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Yıldız F, Tuğrul Aksakal MZ, Yıldız R, Baş F. The Relationship Between Sleep Quality, Sleep Duration, Social Jet Lag and Obesity in Adolescents. J Clin Res Pediatr Endocrinol 2024:0-0. [PMID: 38683020 DOI: 10.4274/jcrpe.galenos.2024.2024-2-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 05/01/2024] Open
Abstract
Objective The frequency of obesity and poor sleep quality among adolescents is increasing and causes many chronic problems. The objective was to investigate the correlation between body mass index (BMI), sleep quality, sleep duration and social jet lag (SJL) among adolescents. Methods This study is cross-sectional. A cohort of 416 adolescents, ranging in age from 12 to 18 participated in the study. Adolescents were divided into three groups according to BMI SDS: adolescents with normal weight, adolescents with overweight and adolescents with obesity. The Pittsburgh Sleep Quality Index (PSQI) questionnaire was used to determine the sleep quality of the adolescents. The calculation of SJL and sleep-corrected social jet lag (SJLsc) was performed. Results The mean age of the adolescents was 15.0 ± 2.9 years.There were 222 males (53.4%). SJL and PSQI scores were significantly higher in the adolescents with obesity compared to the adolescents with normal weight and overweight (p < 0.001). An analysis of the relationship between the PSQI and BMI SDS revealed a correlation that was statistically significant (r = 0.667; p < 0.001). Conclusion Adolescents with obesity reveal poorer sleep quality and a longer duration of SJL compared to adolescents with normal-weight. Moreover, increased SJL was linked to an increase in BMI. Maintaining good sleep quality and less exposure to SJL may help reduce the risk of obesity.
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Affiliation(s)
- Funda Yıldız
- Istanbul University, Institute of Child Health, Department of Pediatric Basic Sciences, Division of Adolescent Medicine
| | - Melike Zeynep Tuğrul Aksakal
- Istanbul University, Institute of Child Health, Department of Pediatric Basic Sciences, Division of Adolescent Medicine
| | - Raif Yıldız
- Basaksehir Cam and Sakura City Hospital, Clinic of Pediatric Emergency
| | - Firdevs Baş
- Istanbul University, Istanbul Faculty of Medicine, Department of Pediatrics, Division of Pediatric Endocrinology
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Karakılıç Özturan E, Öztürk AP, Baş F, Erdoğdu AB, Kaptan S, ardelen Al AD, Poyrazoğlu Ş, Yıldız M, Direk N, Yüksel Ş, Darendeliler F. In response to: “Letter to: Endocrinological Approach to Adolescents with Gender Dysphoria: Experience of a Pediatric Endocrinology Department in a Tertiary Center in Turkey”. J Clin Res Pediatr Endocrinol 2023; 15:451-452. [PMID: 37752752 PMCID: PMC10683545 DOI: 10.4274/jcrpe.galenos.2023.2023-9-20] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/25/2023] [Accepted: 09/26/2023] [Indexed: 09/28/2023] Open
Affiliation(s)
- Esin Karakılıç Özturan
- İstanbul University, İstanbul Faculty of Medicine, Department of Pediatrics, Division of Pediatric Endocrinology, İstanbul, Turkey
| | - Ayşe Pınar Öztürk
- İstanbul University, İstanbul Faculty of Medicine, Department of Pediatrics, Division of Pediatric Endocrinology, İstanbul, Turkey
| | - Firdevs Baş
- İstanbul University, İstanbul Faculty of Medicine, Department of Pediatrics, Division of Pediatric Endocrinology, İstanbul, Turkey
| | - Ayşe Burcu Erdoğdu
- Marmara University, Pendik Training and Research Hospital, Clinic of Child and Adolescent Psychiatry, İstanbul, Turkey
| | - Seven Kaptan
- Psychiatrists in Private Practice, İstanbul, Turkey
| | - Aslı Derya ardelen Al
- İstanbul University, İstanbul Faculty of Medicine, Department of Pediatrics, Division of Pediatric Endocrinology, İstanbul, Turkey
| | - Şükran Poyrazoğlu
- İstanbul University, İstanbul Faculty of Medicine, Department of Pediatrics, Division of Pediatric Endocrinology, İstanbul, Turkey
| | - Melek Yıldız
- İstanbul University, İstanbul Faculty of Medicine, Department of Pediatrics, Division of Pediatric Endocrinology, İstanbul, Turkey
| | - Neşe Direk
- İstanbul University, İstanbul Faculty of Medicine, Department of Psychiatry, İstanbul, Turkey
| | - Şahika Yüksel
- İstanbul University, İstanbul Faculty of Medicine, Department of Psychiatry, Psychiatrist in Private Practice, Emeritus Professor, İstanbul, Turkey
| | - Feyza Darendeliler
- İstanbul University, İstanbul Faculty of Medicine, Department of Pediatrics, Division of Pediatric Endocrinology, İstanbul, Turkey
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Kardelen AD, Najaflı A, Baş F, Karaman B, Toksoy G, Poyrazoğlu Ş, Avcı Ş, Altunoğlu U, Yavaş Abalı Z, Öztürk AP, Karakılıç Özturan E, Başaran S, Darendeliler F, Uyguner ZO. PROKR2 Mutations in Patients with Short Stature Who Have Isolated Growth Hormone Deficiency and Multiple Pituitary Hormone Deficiency. J Clin Res Pediatr Endocrinol 2023; 15:338-347. [PMID: 37338295 PMCID: PMC10683534 DOI: 10.4274/jcrpe.galenos.2023.2023-4-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/09/2023] [Accepted: 06/19/2023] [Indexed: 06/21/2023] Open
Abstract
Objective Recent reports have indicated the role of the prokineticin receptor 2 gene (PROKR2) in the etiology of pituitary hormone deficiencies, suggesting a potential role for the PROK2 pathway in pituitary development, in addition to its role in gonadotropin releasing hormone-expressing neuron development. Here, we present the clinical and molecular findings of four patients with PROKR2 mutations. Methods Next-generation targeted sequencing was used to screen 25 genes in 59 unrelated patients with multiple pituitary hormone deficiency (MPHD), isolated growth hormone (GH) deficiency, or idiopathic short stature. Results Two different, very rare PROKR2 missense alterations classified as pathogenic (NM_144773.4:c.518T>G; NP_658986.1:p. (Leu173Arg)) and likely pathogenic (NM_144773.4:c.254G>A; NP_658986.1:p.(Arg85His)) were identified in four patients in heterozygous form. Patient 1 and Patient 2 presented with short stature and were diagnosed as GH deficiency. Patient 3 and Patient 4 presented with central hypothyroidism and cryptorchidism and were diagnosed as MPHD. No other pathogenic alterations were detected in the remaining 24 genes related to short stature, MPHD, and hypogonadotropic hypogonadism. Segregation analysis revealed asymptomatic or mildly affected carriers in the families. Conclusion PROKR2 dominance should be kept in mind as a very rare cause of GH deficiency and MPHD. Expressional variation or lack of penetrance may imply oligogenic inheritance or other environmental modifiers in individuals who are heterozygous carriers.
