neonatology, Saarland University Medical Center, Homburg/Saar, Germany
| | - Tilman R Rohrer
- Division of Pediatric Endocrinology, Department of General Pediatrics and Neonatology, Saarland University Medical Center, Homburg/Saar, Germany
| | - Martin Zenker
- Institute of Human Genetics, Otto-von-Guericke University Magdeburg, Magdeburg, Germany
| | - Helmuth-Guenther Doerr
- Department of Pediatrics and Adolescent Medicine, Friedrich-Alexander-Universität Erlangen-Nürnberg FAU, Erlangen, Germany
| | - André Reis
- Institute of Human Genetics, Friedrich-Alexander-Universität Erlangen-Nürnberg FAU, Erlangen, Germany
| | - Christian T Thiel
- Institute of Human Genetics, Friedrich-Alexander-Universität Erlangen-Nürnberg FAU, Erlangen, Germany.
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25
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Bechtold SM, Rohrer TR, Raile K, Hofer S, Thon A, Boettcher C, Konrad K, Pozza RD, Bollow E, Holl RW. Diabetes mellitus in pediatric solid organ recipients without and with cystic fibrosis: An analysis from the German-Austrian diabetes database (Diabetes Patienten Verlaufsdokumentation). Pediatr Diabetes 2018; 19:1191-1197. [PMID: 30070005 DOI: 10.1111/pedi.12725] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [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: 02/08/2018] [Revised: 06/17/2018] [Accepted: 07/10/2018] [Indexed: 01/06/2023] Open
Abstract
INTRODUCTION Posttransplantation diabetes mellitus (PTDM) increases the risk of cardiovascular disease, graft loss, and decreased survival. Follow-up treatment after solid organ transplantation (SOT) needs to focus on, inter alia, maintaining balanced glucose metabolism. This study aimed to ascertain the prevalence of PTDM and describe patient characteristics in the large DPV (Diabetes Patienten Verlaufsdokumentation) pediatric diabetes database. METHODS DPV data of 71 902 patients from the January 01, 1995 to January 04, 2015 period were analyzed for patients with and without cystic fibrosis (CF) after SOT (kidney, liver, heart, and lung). Multivariable analysis served to assess differences between SOT patient groups at risk for developing diabetes. RESULTS Out of 109 SOT patients, 51 had CF; 72.5% received steroids and 62% were additionally given tacrolimus. PTDM developed in 45% of CF patients and 12% of non-CF patients. SOT patients were older at diabetes onset (mean age, 12.50 ± 3.98 years), shorter (height z-score, -1.67 ± 1.25), and lighter (weight z-score, -1.59 ± 1.57) than non-SOT diabetes patients (P < 0.01). With transplantation, glycated hemoglobin (HbA1c) was significantly lower and treatment for hypertension and dyslipidemia was increased. Among SOT patients, weight and body mass index (BMI) z-scores were significantly lower in patients with CF-related diabetes (P < 0.05). CONCLUSIONS SOT was present in 6.6% of children with diabetes, and this might aggravate the risk of cardiovascular disease in populations with already increased rates of hypertension and dyslipidemia. Dystrophy and short stature were also present, particularly in transplant recipients with CF and diabetes. Comorbidities and long-term consequences call for multidisciplinary collaboration.
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Affiliation(s)
- Susanne M Bechtold
- Department of Pediatric Endocrinology and Diabetology, Ludwig-Maximilian's University Medicine Munich, Munich, Germany
| | - Tilman R Rohrer
- Department of Pediatrics, Saarland University Medical Center, Homburg/Saar, Germany
| | - Klemens Raile
- Department of Pediatric Endocrinology and Diabetology, Charité University Medicine Berlin, Berlin, Germany
| | - Sabine Hofer
- Department of Pediatrics, University Hospital Innsbruck, Innsbruck, Austria
| | - Angelika Thon
- Department of Pediatrics, Hannover Medical University, Hannover, Germany
| | - Claudia Boettcher
- Division of Pediatric Endocrinology & Diabetology, Center of Child and Adolescent Medicine, Justus Liebig University Giessen, Gießen, Germany
| | - Katja Konrad
- Department of Pediatrics, Elisabeth Krankenhaus Essen, Essen, Germany.,Medical University of Cologne, Köln, Germany
| | - Robert Dalla Pozza
- Department of Pediatric Cardiology, Ludwig-Maximilian's University Medicine Munich, Munich, Germany
| | - Esther Bollow
- Institute of Epidemiology and Medical Biometry, University of Ulm, Ulm, Germany.,German Center for Diabetes Research (DZD), Neuherberg, Germany
| | - Reinhard W Holl
- Institute of Epidemiology and Medical Biometry, University of Ulm, Ulm, Germany.,German Center for Diabetes Research (DZD), Neuherberg, Germany
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Polak M, Blair J, Kotnik P, Pournara E, Pedersen BT, Rohrer TR. Early growth hormone treatment start in childhood growth hormone deficiency improves near adult height: analysis from NordiNet® International Outcome Study. Eur J Endocrinol 2017; 177:421-429. [PMID: 28780521 PMCID: PMC5633042 DOI: 10.1530/eje-16-1024] [Citation(s) in RCA: 30] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/14/2016] [Revised: 07/12/2017] [Accepted: 08/03/2017] [Indexed: 11/08/2022]
Abstract
OBJECTIVE To investigate the effect of age at growth hormone (GH) treatment start on near adult height (NAH) in children with isolated GH deficiency (GHD). DESIGN NordiNet® International Outcome Study (IOS) (Nbib960128), a non-interventional, multicentre study, evaluates the long-term effectiveness and safety of Norditropin® (somatropin) (Novo Nordisk A/S) in the real-life clinical setting. METHODS Patients (n = 172) treated to NAH (height at ≥18 years, or height velocity <2 cm/year at ≥16 (boys) or ≥15 (girls) years) were grouped by age (years) at treatment start (early (girls, <8; boys, <9), intermediate (girls, 8-10; boys, 9-11) or late (girls, >10; boys, >11)) and GHD severity (<3 ng/mL or 3 to ≤10 ng/mL). Multiple regression analysis was used to evaluate the effect of age at treatment start (as a categorical and continuous variable) on NAH standard deviation score (SDS). RESULTS Age at treatment start had a marked effect on NAH SDS; NAH SDS achieved by patients starting treatment early (n = 40 (boys, 70.0%); least squares mean (standard error) -0.76 (0.14)) exceeded that achieved by those starting later (intermediate, n = 42 (boys, 57.1%); -1.14 (0.15); late, n = 90 (boys, 68.9%); -1.21 (0.10)). Multiple regression analysis showed a significant association between NAH SDS and age at treatment start (P < 0.0242), baseline height SDS (HSDS) (P < 0.0001), target HSDS (P < 0.0001), and GHD severity (P = 0.0012). Most (78.5%) patients achieved a normal NAH irrespective of age at treatment start. CONCLUSIONS Early initiation of GH treatment in children with isolated GHD improves their chance of achieving their genetic height potential.