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Affiliation(s)
- Aslı Derya Kardelen
- İstanbul University, İstanbul Faculty of Medicine, Department of Pediatric Endocrinology, İstanbul, Turkey
| | - Adam Najaflı
- İstanbul University, İstanbul Faculty of Medicine, Department of Medical Genetics, İstanbul, Turkey
| | - Firdevs Baş
- İstanbul University, İstanbul Faculty of Medicine, Department of Pediatric Endocrinology, İstanbul, Turkey
| | - Birsen Karaman
- İstanbul University, İstanbul Faculty of Medicine, Department of Medical Genetics, İstanbul, Turkey
- İstanbul University, Institute of Child Health, Department of Pediatric Basic Sciences, İstanbul, Turkey
| | - Güven Toksoy
- İstanbul University, İstanbul Faculty of Medicine, Department of Medical Genetics, İstanbul, Turkey
| | - Şükran Poyrazoğlu
- İstanbul University, İstanbul Faculty of Medicine, Department of Pediatric Endocrinology, İstanbul, Turkey
| | - Şahin Avcı
- İstanbul University, İstanbul Faculty of Medicine, Department of Medical Genetics, İstanbul, Turkey
- Koç University Faculty of Medicine, Department of Medical Genetics, İstanbul, Turkey
| | - Umut Altunoğlu
- İstanbul University, İstanbul Faculty of Medicine, Department of Medical Genetics, İstanbul, Turkey
- Marmara University Faculty of Medicine, Department of Pediatric Endocrinology, İstanbul, Turkey
| | - Zehra Yavaş Abalı
- İstanbul University, İstanbul Faculty of Medicine, Department of Medical Genetics, İstanbul, Turkey
- Marmara University Faculty of Medicine, Department of Pediatric Endocrinology, İstanbul, Turkey
| | - Ayşe Pınar Öztürk
- İstanbul University, İstanbul Faculty of Medicine, Department of Pediatric Endocrinology, İstanbul, Turkey
| | - Esin Karakılıç Özturan
- İstanbul University, İstanbul Faculty of Medicine, Department of Pediatric Endocrinology, İstanbul, Turkey
| | - Seher Başaran
- İstanbul University, İstanbul Faculty of Medicine, Department of Medical Genetics, İstanbul, Turkey
| | - Feyza Darendeliler
- İstanbul University, İstanbul Faculty of Medicine, Department of Pediatric Endocrinology, İstanbul, Turkey
| | - Z. Oya Uyguner
- İstanbul University, İstanbul Faculty of Medicine, Department of Medical Genetics, İstanbul, Turkey
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Kardelen AD, Karakılıç Özturan E, Poyrazoğlu Ş, Baş F, Ceylaner S, Joustra SD, Wit JM, Darendeliler F. A Novel Pathogenic IGSF1 Variant in a Patient with GH and TSH Deficiency Diagnosed by High IGF-I Values at Transition to Adult Care. J Clin Res Pediatr Endocrinol 2023; 15:431-437. [PMID: 35466665 PMCID: PMC10683549 DOI: 10.4274/jcrpe.galenos.2022.2021-12-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/14/2021] [Accepted: 03/29/2022] [Indexed: 12/01/2022] Open
Abstract
IGSF1 deficiency is a rare X-linked condition characterized by central hypothyroidism and a wide variety of other clinical features with variable prevalence, including a delayed pubertal testosterone rise and growth spurt in the context of normal or accelerated testicular growth, and adult macroorchidism with relatively low serum testosterone concentrations. Other features include increased waist circumference, attention deficit, prolactin deficiency and transient partial growth hormone (GH) deficiency in childhood, contrasting with an increased GH secretion in adulthood. Patients with this disorder are not detected shortly after birth if neonatal screening programs are based on thyroid-stimulating hormone (TSH) concentrations. A 13.2-year-old male patient was referred to pediatric endocrinology for evaluation of short stature. He was born large for gestational age into a nonconsanguineous family. During work-up for short stature, deficiencies of TSH, prolactin and GH were detected, leading to treatment with levothyroxine and GH. At 16.9 years, GH treatment was stopped and during transition to adult care, his insulin-like growth factor 1 level was above the normal range. This prompted an analysis of IGSF1, in which a novel hemizygous variant causing a stop codon at c.3559C>T (p.Q1187*) was found, confirming the diagnosis of IGSF1 deficiency syndrome. In this report, we describe his clinical and hormonal characteristics at presentation and during long-term follow-up.
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Affiliation(s)
- Aslı Derya Kardelen
- İstanbul University, İstanbul Faculty of Medicine, Department of Pediatric Endocrinology, İstanbul, Turkey
| | - Esin Karakılıç Özturan
- İstanbul University, İstanbul Faculty of Medicine, Department of Pediatric Endocrinology, İstanbul, Turkey
| | - Şükran Poyrazoğlu
- İstanbul University, İstanbul Faculty of Medicine, Department of Pediatric Endocrinology, İstanbul, Turkey
| | - Firdevs Baş
- İstanbul University, İstanbul Faculty of Medicine, Department of Pediatric Endocrinology, İstanbul, Turkey
| | | | - Sjoerd D. Joustra
- Willem-Alexander Children’s Hospital; Leiden University Medical Center, Department of Pediatrics, Division of Pediatric Endocrinology, Leiden, Netherlands
| | - Jan M. Wit
- Willem-Alexander Children’s Hospital; Leiden University Medical Center, Department of Pediatrics, Division of Pediatric Endocrinology, Leiden, Netherlands
| | - Feyza Darendeliler
- İstanbul University, İstanbul Faculty of Medicine, Department of Pediatric Endocrinology, İstanbul, Turkey
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Karakılıç Özturan E, Öztürk AP, Baş F, Erdoğdu AB, Kaptan S, Kardelen Al AD, Poyrazoğlu Ş, Yıldız M, Direk N, Yüksel Ş, Darendeliler F. Endocrinological Approach to Adolescents with Gender Dysphoria: Experience of a Pediatric Endocrinology Department in a Tertiary Center in Turkey. J Clin Res Pediatr Endocrinol 2023; 15:276-284. [PMID: 36987788 PMCID: PMC10448553 DOI: 10.4274/jcrpe.galenos.2023.2023-1-13] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/17/2023] [Accepted: 03/27/2023] [Indexed: 03/30/2023] Open
Abstract
Objective A significant rise in the number of trans adolescents seeking medical interventions has been reported in recent years. The aim of this study was to report the clinical features, treatment, and follow-up of adolescents with gender dysphoria (GD) with our increased experience. Methods Twenty-six male-to-female (MTF) and twenty-seven female-to-male (FTM) adolescents who were referred to the GD-outpatient clinic between 2016 and 2022 were reviewed. The clinical and laboratory findings of thirty transgender adolescents (15 FTM /15 MTF) who received medical intervention were evaluated retrospectively. Results Most individuals (60.4%) were admitted between 2020 and 2022, and the remaining (39.6%) were admitted between 2016 and 2019. At the time of referral, median age was 16.3 years [interquartile range (IQR) 1.53; range 13.2-19.4] in 26 MTF, and 16.4 years (IQR 1.74; range 11.7-21.6) in 27 FTM adolescents. The median age at pubertal blockage with gonadotropin-releasing hormone analog and androgen receptor blocker was 16.4 years (IQR 1.4; range 11.7-17.8) in 22 adolescents (9 MTF, 13 FTM), and 17.4 years (IQR 1.4; range 15.5-19.4) in 6 MTF individuals, respectively. Cross-sex hormone therapy was commenced in 21 adolescents (12 MTF, 9 FTM) at the median age of 17.7 years (IQR 0.61; range 16-19.5). Fifteen individuals (8 MTF, 7 FTM) have been transferred to the adult endocrinology department in transition clinics. Conclusion All treatments were generally well tolerated and effective, including bicalutamide, and no significant side effects were observed. Transition clinics played an important role in the better management of gender reassignment processes.
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Affiliation(s)
- Esin Karakılıç Özturan
- İstanbul University, İstanbul Faculty of Medicine, Department of Pediatrics, Division of Pediatric Endocrinology, İstanbul, Turkey
| | - Ayşe Pınar Öztürk
- İstanbul University, İstanbul Faculty of Medicine, Department of Pediatrics, Division of Pediatric Endocrinology, İstanbul, Turkey
| | - Firdevs Baş
- İstanbul University, İstanbul Faculty of Medicine, Department of Pediatrics, Division of Pediatric Endocrinology, İstanbul, Turkey
| | - Ayşe Burcu Erdoğdu
- Marmara University, Pendik Training and Research Hospital, Clinic of Child and Adolescent Psychiatry, İstanbul, Turkey
| | - Seven Kaptan
- Psychiatrists in Private Practice, İstanbul, Turkey
| | - Aslı Derya Kardelen Al
- İstanbul University, İstanbul Faculty of Medicine, Department of Pediatrics, Division of Pediatric Endocrinology, İstanbul, Turkey
| | - Şükran Poyrazoğlu
- İstanbul University, İstanbul Faculty of Medicine, Department of Pediatrics, Division of Pediatric Endocrinology, İstanbul, Turkey
| | - Melek Yıldız
- İstanbul University, İstanbul Faculty of Medicine, Department of Pediatrics, Division of Pediatric Endocrinology, İstanbul, Turkey
| | - Neşe Direk
- İstanbul University, İstanbul Faculty of Medicine, Department of Psychiatry, İstanbul, Turkey
| | - Şahika Yüksel
- İstanbul University, İstanbul Faculty of Medicine, Department of Psychiatry, Psychiatrist in Private Practice, Emeritus Professor, İstanbul, Turkey
| | - Feyza Darendeliler
- İstanbul University, İstanbul Faculty of Medicine, Department of Pediatrics, Division of Pediatric Endocrinology, İstanbul, Turkey
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Yavaş Abalı Z, Öztürk AP, Baş F, Poyrazoğlu Ş, Akcan N, Kebudi R, İribaş Çelik A, Bundak R, Darendeliler F. Long-Term Endocrinologic Follow-Up of Children with Brain Tumors and Comparison of Growth Hormone Therapy Outcomes: A SingleCenter Experience. Turk Arch Pediatr 2023; 58:308-313. [PMID: 37144265 DOI: 10.5152/turkarchpediatr.2023.22147] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/06/2023]
Abstract
OBJECTIVE Brain tumors in childhood carry a high risk for endocrine disorders due to the direct effects of the tumor and/or surgery and radiotherapy. Somatotropes are vulnerable to pressure and radiotherapy; therefore, growth hormone deficiency is one of the most frequent abnormalities. This study aimed to evaluate endocrine disorders and recombinant growth hormone treatment outcomes in brain tumor survivors. MATERIALS AND METHODS In this study, 65 (27 female) patients were classified into 3 groups as craniopharyngioma (n = 29), medulloblastoma (n = 17), and others (n = 19). "Others" group included astrocytoma, ependymoma, germinoma, pineoblastoma, and meningioma patients. Anthropometric data and endocrine parameters of patients and their growth outcome with/without recombinant growth hormone therapy were collected from medical records, retrospectively. RESULTS Mean age at the first endocrinological evaluation was 8.7 ± 3.6 years (range: 1.0- 17.1 years). Height, weight, and body mass index standard deviation score, mean ± standard deviation (median) values were -1.7 ± 1.7 (-1.5), -0.8 ± 1.9 (-0.8), and 0.2 ± 1.5 (0.4), respectively. Hypothyroidism (central 86.9%, primary 13.1%) was detected during follow-up in 81.5% of patients. Primary hypothyroidism in medulloblastoma (29.4%) was significantly higher compared to other groups (P = .002). The frequency of hypogonadotropic hypogonadism, central adrenal insufficiency, and diabetes insipidus was significantly high in the craniopharyngioma cases. CONCLUSION In our study, endocrine disorders other than growth hormone deficiency were also frequently observed. In craniopharyngioma cases, the response to recombinant growth hormone therapy was satisfactory. However, there was no improvement in height prognosis during recombinant growth hormone therapy in medulloblastoma patients. A multidisciplinary approach to the care of these patients, referral for endocrine complications, and guidelines on when recombinant growth hormone therapy is required.