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Affiliation(s)
- Michel Polak
- Endocrinologie Gynécologie Diabétologie PédiatriquesHôpital Universitaire Necker Enfants Malades, Assistance Publique-Hôpitaux de Paris Université Paris Descartes, INSERM U1016, Institut IMAGINE, Centre de Référence des Maladies Endocriniennes Rares de la Croissance, Paris, France
- Correspondence should be addressed to M Polak;
| | - Jo Blair
- Department of EndocrinologyAlder Hey Children’s NHS Foundation Trust, Liverpool, UK
| | - Primoz Kotnik
- Department of Pediatric EndocrinologyUniversity Children’s Hospital, University Medical Center Ljubljana, and Medical Faculty, University of Ljubljana, Ljubljana, Slovenia
| | - Effie Pournara
- Global Medical AffairsNovo Nordisk Health Care AG, Zürich, Switzerland
| | | | - Tilman R Rohrer
- Department of Pediatric EndocrinologyUniversity Children’s Hospital, Saarland University Medical Center, Homburg, Germany
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Schoch J, Rohrer TR, Kaestner M, Abdul-Khaliq H, Gortner L, Sester U, Sester M, Schmidt T. Quantitative, Phenotypical, and Functional Characterization of Cellular Immunity in Children and Adolescents With Down Syndrome. J Infect Dis 2017; 215:1619-1628. [PMID: 28379413 DOI: 10.1093/infdis/jix168] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2017] [Accepted: 03/29/2017] [Indexed: 01/08/2023] Open
Abstract
Background Infections and autoimmune disorders are more frequent in Down syndrome, suggesting abnormality of adaptive immunity. Although the role of B cells and antibodies is well characterized, knowledge regarding T cells is limited. Methods Lymphocyte subpopulations of 40 children and adolescents with Down syndrome and 51 controls were quantified, and phenotype and functionality of antigen-specific effector T cells were analyzed with flow cytometry after polyclonal and pathogen-specific stimulation (with varicella-zoster virus [VZV] and cytomegalovirus [CMV]). Results were correlated with immunoglobulin (Ig) G responses. Results Apart from general alterations in the percentage of lymphocytes, regulatory T cells, and T-helper 1 and 17 cells, all major T-cell subpopulations showed higher expression of the inhibitory receptor PD-1. Polyclonally stimulated effector CD4+ T-cell frequencies were significantly higher in subjects with Down syndrome, whereas their inhibitory receptor expression (programmed cell death 1 [PD-1] and cytotoxic T-lymphocyte antigen 4 [CTLA-4]) was similar to that of controls and cytokine expression profiles were only marginally altered. Pathogen-specific immunity showed age-appropriate levels of endemic infection, with correlation of CMV-specific cellular and humoral immunity in all subjects. Among VZV IgG-positive individuals, a higher percentage of VZV-specific T-cell-positive subjects was seen in those with Down syndrome. Conclusions Despite alterations in lymphocyte subpopulations, individuals with Down syndrome can mount effector T-cell responses with similar phenotype and functionality as controls but may require higher effector T-cell frequencies to ensure pathogen control.
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Affiliation(s)
| | | | | | | | - Ludwig Gortner
- Department of Pediatrics and Adolescent Medicine, Medical University of Vienna, Austria
| | - Urban Sester
- Internal Medicine IV, Saarland University, Homburg, Germany; and
| | | | - Tina Schmidt
- Departments of Transplant and Infection Immunology
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Abstract
The "360° GH in Europe" meeting, which examined various aspects of GH diseases, was held in Lisbon, Portugal, in June 2016. The Merck KGaA (Germany) funded meeting comprised three sessions entitled "Short Stature Diagnosis and Referral," "Optimizing Patient Management," and "Managing Transition." Each session had three speaker presentations, followed by a discussion period, and is reported as a manuscript, authored by the speakers. The first session examined current processes of diagnosis and referral by endocrine specialists for pediatric patients with short stature. Requirements for referral vary widely, by country and by patient characteristics such as age. A balance must be made to ensure eligible patients get referred while healthcare systems are not over-burdened by excessive referrals. Late referral and diagnosis of non-GH deficiency conditions can result in increased morbidity and mortality. The consequent delays in making a diagnosis may compromise the effectiveness of GH treatment. Algorithms for growth monitoring and evaluation of skeletal disproportions can improve identification of non-GH deficiency conditions. Performance and validation of guidelines for diagnosis of GH deficiency have not been sufficiently tested. Provocative tests for investigation of GH deficiency remain equivocal, with insufficient information on variations due to patient characteristics, and cutoff values for definition differ not only by country but also by the assay used. When referring and diagnosing causes of short stature in pediatric patients, clinicians need to rely on many factors, but the most essential is clinical experience.
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Affiliation(s)
- Mohamad Maghnie
- Department of Pediatrics, IRCCS Children’s Hospital Giannina Gaslini, University of Genoa, Genoa, Italy
| | - José I. Labarta
- Endocrinology Unit, Children’s Hospital Miguel Servet, University of Zaragoza, Zaragoza, Spain
| | | | - Tilman R. Rohrer
- Department of Pediatrics, Saarland University Medical Center, Homburg, Germany
- *Correspondence: Tilman R. Rohrer,
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Rohrer TR, Horikawa R, Kappelgaard AM. Growth hormone delivery devices: current features and potential for enhanced treatment adherence. Expert Opin Drug Deliv 2016; 14:1253-1264. [DOI: 10.1080/17425247.2017.1243526] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Affiliation(s)
- Tilman R. Rohrer
- Department of Pediatrics and Adolescent Medicine, Saarland University Medical Center, Homburg/Saar, Germany
| | - Reiko Horikawa
- Division of Endocrinology and Metabolism, National Center for Child Health and Development, Tokyo, Japan
| | - Anne-Marie Kappelgaard
- Clinical, Medical and Regulatory, Novo Nordisk International Operations A/G, Zurich, Switzerland
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Dost A, Rohrer TR, Fröhlich-Reiterer E, Bollow E, Karges B, Böckmann A, Hamann J, Holl RW. Hyperthyroidism in 276 Children and Adolescents with Type 1 Diabetes from Germany and Austria. Horm Res Paediatr 2016. [PMID: 26202175 DOI: 10.1159/000436964] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.4] [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] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND/AIMS Little is known about the incidence and clinical consequences of hyperthyroidism in pediatric patients with type 1 diabetes mellitus (T1DM). METHODS We analyzed the DPV database (Diabetes Prospective Follow-Up Registry) to investigate the rate of hyperthyroidism in pediatric T1DM patients, its impact on metabolic control, and potential associations with organ-specific autoantibodies. RESULTS Hyperthyroidism was found in 276/60,456 patients (0.46%) and was associated with younger age, shorter diabetes duration, female sex, and reduced body mass index. Diabetic ketoacidosis (DKA) and hypoglycemia were more frequent in T1DM with comorbid hyperthyroidism, while long-term metabolic control (HbA1c) was similar in both groups. Absolute blood pressure and arterial hypertension rate were elevated in the hyperthyroid patients. Rates of microalbuminuria and diabetic retinopathy were not different. Thyroid-specific antibodies (thyroid peroxidase, thyroglobulin, thyroid receptor) were associated with hyperthyroidism. Thyroid volume and rates of cysts and nodules were higher, and echogenicity was decreased. CONCLUSION Prevalence of hyperthyroidism is low in diabetic children with T1DM but increased compared to children <18 years without diabetes. Hyperthyroidism is primarily associated with acute diabetes complications (DKA and hypoglycemia) and affects blood pressure regulation. Long-term metabolic control or insulin requirement were not different.
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Affiliation(s)
- Axel Dost
- Department of Pediatrics, Medical University of Graz, Graz, Austria
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Warncke K, Liptay S, Fröhlich-Reiterer E, Scheuing N, Schebek M, Wolf J, Rohrer TR, Meissner T, Holl RW. Vascular risk factors in children, adolescents, and young adults with type 1 diabetes complicated by celiac disease: results from the DPV initiative. Pediatr Diabetes 2016; 17:191-8. [PMID: 25677756 DOI: 10.1111/pedi.12261] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/07/2014] [Revised: 11/28/2014] [Accepted: 01/14/2015] [Indexed: 12/12/2022] Open
Abstract
OBJECTIVE Celiac disease (CD) is a common comorbidity of type 1 diabetes (T1D). Long-term consequences of CD are not completely understood, and adhering to a gluten-free diet is a burden for many patients. We investigated the effect of CD on vascular risk factors in a large cohort of T1D patients aged <20 yr. RESEARCH DESIGN AND METHODS Within the longitudinal Diabetes Patienten Verlaufsdokumentation (DPV)-diabetes registry, data were analyzed from 59,909 < 20-yr-old T1D patients treated at 392 centers in Germany and Austria. A total of 974 patients with biopsy-proven celiac disease (BPCD) were compared with 28,398 patients without CD with respect to blood pressure (BP), lipids, glycohemoglobin (HbA1c ), body mass index (BMI), and reported smoking behavior. RESULTS Patients with T1D and BPCD showed significantly lower high-density lipoprotein (HDL) cholesterol levels [median (interquartile range): 53.0 (43.0-62.6) mg/dL] than patients without CD [55.0 (45.0-66.0) mg/dL; p < 0.01; p < 0.001 after adjustment for confounding variables]. Systolic BP was lower in patients with CD [105.5 (100.0-112.5) mmHg] than in patients without CD [110.0 (102.0-117.0) mmHg; p < 0.0001; p < 0.001 after adjustment]. There were no significant differences regarding smoking behavior, BMI, or HbA1c . In a subgroup of 335 patients with BPCD, HDL cholesterol was measured 1 yr after diagnosis of CD:HDL increased by 8% (p < 0.01). CONCLUSION Young people with T1D and CD have lower HDL cholesterol values than patients without CD. As low HDL cholesterol is associated with vascular risk, our findings support screening for CD and monitoring of HDL cholesterol in young people with T1D.