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Affiliation(s)
- Zehra Yavaş Abalı
- Department of Pediatric Endocrinology and Diabetes, İstanbul University İstanbul Faculty of Medicine, İstanbul, Turkey
| | - Ayşe Pınar Öztürk
- Department of Pediatric Endocrinology and Diabetes, İstanbul University İstanbul Faculty of Medicine, İstanbul, Turkey
| | - Firdevs Baş
- Department of Pediatric Endocrinology and Diabetes, İstanbul University İstanbul Faculty of Medicine, İstanbul, Turkey
| | - Şükran Poyrazoğlu
- Department of Pediatric Endocrinology and Diabetes, İstanbul University İstanbul Faculty of Medicine, İstanbul, Turkey
| | - Neşe Akcan
- Department of Pediatric Endocrinology and Diabetes, İstanbul University İstanbul Faculty of Medicine, İstanbul, Turkey; Department of Pediatric Endocrinology, Near East University Faculty of Medicine, Nicosia, Turkish Republic of Northern Cyprus
| | - Rejin Kebudi
- Department of Pediatric Hematology-Oncology, İstanbul University Institute of Oncology, İstanbul, Turkey
| | - Ayça İribaş Çelik
- Department of Radiation Oncology, İstanbul University İstanbul Faculty of Medicine, İstanbul, Turkey
| | - Rüveyde Bundak
- Department of Pediatric Endocrinology and Diabetes, İstanbul University İstanbul Faculty of Medicine, İstanbul, Turkey; Department of Pediatric Endocrinology, University of Kyrenia Faculty of Medicine, Kyrenia, Turkish Republic of Northern Cyprus
| | - Feyza Darendeliler
- Department of Pediatric Endocrinology and Diabetes, İstanbul University İstanbul Faculty of Medicine, İstanbul, Turkey
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Al ADK, Şükür NM, Özturan EK, Öztürk AP, Poyrazoğlu Ş, Baş F, Darendeliler FF. Body proportions in patients with Turner syndrome on growth hormone treatment. Turk J Med Sci 2023; 53:518-525. [PMID: 37476877 PMCID: PMC10388058 DOI: 10.55730/1300-0144.5612] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2022] [Accepted: 07/28/2022] [Indexed: 07/22/2023] Open
Abstract
BACKGROUND : In this cross-sectional study, we aimed to evaluate auxological measurements and detailed body proportions of recombinant human growth hormone (GH)-treated patients with Turner syndrome (TS) and compare them with a group of healthy females. METHODS We evaluated 42 patients with TS who received GH treatment and 20 healthy controls. Anthropometric measurements were taken and target height, body mass index (BMI), arm span-height difference, extremity-to-trunk ratio, and Manouvrier's skelic index were calculated. RESULTS : The median (min-max) age of the patients at the time of evaluation was 13.6 (4.3-20.7) years, and the control group was 12.9 (3.8-23.7) years. Height, sitting height, and arm span of TS patients were significantly lower than those of the control group. Sitting height/height ratio (SHR) was in normal ranges in both groups and BMI was significantly higher in TS patients when compared to the control group. According to Manouvrier's skelic index, TS patients had shorter legs than the control group (p = 0.001). The extremity-trunk ratio was significantly decreased in TS patients compared to healthy controls (p < 0.001). There was no significant difference between the karyotype groups in terms of these indexes. DISCUSSION TS patients had short stature, increased BMI and waist circumference, normal head circumference, and decreased extremity-trunk ratio. Sitting height and leg length were short; however, the SHR standard deviation score (SDS) was in the normal range. Despite being treated with GH, TS patients had disproportionate short stature. The disproportion in TS patients was similar to short-stature homeobox-containing gene (SHOX) deficiency, which is considered to be SHOX haploinsufficiency in the etiopathogenesis of short stature.
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Affiliation(s)
- Aslı Derya Kardelen Al
- Department of Pediatric Endocrinology, Istanbul Faculty of Medicine, Istanbul University, İstanbul, Turkey ; Department of Pediatric Endocrinology, Child Health Institute, Istanbul University, İstanbul, Turkey
| | - Nur Mine Şükür
- Department of Pediatric Endocrinology, Child Health Institute, Istanbul University, İstanbul, Turkey
| | - Esin Karakılıç Özturan
- Department of Pediatric Endocrinology, Istanbul Faculty of Medicine, Istanbul University, İstanbul, Turkey
| | - Ayşe Pınar Öztürk
- Department of Pediatric Endocrinology, Istanbul Faculty of Medicine, Istanbul University, İstanbul, Turkey
| | - Şükran Poyrazoğlu
- Department of Pediatric Endocrinology, Istanbul Faculty of Medicine, Istanbul University, İstanbul, Turkey
| | - Firdevs Baş
- Department of Pediatric Endocrinology, Istanbul Faculty of Medicine, Istanbul University, İstanbul, Turkey
| | - Fatma Feyza Darendeliler
- Department of Pediatric Endocrinology, Istanbul Faculty of Medicine, Istanbul University, İstanbul, Turkey
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Saygılı S, Kocaağa M, Kaya G, Şükür M, Baş F, Poyrazoğlu Ş, Bundak R, Darendeliler F. Increased Carotid Intima-media Thickness and Its Association with Carbohydrate Metabolism and Adipocytokines in Children Treated with Recombinant Growth Hormone. J Clin Res Pediatr Endocrinol 2023; 15:69-80. [PMID: 36416456 PMCID: PMC9976170 DOI: 10.4274/jcrpe.galenos.2022.2022-8-19] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
OBJECTIVE Reports on the association between growth hormone (GH) therapy and cardiovascular risk factors in children are limited. This study aimed to evaluate carotid intima-media thickness (cIMT) in children treated with recombinant human GH (rhGH) and assess the effects of rhGH therapy and changes in serum carbohydrate metabolism, lipid profile and adipocytokines on cIMT. METHODS Seventy-one isolated idiopathic GH deficiency (GHD) children and 44 age- and sex-matched healthy controls were enrolled in this study. The study group was divided into two subgroups according to insulin resistance (IR) on oral glucose tolerance tests. Insulin secretion [homeostatic model assessment (HOMA) B, total insulin] and sensitivity (HOMA-IR, QUICKI, Matsuda) indices were calculated. cIMT was measured and the standard deviation scores (SDS) were calculated. Associations between cIMT-SDS and insulin secretion and sensitivity indices, serum lipid levels, adipocytokines (leptin, resistin, ghrelin), and other rhGH treatment-related factors were evaluated. RESULTS cIMT-SDS was increased in GHD children treated with rhGH compared to the controls [0.02 (2.27) vs. -1.01 (1.63), p=0.003]. cIMT-SDS did not differ between those children on rhGH treatment with or without IR. High cIMT-SDS was significantly associated with higher serum ghrelin levels and lower serum high density lipoprotein (HDL) levels (β=0.491, p=0.001 and β=-0.027, p=0.017), but not with BMI-SDS, blood pressure, insulin secretion and sensitivity indices, or the dose and duration of rhGH therapy. CONCLUSION Our findings showed that GHD children treated with rhGH have increased cIMT. Alterations in carbohydrate metabolism were not associated with cIMT in children treated with rhGH. GH therapy per se appears to be associated with this increased cIMT but causality should be elucidated in further studies. cIMT also appears to be associated with higher ghrelin and lower HDL levels.