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Affiliation(s)
- Katharina Warncke
- Department of Pediatrics, Klinikum rechts der Isar, Technische Universität München, München, Germany.,Institute of Diabetes Research, Helmholtz Zentrum München, and Forschergruppe Diabetes, Klinikum rechts der Isar, Technische Universität München, Neuherberg, Germany.,Forschergruppe Diabetes e.V., Neuherberg, Germany
| | - Susanne Liptay
- Department of Pediatrics, Klinikum rechts der Isar, Technische Universität München, München, Germany
| | | | - Nicole Scheuing
- Institute of Epidemiology and Medical Biometry, Central Institute for Biomedical Technology, University of Ulm, Ulm, Germany
| | - Martin Schebek
- Department of children's diabetology, Children's Hospital Klinikum Kassel, Kassel, Germany
| | | | - Tilman R Rohrer
- Department of Pediatrics and Neonatology, Saarland University Medical Center, Homburg/Saar, Germany
| | - Thomas Meissner
- Department of General Pediatrics, Neonatology and Pediatric Cardiology, University Children's Hospital Düsseldorf, Düsseldorf, Germany
| | - Reinhard W Holl
- Institute of Epidemiology and Medical Biometry, Central Institute for Biomedical Technology, University of Ulm, Ulm, Germany
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Hoffmann PF, Jung AM, Stierkorb E, Monz D, Gortner L, Rohrer TR. Down Syndrome: Gestational Age-Related Neonatal Anthropometrics for Germany. Neonatology 2016; 109:195-202. [PMID: 26780734 DOI: 10.1159/000442812] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/23/2015] [Accepted: 11/27/2015] [Indexed: 11/19/2022]
Abstract
BACKGROUND Neonates with Down syndrome (DS) weigh less, are smaller and have increased first-year mortality, especially if born small for gestational age (GA). DS-specific GA-related neonatal anthropometrics for Germany are lacking. OBJECTIVES To construct reference tables and centile curves for birth weight (g), crown-heel length (cm) and head circumference (cm) by sex and GA for German DS neonates. METHODS Retrospective anthropometric data from live-born singleton DS neonates born in Germany from January 1966 to June 2010 were collected using standardized questionnaires and patient records. Reference tables were created based on means and standard deviations. The 3rd, 10th, 25th, 50th, 75th, 90th and 97th centile curves were constructed and smoothed using running medians and Cole's LMS method. RESULTS Anthropometric measurements were obtained for 1,304 DS neonates [males/females: 713/591 (54.7%/45.3%)]. Reference tables and centile charts were constructed from 3,542 (males/females: 1,932/1,610) observations for GA 32-41 weeks. Compared with general-population newborns, prematurity was increased (21.1 vs. 6.3%) at GA 32-36 weeks. Term-born (GA 40 weeks) male and female DS neonates were 352.5 and 223.5 g lighter and 1.5 and 1.4 cm smaller than general-population neonates, and head circumference was also 1.4 and 1.5 cm smaller, respectively. CONCLUSION This is the first study to report GA-related, sex-specific reference tables and centile charts of birth weight, length and head circumference for DS neonates born in Germany. Compared with the general German population, DS newborns are more frequently born prematurely, weigh less, are smaller and have a smaller head circumference at birth.
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Affiliation(s)
- Paul F Hoffmann
- Division of General Paediatrics and Neonatology, Department of Paediatric and Adolescent Medicine, Saarland University Medical Centre, Homburg/Saar, Germany
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Schwab KO, Doerfer J, Hungele A, Scheuing N, Krebs A, Dost A, Rohrer TR, Hofer S, Holl RW. Non-High-Density Lipoprotein Cholesterol in Children with Diabetes: Proposed Treatment Recommendations Based on Glycemic Control, Body Mass Index, Age, Sex, and Generally Accepted Cut Points. J Pediatr 2015; 167:1436-9. [PMID: 26427965 DOI: 10.1016/j.jpeds.2015.09.006] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [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: 03/04/2015] [Revised: 07/27/2015] [Accepted: 09/02/2015] [Indexed: 10/23/2022]
Abstract
Percentile-based non-high-density lipoprotein cholesterol levels were analyzed by glycemic control, weight, age, and sex of children with type 1 diabetes (n = 26,358). Ten percent of all children and 25% of overweight adolescent girls require both immediate lipid-lowering medication and lifestyle changes to achieve non-high-density lipoprotein cholesterol levels <120 mg/dL and cardiovascular risk reduction.
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Affiliation(s)
- K Otfried Schwab
- Department of Pediatrics and Adolescent Medicine, University Medical Center, Freiburg, Germany.
| | - Jürgen Doerfer
- Department of Pediatrics and Adolescent Medicine, University Medical Center, Freiburg, Germany
| | - Andreas Hungele
- Institute of Epidemiology and Medical Biometry, German Center for Diabetes Research (DHZ), University of Ulm, Ulm, Germany
| | - Nicole Scheuing
- Institute of Epidemiology and Medical Biometry, German Center for Diabetes Research (DHZ), University of Ulm, Ulm, Germany
| | - Andreas Krebs
- Department of Pediatrics and Adolescent Medicine, University Medical Center, Freiburg, Germany
| | - Axel Dost
- Department of Pediatrics and Adolescent Medicine, University of Jena, Jena, Germany
| | - Tilman R Rohrer
- Division of Pediatric Endocrinology, Department of General Pediatrics and Neonatology, Saarland University Medical Center, Homburg/Saar, Germany
| | - Sabine Hofer
- Department of Pediatrics, Medical University Innsbruck, Innsbruck, Austria
| | - Reinhard W Holl
- Institute of Epidemiology and Medical Biometry, German Center for Diabetes Research (DHZ), University of Ulm, Ulm, Germany
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Rohrer TR, Wolf J, Liptay S, Zimmer KP, Fröhlich-Reiterer E, Scheuing N, Marg W, Stern M, Kapellen TM, Hauffa BP, Wölfle J, Holl RW. Microvascular Complications in Childhood-Onset Type 1 Diabetes and Celiac Disease: A Multicenter Longitudinal Analysis of 56,514 Patients From the German-Austrian DPV Database. Diabetes Care 2015; 38:801-7. [PMID: 25690004 DOI: 10.2337/dc14-0683] [Citation(s) in RCA: 54] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/17/2014] [Accepted: 01/02/2015] [Indexed: 02/06/2023]
Abstract
OBJECTIVE To investigate whether celiac disease (CD) associated with type 1 diabetes increases the risk of microvascular complications. RESEARCH DESIGN AND METHODS Patients (n = 56,514) aged >10 years with diabetes duration <20 years from 392 centers in Germany and Austria were assigned to one of three categories (n): no CD (50,933), biopsy-confirmed CD (812), or suspected CD (4,769; clinical diagnosis or positive antibodies). The confirmed and suspected groups were combined and analyzed for retinopathy or nephropathy. Cox proportional hazards regression was used to adjust for potential confounders (glycated hemoglobin [HbA1c], age at diabetes onset, sex, smoking, dyslipidemia, and hypertension). RESULTS Kaplan-Meier analysis revealed that retinopathy and nephropathy occurred earlier in the presence versus absence of CD: retinopathy at age 26.7 years (95% CI 23.7-30.2) in 25% of patients with CD vs. age 33.7 years (33.2-34.4) in 25% without CD and microalbuminuria at age 32.8 years (29.7-42.5) vs. 42.4 years (41.4-43.3). The adjusted risk for both retinopathy (hazard ratio 1.263 [95% CI 1.078-1.481]) and nephropathy (1.359 [1.228-1.504]) was higher in patients with diabetes and CD versus those without CD. Cox regression revealed CD as an independent risk factor for microvascular complications after adjustment for confounders. CONCLUSIONS CD is an independent risk factor for retinopathy and nephropathy in patients with type 1 diabetes. Our study therefore supports the recommendation for regular serologic testing for CD, even in the absence of clinical CD. Further prospective studies are required to investigate whether a gluten-free diet might reduce the risk of microvascular disorders in patients with diabetes and CD.
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Affiliation(s)
- Tilman R Rohrer
- Division of Pediatric Endocrinology, Department of Pediatric and Adolescent Medicine, Saarland University Medical Center, Homburg/Saar, Germany
| | - Johannes Wolf
- Department of Pediatric and Adolescent Medicine, St. Vincenz Hospital, Paderborn, Germany
| | - Susanne Liptay
- Department of Pediatrics, Technical University Munich, Munich, Germany
| | - Klaus-Peter Zimmer
- Department of General Pediatrics and Neonatology, Children's Hospital, University of Giessen, Giessen, Germany
| | | | - Nicole Scheuing
- Institute of Epidemiology and Medical Biometry, ZIBMT, University of Ulm, Ulm, Germany
| | - Wolfgang Marg
- Center for Pediatrics and Adolescent Medicine, Bremen-Mitte Hospital, Bremen, Germany
| | - Martin Stern
- University of Tübingen Children's Hospital, Tübingen, Germany
| | | | - Berthold P Hauffa
- Division of Pediatric Endocrinology and Diabetology, Department of Pediatrics II, University of Duisburg-Essen, Essen, Germany
| | - Joachim Wölfle
- Pediatric Endocrinology Division, Children's Hospital, University of Bonn, Bonn, Germany
| | - Reinhard W Holl
- Institute of Epidemiology and Medical Biometry, ZIBMT, University of Ulm, Ulm, Germany
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Schwab KO, Doerfer J, Scheidt-Nave C, Kurth BM, Hungele A, Scheuing N, Krebs A, Dost A, Rohrer TR, Schober E, Holl RW. Algorithm-based cholesterol monitoring in children with type 1 diabetes. J Pediatr 2014; 164:1079-1084.e2. [PMID: 24485823 DOI: 10.1016/j.jpeds.2013.12.038] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [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: 07/17/2013] [Revised: 10/31/2013] [Accepted: 12/18/2013] [Indexed: 01/12/2023]
Abstract
OBJECTIVE To facilitate child-specific and diabetes-related cholesterol control, we developed a monitoring algorithm derived from population-based reference values. STUDY DESIGN Low-density lipoprotein (LDL)-, non-high-density lipoprotein (HDL)-, and HDL cholesterol percentile values were calculated for children with type 1 diabetes (T1D) and their peers without T1D within algorithm-based categories of sex, age: 1-10 vs >10-<18 years, body mass index: <90th vs ≥90th percentile, and hemoglobin A1c <6%, 6%-<7.5%, 7.5%-9%, >9%. Analyses included 26 147 patients sampled from a German/Austrian population-based registry for T1D (Diabetes Documentation and Quality Management System) and 14 057 peers without diabetes participating in the national Health Interview and Examination Survey for Children and Adolescents in Germany. RESULTS Reference percentile values for cholesterol were derived as a diagnostic algorithm aimed at supporting long-term cholesterol control. Taking account of a patient's sex, age-group, weight-, and hemoglobin A1c-category, the flowcharts of the algorithm developed separately for LDL-, non-HDL-, and HDL cholesterol allow comparing his/her cholesterol levels with population-based reference percentile values of peers without T1D. CONCLUSIONS The population-based algorithmic approach applied to LDL-, non-HDL-, and HDL cholesterol allows referencing children with T1D with regard to their peers without T1D and, if necessary, suggests corrections of glycemic control to optimize long-term cholesterol levels.
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Affiliation(s)
- K Otfried Schwab
- Department of Pediatrics and Adolescent Medicine, University Medical Center, Freiburg, Germany
| | - Jürgen Doerfer
- Department of Pediatrics and Adolescent Medicine, University Medical Center, Freiburg, Germany
| | - Christa Scheidt-Nave
- Department of Epidemiology and Health Reporting, Robert Koch Institute, Berlin, Germany
| | - Bärbel-Maria Kurth
- Department of Epidemiology and Health Reporting, Robert Koch Institute, Berlin, Germany
| | - Andreas Hungele
- Institute of Epidemiology and Medical Biometry, University of Ulm, Ulm, Germany
| | - Nicole Scheuing
- Institute of Epidemiology and Medical Biometry, University of Ulm, Ulm, Germany
| | - Andreas Krebs
- Department of Pediatrics and Adolescent Medicine, University Medical Center, Freiburg, Germany
| | - Axel Dost
- Department of Pediatrics and Adolescent Medicine, University of Jena, Jena, Germany
| | - Tilman R Rohrer
- Division of Pediatric Endocrinology, Department of General Pediatrics and Neonatology, Saarland University Medical Center, Homburg, Germany
| | | | - Reinhard W Holl
- Institute of Epidemiology and Medical Biometry, University of Ulm, Ulm, Germany
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Rohrer TR, Winter F, Qvist M, Kappelgaard AM. Comparison of intuitiveness, ease of use and preference among three prefilled, disposable growth hormone injection pens. Expert Opin Drug Deliv 2013; 10:1603-12. [DOI: 10.1517/17425247.2013.829451] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
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Aitken RJ, Mehers KL, Williams AJ, Brown J, Bingley PJ, Holl RW, Rohrer TR, Schober E, Abdul-Rasoul MM, Shield JPH, Gillespie KM. Early-onset, coexisting autoimmunity and decreased HLA-mediated susceptibility are the characteristics of diabetes in Down syndrome. Diabetes Care 2013; 36:1181-5. [PMID: 23275362 PMCID: PMC3631858 DOI: 10.2337/dc12-1712] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.5] [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] [Indexed: 02/03/2023]
Abstract
OBJECTIVE Down syndrome (DS) is associated with an increased risk of diabetes, particularly in young children. HLA-mediated risk is however decreased in children with DS and diabetes (DSD). We hypothesized that early-onset diabetes in children with DS is etiologically different from autoimmune diabetes. RESEARCH DESIGN AND METHODS Clinical and immunogenetic markers of autoimmune diabetes were studied in 136 individuals with DSD and compared with 194 age- and sex-matched individuals with type 1 diabetes, 222 with DS, and 671 healthy controls. HLA class II was analyzed by sequence-specific primed PCR. Islet autoantibodies were measured by radioimmunoassay. RESULTS Age at onset of diabetes was biphasic, with 22% of DS children diagnosed before 2 years of age, compared with only 4% in this age-group with type 1 diabetes in the general population (P < 0.0001). The frequency of the highest-risk type 1 diabetes-associated HLA genotype, DR3-DQ2/DR4-DQ8, was decreased in both early- and later-onset DSD compared with age-matched children with type 1 diabetes (P < 0.0001), although HLA DR3-DQ2 genotypes were increased (P = 0.004). Antibodies to GAD were observed in all five samples tested from children diagnosed at ≤2 years of age, and persistent islet autoantibodies were detected in 72% of DSD cases. Thyroid and celiac disease were diagnosed in 74 and 14%, respectively, of the DSD cohort. CONCLUSIONS Early-onset diabetes in children with DS is unlikely to be etiologically different from autoimmune diabetes occurring in older DS children. Overall, these studies demonstrate more extreme autoimmunity in DSD typified by early-onset diabetes with multiple autoimmunity, persistent islet autoantibodies, and decreased HLA-mediated susceptibility.