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Affiliation(s)
- Seha Saygılı
- İstanbul University, İstanbul Faculty of Medicine, Department of Pediatrics, İstanbul, Turkey,* Address for Correspondence: İstanbul University, İstanbul Faculty of Medicine, Department of Pediatrics, İstanbul, Turkey E-mail:
| | - Mehmet Kocaağa
- İstanbul University, İstanbul Faculty of Medicine, Department of Cardiology, İstanbul, Turkey
| | - Gamze Kaya
- İstanbul University, İstanbul Faculty of Medicine, Department of Pediatrics, İstanbul, Turkey
| | - Mine Şükür
- İstanbul University, İstanbul Faculty of Medicine, Department of Pediatric Endocrinology, İstanbul, Turkey
| | - Firdevs Baş
- İstanbul University, İstanbul Faculty of Medicine, Department of Pediatric Endocrinology, İstanbul, Turkey
| | - Şükran Poyrazoğlu
- İstanbul University, İstanbul Faculty of Medicine, Department of Pediatric Endocrinology, İstanbul, Turkey
| | - Rüveyde Bundak
- University of Kryrenia Faculty of Medicine, Department of Pediatrics Endocrinology, Kyrenia, Northern Cyprus
| | - Feyza Darendeliler
- İstanbul University, İstanbul Faculty of Medicine, Department of Pediatric Endocrinology, İstanbul, Turkey
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Aycan Z, Keskin M, Lafcı NG, Savaş-Erdeve Ş, Baş F, Poyrazoğlu Ş, Öztürk P, Parlak M, Ercan O, Güran T, Hatipoğlu N, Uçaktürk AS, Çatlı G, Akyürek N, Önder A, Kılınç S, Çetinkaya S. Genotype of congenital adrenal hyperplasia patients with testicular adrenal rest tumor. Eur J Med Genet 2022; 65:104654. [DOI: 10.1016/j.ejmg.2022.104654] [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: 02/05/2022] [Revised: 09/25/2022] [Accepted: 10/20/2022] [Indexed: 11/06/2022]
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Bundak R, Yavaş Abalı Z, Furman A, Darendeliler F, Gökçay G, Baş F, Günöz H, Neyzi O. Comparison of National Growth Standards for Turkish Infants and Children with World Health Organization Growth Standards. J Clin Res Pediatr Endocrinol 2022; 14:207-215. [PMID: 35135183 PMCID: PMC9176092 DOI: 10.4274/jcrpe.galenos.2022.2021-9-10] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [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] [Indexed: 12/01/2022] Open
Abstract
OBJECTIVE Using World Health Organization (WHO) standards in pediatric practice is still controversial in many countries. It is suggested that national growth charts best reflect the genetic and ethnic characteristics of a population. The aim of this study was to compare length/height, body weight, and body mass index (BMI) in healthy Turkish children of ages 0 to 18 with those proposed by WHO as the international growth standards. METHODS The data of Turkish children were collected from infant/child population aged 0-5 years (2391 boys, 2102 girls) and children of ages between 6-18 years (1100 boys, 1020 girls). For comparison, the 50th, 3rd, and 97th percentile curves for length/height, weight, and BMI in Turkish children were plotted together with respective WHO data. RESULTS Heights were essentially similar in the Turkish and WHO data at ages between 3-10 years. Turkish children were markedly taller compared to the WHO standards after the age of 10 years. Evaluation of the 3rd percentile data revealed that Turkish boys were shorter than the WHO subjects in the first 2 years of life. From 6 months of age, Turkish children showed higher weight for age values in the 3rd, 50th, and 97th percentiles. In all age groups between 6 months and 3 years, and in between 6-18 years of age, Z-score values, as well as the 50th, 15th, 85th, and 95th percentile values were higher in Turkish children. The differences were particularly noteworthy at ages 1-2 years and in the pubertal years. CONCLUSION WHO growth standards do not reflect the growth of Turkish children and may substantially alter the prevalence of short stature and underweight in Turkish children in the 0-5 years age group. When assessing the nutritional and growth status of children, national growth standards may be more appropriate.
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Affiliation(s)
- Rüveyde Bundak
- University of Kyrenia, Faculty of Medicine, Department of Pediatric Endocrinology, Kyrenia, North Cyprus,* Address for Correspondence: University of Kyrenia, Faculty of Medicine, Department of Pediatric Endocrinology, Kyrenia, North Cyprus Phone: +90 392 650 26 00-4010 E-mail:
| | - Zehra Yavaş Abalı
- İstanbul University, İstanbul Faculty of Medicine, Department of Pediatric Endocrinology, İstanbul, Turkey
| | - Andrzej Furman
- Boğaziçi University, Institute of Environmental Sciences, İstanbul, Turkey
| | - Feyza Darendeliler
- İstanbul University, İstanbul Faculty of Medicine, Department of Pediatric Endocrinology, İstanbul, Turkey
| | - Gülbin Gökçay
- İstanbul University, Institute of Child Health, Department of Social Pediatrics, İstanbul, Turkey
| | - Firdevs Baş
- İstanbul University, İstanbul Faculty of Medicine, Department of Pediatric Endocrinology, İstanbul, Turkey
| | - Hülya Günöz
- İstanbul University, İstanbul Faculty of Medicine, Department of Pediatric Endocrinology, İstanbul, Turkey
| | - Olcay Neyzi
- İstanbul University, İstanbul Faculty of Medicine, Department of Pediatric Endocrinology, İstanbul, Turkey
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11
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Akcan N, Uyguner O, Baş F, Altunoğlu U, Toksoy G, Karaman B, Avcı Ş, Yavaş Abalı Z, Poyrazoğlu Ş, Aghayev A, Karaman V, Bundak R, Başaran S, Darendeliler F. Mutations in AR or SRD5A2 Genes: Clinical Findings, Endocrine Pitfalls, and Genetic Features of Children with 46,XY DSD. J Clin Res Pediatr Endocrinol 2022; 14:153-171. [PMID: 35135181 PMCID: PMC9176093 DOI: 10.4274/jcrpe.galenos.2022.2021-9-19] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [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] [Indexed: 12/01/2022] Open
Abstract
OBJECTIVE Androgen insensivity syndrome (AIS) and 5α-reductase deficiency (5α-RD) present with indistinguishable phenotypes among the 46,XY disorders of sexual development (DSD) that usually necessitate molecular analyses for the definitive diagnosis in the prepubertal period. The aim was to evaluate the clinical, hormonal and genetic findings of 46,XY DSD patients who were diagnosed as AIS or 5α-RD. METHODS Patients diagnosed as AIS or 5α-RD according to clinical and hormonal evaluations were investigated. Sequence variants of steroid 5-α-reductase type 2 were analyzed in cases with testosterone/dihydrotestosterone (T/DHT) ratio of ≥20, whereas the androgen receptor (AR) gene was screened when the ratio was <20. Stepwise analysis of other associated genes were screened in cases with no causative variant found in initial analysis. For statistical comparisons, the group was divided into three main groups and subgroups according to their genetic diagnosis and T/DHT ratios. RESULTS A total of 128 DSD patients from 125 non-related families were enrolled. Birth weight SDS and gestational weeks were significantly higher in 5α-RD group than in AIS and undiagnosed groups. Completely female phenotype was higher in all subgroups of both AIS and 5α-RD patients than in the undiagnosed subgroups. In those patients with stimulated T/DHT <20 in the prepubertal period, stimulated T/DHT ratio was significantly lower in AIS than in the undiagnosed group, and higher in 5α-RD. Phenotype associated variants were detected in 24% (n=18 AIS, n=14 5α-RD) of the patients, revealing four novel AR variants (c.94G>T, p.Glu32*, c.330G>C, p.Leu110=; c.2084C>T, p.Pro695Leu, c.2585_2592delAGCTCCTG, p.(Lys862Argfs*16), of these c.330G>C with silent status remained undefined in terms of its causative effects. CONCLUSION T/DHT ratio is an important hormonal criterion, but in some cases, T/DHT ratio may lead to diagnostic confusion. Molecular diagnosis is important for the robust diagnosis of 46,XY DSD patients. Four novel AR variants were identified in our study.
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Affiliation(s)
- Neşe Akcan
- Near East University Faculty of Medicine, Department of Pediatric Endocrinology, Nicosia, Cyprus,* Address for Correspondence: Near East University Faculty of Medicine, Department of Pediatric Endocrinology, Nicosia, Cyprus Phone: +90 392 675 10 00 (1388) E-mail:
| | - Oya Uyguner
- İstanbul University, İstanbul Faculty of Medicine, Department of Medical Genetics, İstanbul, Turkey
| | - Firdevs Baş
- İstanbul University, İstanbul Faculty of Medicine, Department of Pediatric Endocrinology, İstanbul, Turkey
| | - Umut Altunoğlu
- İstanbul University, İstanbul Faculty of Medicine, Department of Medical Genetics, İstanbul, Turkey,Koç University Faculty of Medicine, Department of Medical Genetics, İstanbul, Turkey
| | - Güven Toksoy
- İstanbul University, İstanbul Faculty of Medicine, Department of Medical Genetics, İstanbul, Turkey
| | - Birsen Karaman
- İstanbul University, İstanbul Faculty of Medicine, Department of Medical Genetics, İstanbul, Turkey
| | - Şahin Avcı
- İstanbul University, İstanbul Faculty of Medicine, Department of Medical Genetics, İstanbul, Turkey,Koç University Faculty of Medicine, Department of Medical Genetics, İstanbul, Turkey
| | - Zehra Yavaş Abalı
- İstanbul University, İstanbul Faculty of Medicine, Department of Pediatric Endocrinology, İstanbul, Turkey
| | - Şükran Poyrazoğlu
- İstanbul University, İstanbul Faculty of Medicine, Department of Pediatric Endocrinology, İstanbul, Turkey
| | - Agharza Aghayev
- İstanbul University, İstanbul Faculty of Medicine, Department of Medical Genetics, İstanbul, Turkey
| | - Volkan Karaman
- İstanbul University, İstanbul Faculty of Medicine, Department of Medical Genetics, İstanbul, Turkey
| | - Rüveyde Bundak
- University of Kyrenia, Faculty of Medicine, Department of Pediatric Endocrinology, Kyrenia, Cyprus
| | - Seher Başaran
- İstanbul University, İstanbul Faculty of Medicine, Department of Medical Genetics, İstanbul, Turkey
| | - Feyza Darendeliler
- İstanbul University, İstanbul Faculty of Medicine, Department of Pediatric Endocrinology, İstanbul, Turkey
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12
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Öztürk AP, Karakılıç Özturan E, Gün Soysal F, Ünal S, Işık G, Yegen G, Önder S, Yıldız M, Poyrazoğlu Ş, Baş F, Darendeliler F. Long-term Follow-up of a Toddler with Papillary Thyroid Carcinoma: A Case Report with a Literature Review of Patients Under 5 Years of Age. J Clin Res Pediatr Endocrinol 2022; 14:119-125. [PMID: 33448212 PMCID: PMC8900071 DOI: 10.4274/jcrpe.galenos.2020.2020.0178] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/01/2022] Open
Abstract
Papillary thyroid cancer (PTC) is extremely rare in children. Herein, we present a case diagnosed with PTC at 15 months of age. We conducted a literature review of the published cases with PTC under five years of age. A 1.25-year-old male patient had initially presented with a complaint of progressively enlarging cervical mass that appeared four months earlier. On physical examination, a mass located in the anterior cervical region with the largest measurements of around 3x3 cm was detected. Cervical and thyroid ultrasonography showed a 50x27 mm solid mass in the right lateral neck. Excisional biopsy revealed a follicular variant of PTC with capsular invasion. Subsequently, he underwent a complementary total thyroidectomy. He was diagnosed with intermediate-risk (T3N0M0) PTC. He developed permanent hypoparathyroidism. In the first year of the operation, he was treated with radioiodine ablation (RAI) since basal and stimulated thyroglobulin (Tg) levels tended to increase. Whole-body scintigraphy was normal in the first year of RAI ablation. On levothyroxine sodium (LT4) treatment, levels of thyroid stimulating hormone (TSH) and Tg were adequately suppressed. He is now 8.5-years-old and disease-free on LT4 replacement therapy for seven years and three months. Pediatric PTC has different biological behavior and an excellent prognosis compared to adults. The optimal treatment strategy for pediatric TC is total thyroidectomy, followed by RAI ablation. Post-operative management should include regular follow-up, TSH suppression by adequate LT4 therapy, serial Tg evaluation, and radioiodine scanning when indicated.