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Obeid R, Hartmuth K, Herrmann W, Gortner L, Rohrer TR, Geisel J, Reed MC, Nijhout HF. Blood biomarkers of methylation in Down syndrome and metabolic simulations using a mathematical model. Mol Nutr Food Res 2012; 56:1582-9. [PMID: 22930479 DOI: 10.1002/mnfr.201200162] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2012] [Revised: 06/22/2012] [Accepted: 07/05/2012] [Indexed: 12/29/2022]
Abstract
SCOPE The study tests the metabolites of the methylation cycle in individuals with Down syndrome (DS) and applies a mathematical model in order to change this cycle by nutritional factors. METHODS AND RESULTS We measured concentrations of the metabolites related to the methylation cycle in the blood of 35 young individuals with DS and 47 controls of comparable age. Moreover, we applied a mathematical model to learn more about the regulation of the methylation cycle in DS. Concentrations of cystathionine, cysteine, betaine, choline, dimethylglycine, S-adenosylhomocysteine (SAH), S-adenosylmethionine (SAM), and holotranscobalamin were significantly higher in DS compared to the controls. The median SAM/SAH ratio was lower in DS and that of methionine and reduced glutathione did not differ significantly between the groups. The mathematical model showed that enhanced methionine turnover and accelerated Hcy-remethylation might explain the shift in the methylation cycle in DS. CONCLUSION In addition to the DS-related excess of cystathionine beta synthase (CBS) activity, increases in the activities of MS and betaine homocysteine methyl transferase, and in methionine input were necessary to account for the changes in metabolite levels observed in DS. A low-methionine diet might offer a perspective for reversing the metabolic imbalance in DS, but this awaits clinical investigations.
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Affiliation(s)
- Rima Obeid
- Department of Clinical Chemistry and Laboratory Medicine, Saarland University, Medical Centre, Homburg, Germany.
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Pfützner A, Hartmann K, Winter F, Fuchs GS, Kappelgaard AM, Rohrer TR. Intuitiveness, ease of use, and preference of a prefilled growth hormone injection pen: A noninterventional, randomized, open-label, crossover, comparative usability study of three delivery devices in growth hormone-treated pediatric patients. Clin Ther 2010; 32:1918-34. [DOI: 10.1016/j.clinthera.2010.10.010] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/08/2010] [Indexed: 11/30/2022]
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Rohrer TR, Langer T, Grabenbauer GG, Buchfelder M, Glowatzki M, Dörr HG. Growth hormone therapy and the risk of tumor recurrence after brain tumor treatment in children. J Pediatr Endocrinol Metab 2010; 23:935-42. [PMID: 21175094 DOI: 10.1515/jpem.2010.150] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.4] [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] [Indexed: 11/15/2022]
Abstract
To assess the effect of human growth hormone (hGH) therapy and other factors on tumor recurrence after treatment of pediatric brain tumors (BTs), we retrospectively analyzed data from 108 craniopharyngioma, medulloblastoma, and ependymoma patients. Risk factors were identified using multifactorial univariate regression analysis. Recurrences occurred in 41 and second malignant neoplasms in 4 patients. There were significant correlations for completeness of tumor removal and recurrence-free survival (RFS). 13/44 hGH-treated and 28/59 non-hGH-treated children relapsed. This difference was found only for medulloblastomas and accounted for by higher rates of incomplete tumor removal in non-hGH patients. Craniopharyngioma recurrence correlated only with RFS. Malignant BT recurrence correlated with completeness of tumor removal, chemotherapy, and RFS. 4 children developed SMNs, 3/4 after hGH therapy. Our regression model yielded accurate within-sample prediction of recurrence for 90% of the study population. We conclude that hGH therapy after treatment of pediatric BTs does not increase tumor recurrence risk.