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Affiliation(s)
- Ayşe Pınar Öztürk
- İstanbul University, İstanbul Faculty of Medicine, Department of Pediatrics, Division of Pediatric Endocrinology, İstanbul, Turkey,* Address for Correspondence: İstanbul University, İstanbul Faculty of Medicine, Department of Pediatrics, Division of Pediatric Endocrinology, İstanbul, Turkey Phone: +90 505 776 99 57 E-mail:
| | - Esin Karakılıç Özturan
- İstanbul University, İstanbul Faculty of Medicine, Department of Pediatrics, Division of Pediatric Endocrinology, İstanbul, Turkey
| | - Feryal Gün Soysal
- İstanbul University, İstanbul Faculty of Medicine, Department of Pediatric Surgery, İstanbul, Turkey
| | - Seher Ünal
- İstanbul University, İstanbul Faculty of Medicine, Department of Nuclear Medicine, İstanbul, Turkey
| | - Göknur Işık
- İstanbul University, İstanbul Faculty of Medicine, Department of Nuclear Medicine, İstanbul, Turkey
| | - Gülçin Yegen
- İstanbul University, İstanbul Faculty of Medicine, Department of Pathology, İstanbul, Turkey
| | - Semen Önder
- İstanbul University, İstanbul Faculty of Medicine, Department of Pathology, İstanbul, Turkey
| | - Melek Yıldız
- İstanbul University, İstanbul Faculty of Medicine, Department of Pediatrics, Division of Pediatric Endocrinology, İstanbul, Turkey
| | - Şükran Poyrazoğlu
- İstanbul University, İstanbul Faculty of Medicine, Department of Pediatrics, Division of Pediatric Endocrinology, İstanbul, Turkey
| | - Firdevs Baş
- İstanbul University, İstanbul Faculty of Medicine, Department of Pediatrics, Division of Pediatric Endocrinology, İstanbul, Turkey
| | - Feyza Darendeliler
- İstanbul University, İstanbul Faculty of Medicine, Department of Pediatrics, Division of Pediatric Endocrinology, İstanbul, Turkey
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Hatun Ş, Dalgıç B, Gökşen D, Aydoğdu S, Savaş Erdeve Ş, Kuloğu Z, Doğan Y, Aycan Z, Yeşiltepe Mutlu G, Uslu Kızılkan N, Keser A, Beşer ÖF, Özbek MN, Bideci A, Ertem D, Evliyaoğlu O, Eliuz Tipici B, Gökçe T, Muradoğlu S, Taşkın OÇ, Koca T, Tütüncüler F, Baş F, Darendeliler F, Selimoğlu MA. Recommendations for Clinical Decision-making in Children with Type 1 Diabetes and Celiac Disease: Type 1 Diabetes and Celiac Disease Joint Working Group Report. J Clin Res Pediatr Endocrinol 2022; 14:1-9. [PMID: 34538045 PMCID: PMC8900077 DOI: 10.4274/jcrpe.galenos.2021.2021.0139] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/01/2022] Open
Abstract
It is well-known that in children with type 1 diabetes (T1D), the frequency of Celiac disease (CD) is increased due to mechanisms which are not fully elucidated but include autoimmune injury as well as shared genetic predisposition. Although histopathologic examination is the gold standard for diagnosis, avoiding unnecessary endoscopy is crucial. Therefore, for both clinicians and patients’ families, the diagnosis of CD remains challenging. In light of this, a joint working group, the Type 1 Diabetes and Celiac Disease Joint Working Group, was convened, with the aim of reporting institutional data and reviewing current international guidelines, in order to provide a framework for clinicians. Several controversial issues were discussed: For CD screening in children with T1D, regardless of age, it is recommended to measure tissue transglutaminase-immunoglobulin A (tTG-IgA) and/or endomysial-IgA antibody due to their high sensitivity and specificity. However, the decision-making process based on tTG-IgA titer in children with T1D is still debated, since tTG-IgA titers may fluctuate in children with T1D. Moreover, seronegativity may occur spontaneously. The authors’ own data showed that most of the cases who have biopsy-proven CD had tTG-IgA levels 7-10 times above the upper limit. The decision for endoscopy based solely on tTG-IgA levels should be avoided, except in cases where tTG-IgA levels are seven times and above the upper limit. A closer collaboration should be built between divisions of pediatric endocrinology and gastroenterology in terms of screening, diagnosis and follow-up of children with T1D and suspicious CD.