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Affiliation(s)
- Tilman R Rohrer
- Department of Pediatrics and Adolescent Medicine, Saarland University Hospital, Homburg/Saar, Germany
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Rohrer TR, Hennes P, Thon A, Dost A, Grabert M, Rami B, Wiegand S, Holl RW. Down's syndrome in diabetic patients aged <20 years: an analysis of metabolic status, glycaemic control and autoimmunity in comparison with type 1 diabetes. Diabetologia 2010; 53:1070-5. [PMID: 20186386 DOI: 10.1007/s00125-010-1686-z] [Citation(s) in RCA: 24] [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: 11/11/2009] [Accepted: 01/20/2010] [Indexed: 11/24/2022]
Abstract
AIMS/HYPOTHESIS Intellectual impairment in individuals with Down's syndrome and diabetes mellitus potentially limits the quality of diabetic control. In addition, these patients are at risk of having immunological abnormalities. The present study compared metabolic status and concomitant diseases in young (<20 years old) Down's syndrome patients with diabetes vs young type 1 diabetic patients. METHODS The Diabetes-Patienten-Verlaufsdaten is a longitudinal follow-up database, which collects data from 298 German and Austrian diabetes centres. Data available on diabetic patients aged <20 years were analysed statistically. RESULTS We compared data for 159 Down's syndrome patients with diabetes and 41,983 type 1 diabetic patients. The former used less insulin, but showed better glycaemic control (HbA1c). Diabetes onset during the first 3 years of life occurred in 18.9% of Down's syndrome patients with diabetes and in 6.4% of type 1 diabetic patients. Antibody titres indicative of coeliac disease and thyroid peroxidase antibodies were more frequent in Down's syndrome patients with diabetes. No significant differences were found regarding the beta cell autoantibodies studied. CONCLUSIONS/INTERPRETATION The age-of-onset distribution showed a shift towards younger ages and was bimodal in the Down's syndrome group. The better metabolic control found, despite intellectual impairment, in young Down's syndrome patients with diabetes cannot be conclusively explained by our data, but is likely to be due to a less complex lifestyle. Our data provide further confirmation that coeliac and thyroid antibodies are more prevalent in Down's syndrome. The presence of beta cell autoantibodies supports an autoimmune cause of diabetes in some children with Down's syndrome.
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Affiliation(s)
- T R Rohrer
- Department of Paediatrics and Neonatology, Saarland University Hospital, Kirrberger Str. 1, Geb. 9, 66421 Homburg/Saar, Germany.
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Rohrer TR, Beck JD, Grabenbauer GG, Fahlbusch R, Buchfelder M, Dörr HG. Late endocrine sequelae after radiotherapy of pediatric brain tumors are independent of tumor location. J Endocrinol Invest 2009; 32:294-7. [PMID: 19636193 DOI: 10.1007/bf03345714] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.2] [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: 10/25/2022]
Abstract
INTRODUCTION Irradiation of brain tumors (BT) in children can lead to the loss of pituitary function, predominantly manifesting as deficiencies in GH and ACTH. OBJECTIVE To assess the incidence and nature of pituitary deficiency in relation to initial tumor location in children after radiotherapy of BT. METHODS Twenty survivors (16 males and 4 females) of radiation-treated BT aged 1.4-10.9 (median 3.6) yr at diagnosis were studied, 10 with supratentorial and 10 with infratentorial BT. Radiation doses to the hypothalamus- pituitary (HP) area ranged from 30 to 54 (median 45) Gray. Follow-up was 9.4-16.9 (median 12.2) yr. Basal pituitary hormone levels were measured every 6 months. When growth failure became evident or pituitary deficiency was suspected, provocation tests of the HP axis were performed to assess GH, ACTH, and TSH function. RESULTS GH deficiency (GHD) developed in 17/20 (85%) children. In 10 patients, it occurred 4 yr after radiotherapy and in 2, 11 and 12 yr after radiotherapy. Six (30%) patients developed secondary hypothyroidism and 4 (20%) developed ACTH deficiency. Precocious puberty occurred in 2 girls. The course of development and the severity of hormone deficiencies were similar for supratentorial and infratentorial tumors. CONCLUSION The major hormonal effect of BT irradiation in children is GHD, which may sometimes take more than 10 yr to manifest. We confirm findings by others that ACTH insufficiency occurs less frequently in children than reported for adults. Tumor location has no prognostic significance regarding the loss of HP function.
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Affiliation(s)
- T R Rohrer
- Department of Paediatrics and Adolescent Medicine, Saarland University Hospital, Homburg/Saar, Germany
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Rohrer TR, Rizzo VF, Cäsar JJ, Muelbredt O, Sprengart S, Gortner L, Stierkorb E. Changes in hepatic risk factors, metabolic variables, body composition, and physical fitness in obese children after a one-year weight loss program. J Pediatr Endocrinol Metab 2008; 21:837-45. [PMID: 18924577 DOI: 10.1515/jpem.2008.21.9.837] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Obesity can cause insulin resistance and cardiovascular and liver disease. The aim of this study was to analyze changes in laboratory values, body composition, and physical fitness before and after a one-year weight loss program with nutritional education, psychological care, and physical exercise. Twenty-two obese children (16 boys, 6 girls; median age 11.9 [range 7-15] years; BMI SDS +2.4 [1.6-3.1]) participated in the program. Outcome measures included liver enzymes, insulin resistance (HOMA), lipids, body composition, physical strength and endurance. All children had an inverse HOMA/body composition correlation; Group 1 (reduced BMI SDS after one year) had lower triglycerides, liver enzymes and improved body composition and fitness (p < 0.05). Group 2 (unchanged or increased BMI SDS) had worse body composition and increased endurance and strength of trunk extension (p < 0.05). Weight loss reduced risk factors for liver disease and improved insulin sensitivity. Body composition proved useful as a non-invasive indicator for insulin sensitivity.
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Affiliation(s)
- Tilman R Rohrer
- Department of Paediatrics and Neonatology, Saarland University Hospital, Homburg/Saar, Germany.
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Rohrer TR, Fahlbusch R, Buchfelder M, Dörr HG. Craniopharyngioma in a Female Adolescent Presenting with Symptoms of Anorexia Nervosa. Klin Padiatr 2006; 218:67-71. [PMID: 16506105 DOI: 10.1055/s-2006-921506] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
BACKGROUND Tumours of the central nervous system mostly present with neurological symptoms and signs of intracranial hypertension. Several reports of cerebral tumors in adolescents outline initial symptoms of anorexia and emaciation, leading to the diagnosis of anorexia nervosa. PATIENT We report on a 15.5-year-old girl with a craniopharyngioma. The girl had a 2 year history of weight loss, dystrophy, no onset of puberty, and a 6 year history of headache. These symptoms had led initially to the clinical diagnoses of migraine and anorexia nervosa, since unenhanced computed tomography of the brain was normal. At presentation, physical examination showed short stature (height SDS - 3.6) and Tanner stage I. Bone age delay was about four years. Laboratory analyses showed hypopituitarism. The diagnosis of craniopharyngioma was made by repeated imaging, depicting an intrasellar and parasellar mass, which was totally removed by neurosurgery. Hormonal substitution with hGH, L-thyroxine, hydrocortisone, and estrogens led to normal physiological development and final height within upper target height. CONCLUSIONS The reported case illustrates that the diagnosis of craniopharyngioma is often delayed due to unspecific clinical symptoms. Careful evaluation of anthropometrics, ophthalmologic, and endocrine data in patients with suspected eating disorders may give additional clues to the diagnosis of a craniopharyngioma.
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Affiliation(s)
- T R Rohrer
- Klinik für Allgmeine Pädiatrie und Neonatologie, Universitätsklinikum des Saarlandes, Homburg/Saar
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Völkl TMK, Simm D, Schwöbel K, Beier C, Rohrer TR, Dörr HG. Spontaneous growth hormone secretion and IGF1:IGFBP3 molar ratios in children born small for Gestational Age (SGA). Exp Clin Endocrinol Diabetes 2005. [DOI: 10.1055/s-2005-863009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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Völkl TMK, Schwöbel K, Simm D, Beier C, Rohrer TR, Dörr HG. Spontaneous growth hormone secretion and IGF1:IGFBP3 molar ratios in children born small for gestational age (SGA). Growth Horm IGF Res 2004; 14:455-461. [PMID: 15519254 DOI: 10.1016/j.ghir.2004.08.002] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/23/2004] [Revised: 08/05/2004] [Accepted: 08/05/2004] [Indexed: 10/26/2022]
Abstract
OBJECTIVE To analyze spontaneous nocturnal GH profiles, IGF1 and IGFBP3 serum levels, as well as IGF1:IGFBP3 molar ratios in SGA children without postnatal catch-up growth. METHODS Short statured prepubertal SGA children (n = 24) were matched retrospectively for sex, age and BMI to short statured children born appropriate for gestational age (AGA), who underwent the same diagnostic program. GH deficiency was excluded in all children by a normal increase of GH in 2 stimulation tests (>8 microg/L). For assessment of spontaneous nocturnal GH secretion, GH serum levels were measured every 20 min for 10 h. Pulsatility was analyzed with Pulsar. RESULTS None of the Pulsar derived descriptive parameters showed a significant difference between SGA and AGA children. Overall, median IGF1 levels were approximately one SDS below zero SDS (p < 0.001), whereas IGFBP3 levels were normal in both groups. Thus, the IGF1:IGFBP3 molar ratios were significantly lower from zero (p < 0.01) in SGA as well as in AGA children. However, IGF1- and IGFBP3-SDS levels related either to chronological or to bone age did not differ significantly between SGA and AGA children. CONCLUSIONS Building matched pairs of short statured children born either SGA or AGA for sex, age and BMI we did not find any significant differences in spontaneous nocturnal GH secretion, IGF1, IGFBP3, and IGF1:IGFBP3 molar ratios.
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Affiliation(s)
- Thomas M K Völkl
- Division of Pediatric Endocrinology, Hospital for Children and Adolescents, Friedrich-Alexander-University of Erlangen-Nuremberg, Loschgestrasse 15, 91054 Erlangen, Germany
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Rohrer TR, Gassmann KF, Rauch A, Pfeiffer RA, Doerr HG. Growth of heterokaryotic monozygotic twins discordant for Ullrich-Turner syndrome during the first years of life. Am J Med Genet A 2004; 126A:78-83. [PMID: 15039976 DOI: 10.1002/ajmg.a.20446] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2023]
Abstract
The rare observation of different karyotypes in monozygotic (MZ) twins, i.e., heterokaryotic monozygosity, occurs due to chromosomal aberration in one of the twins after separation of the embryos. We report on the differences of heterokaryotic MZ Turkish twins who are discordant for Ullrich-Turner syndrome. Chromosomal analyses from peripheral lymphocytes revealed a 45,X/46,XX mosaicism in both twins. FISH analyses of buccal smears showed 99% of nuclei 45,X in twin A and 98% of nuclei 46,XX in twin B. These results are consistent with a non-mosaic 45,X and 46,XX karyotype, respectively. The girls showed a different growth pattern in the first years. As their genotype should be identical except for the number of X chromosomes, the difference in phenotype may be a pure result of loss of one X chromosome in the affected girl. Special interest is set on the spontaneous and growth hormone induced growth of the twins.
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Affiliation(s)
- T R Rohrer
- Hospital for Children and Adolescents, Division of Pediatric Endocrinology, Erlangen, Germany
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Abstract
We report on a newborn with a severe salt-wasting crisis due to congenital adrenal hyperplasia (CAH) with 21-hydroxylase deficiency, in spite of prenatal diagnosis of CAH and awareness of this diagnosis by the parents and the gynecologic and pediatric practitioners. Due to the diagnosis of CAH in the older sister, prenatal treatment with dexamethasone (Dexa) was initiated. Prenatal diagnosis showed an affected male fetus and the prenatal treatment was stopped. The parents and the involved physicians were informed about the diagnosis, treatment, follow-up, and possible complications. Amniotic infection led to preterm delivery in another hospital. Due to perinatal asphyxia, the male newborn received Dexa during mechanical ventilation. Neonatal CAH screening was unsuspicious. An acute salt-wasting crisis with metabolic acidosis at the age of 3 weeks finally led to the correct diagnosis. This experience emphasizes the need to obtain a careful medical history. Furthermore, this case illustrates that neonatal screening for CAH is falsely negative in the event of neonatal Dexa treatment.
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Affiliation(s)
- Tilman R Rohrer
- Division of Pediatric Endocrinology, Hospital for Children and Adolescents, Erlangen University Medical School, Loschgestrasse 15, D-91054 Erlangen, Germany
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Abstract
An 11 year-old girl presented with 47,XXX karyotype. Our report emphasizes the fact that triple X syndrome has also to be considered in girls presenting with tall stature that is not explained by parental heights.
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Affiliation(s)
- B U Liebezeit
- Division of Pediatric Endocrinology, Hospital for Children and Adolescents, Erlangen-Nürnberg University Medical School, Erlangen, Germany
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Rohrer TR, Engelcke G, Rudin C. Infants with CMV and HIV-1. N Engl J Med 1999; 341:1476-7. [PMID: 10577105 DOI: 10.1056/nejm199911043411917] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
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