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Affiliation(s)
- Şükrü Hatun
- Koç University Faculty of Medicine, Department of Pediatric Endocrinology and Diabetes, İstanbul, Turkey,* Address for Correspondence: Koç University Faculty of Medicine, Department of Pediatric Endocrinology and Diabetes, İstanbul, Turkey Phone: +90 532 346 80 06 E-mail:
| | - Buket Dalgıç
- Gazi University Faculty of Medicine, Department of Pediatrics, Division of Pediatric Gastroenterology, Ankara, Turkey
| | - Damla Gökşen
- Ege University Faculty of Medicine, Department of Pediatric Endocrinology, İzmir, Turkey
| | - Sema Aydoğdu
- Ege University Faculty of Medicine, Department of Pediatric Gastroenterology, İzmir, Turkey
| | - Şenay Savaş Erdeve
- University of Health Sciences Turkey, Ankara Dr. Sami Ulus Obstetrics and Gynecology and Pediatrics Training and Research Hospital, Clinic of Pediatric Endocrinology, Ankara, Turkey
| | - Zarife Kuloğu
- Ankara University Faculty of Medicine, Department of Pediatrics, Division of Pediatric Gastroenterology, Ankara, Turkey
| | - Yaşar Doğan
- Fırat University Faculty of Medicine, Department of Pediatric Gastroenterology, Elazığ, Turkey
| | - Zehra Aycan
- Ankara University Faculty of Medicine, Department of Pediatric Endocrinology, Ankara, Turkey
| | - Gül Yeşiltepe Mutlu
- Koç University Faculty of Medicine, Department of Pediatric Endocrinology and Diabetes, İstanbul, Turkey
| | - Nuray Uslu Kızılkan
- Koç University Hospital, Department of Pediatric Gastroenterology, İstanbul, Turkey
| | - Alev Keser
- Ankara University Faculty of Health Sciences, Department of Nutrition and Dietetics, Ankara, Turkey
| | - Ömer Faruk Beşer
- İstanbul University-Cerrahpaşa, Cerrahpaşa Faculty of Medicine, Department of Pediatric Gastroenterology, Hepatology, and Nutrition, İstanbul, Turkey
| | - Mehmet Nuri Özbek
- University of Health Sciences Turkey, Gazi Yaşargil Training and Research Hospital, Clinic of Pediatric Endocrinology, Diyarbakır, Turkey
| | - Aysun Bideci
- Gazi University Faculty of Medicine, Department of Pediatric Endocrinology and Diabetes, Ankara, Turkey
| | - Deniz Ertem
- Marmara University Faculty of Medicine, Department of Pediatric Gastroenterology, Hepatology and Nutrition, İstanbul, Turkey
| | - Olcay Evliyaoğlu
- İstanbul University-Cerrahpaşa, Cerrahpaşa Faculty of Medicine, Department of Pediatrics, Division of Pediatric Endocrinology, İstanbul, Turkey
| | - Beyza Eliuz Tipici
- İstanbul University, İstanbul Faculty of Medicine, Department of Nutrition and Dietetics, İstanbul, Turkey
| | - Tuğba Gökçe
- Koç University Faculty of Medicine, Department of Pediatric Endocrinology and Diabetes, İstanbul, Turkey
| | - Serra Muradoğlu
- Koç University Faculty of Medicine, Department of Pediatric Endocrinology and Diabetes, İstanbul, Turkey
| | - Orhun Çığ Taşkın
- Koç University Faculty of Medicine, Department of Pathology, İstanbul, Turkey
| | - Tuğba Koca
- Süleyman Demirel University Faculty of Medicine, Department of Pediatric Gastroenterology, Hepatology and Nutrition, Isparta, Turkey
| | - Filiz Tütüncüler
- Trakya University Faculty of Medicine, Department of Pediatrics, Division of Pediatric Endocrinology, Edirne, Turkey
| | - Firdevs Baş
- İstanbul University, İstanbul Faculty of Medicine, Department of Pediatric Endocrinology, İstanbul, Turkey
| | - Feyza Darendeliler
- İstanbul University, İstanbul Faculty of Medicine, Department of Pediatric Endocrinology, İstanbul, Turkey
| | - Mukadder Ayşe Selimoğlu
- Memorial Ataşehir/Bahçelievler Hospitals, Clinic of Pediatric Gastroenterology, Hepatology and Nutrition, İstanbul, Turkey
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Öztürk AP, Dudaklı A, Özturan EK, Poyrazoğlu Ş, Baş F, Darendeliler F. Growth and Pubertal Features in a Cohort of 83 Patients with Osteogenesis Imperfecta. Klin Padiatr 2022; 234:199-205. [PMID: 35139543 DOI: 10.1055/a-1730-5412] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Abstract
BACKGROUND Osteogenesis imperfecta (OI) is a genetic disease characterized by fragile bones and variable short stature. METHOD We performed a retrospective cohort study to evaluate demographic data, clinical findings, growth and pubertal characteristics, and medical treatment of 83 OI patients. RESULTS 83 (31 female/52 male) patients were enrolled in the study. The median follow-up duration was 4.7 (0.6-17.7) years. 51 out of 83 patients (61.4%) received bisphosphonate therapy. The median Z-score of the bone mineral density improved in patients with OI-I and OI-III with the treatment. During follow-up, height-SDS significantly increased in both OI-I and OI-III on treatment; however, final adult height SDS of patients did not improve. The frequency of overweight and obesity was found to be increased at the last evaluation compared to the admission. The rate of precocious puberty (PP) and early puberty (EP) were 20 and 10% in girls, and they were 15.7 and 47.3% in boys, respectively. CONCLUSION Reduced growth, significant weight gain over time due to impaired mobility, and high frequency of PP/EP require effective interventions to improve mobility and functional parameters as early as possible in children with OI.
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Affiliation(s)
- Ayşe Pınar Öztürk
- Pediatric Endocrinology, Istanbul University Istanbul Faculty of Medicine, Istanbul, Turkey
| | - Aslı Dudaklı
- Pediatrics, Istanbul University Istanbul Faculty of Medicine, Istanbul, Turkey
| | - Esin Karakılıç Özturan
- Pediatric Endocrinology, Istanbul University Istanbul Faculty of Medicine, Istanbul, Turkey
| | - Şükran Poyrazoğlu
- Pediatric Endocrinology, Istanbul University Istanbul Faculty of Medicine, Istanbul, Turkey
| | - Firdevs Baş
- Pediatric Endocrinology, Istanbul University Istanbul Faculty of Medicine, Istanbul, Turkey
| | - Feyza Darendeliler
- Pediatric Endocrinology, Istanbul University Istanbul Faculty of Medicine, Istanbul, Turkey
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15
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Dağdeviren Çakır A, Baş F, Akın O, Şıklar Z, Özcabı B, Berberoğlu M, Kardelen AD, Bayramoğlu E, Poyrazoğlu Ş, Aydın M, Törel Ergür A, Gökşen D, Bolu S, Aycan Z, Tüysüz B, Ercan O, Evliyaoğlu O. Clinical Characteristics and Growth Hormone Treatment in Patients with Prader-Willi Syndrome. J Clin Res Pediatr Endocrinol 2021; 13:308-319. [PMID: 33565750 PMCID: PMC8388048 DOI: 10.4274/jcrpe.galenos.2021.2020.0228] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/01/2022] Open
Abstract
OBJECTIVE To investigate clinical characteristics and response to growth hormone (GH) treatment in patients with Prader-Willi syndrome (PWS) in Turkey. METHODS The data of 52 PWS patients from ten centers was retrospectively analyzed. A nation-wide, web-based data system was used for data collection. Demographic, clinical, genetic, and laboratory data and follow-up information of the patients were evaluated. RESULTS The median age of patients at presentation was 1.5 years, and 50% were females. Genetic analysis showed microdeletion in 69.2%, uniparental disomy in 11.5%, imprinting defect in 1.9% and methylation abnormality in 17.3%. Hypotonia (55.7%), feeding difficulties (36.5%) and obesity (30.7%) were the most common complaints. Cryptorchidism and micropenis were present in 69.2% and 15.3% of males, respectively. At presentation, 25% had short stature, 44.2% were obese, 9.6% were overweight and 17.3% were underweight. Median age of obese patients was significantly higher than underweight patients. Central hypothyroidism and adrenal insufficiency were present in 30.7% and 4.7%, respectively. Hypogonadism was present in 75% at normal age of puberty. GH treatment was started in 40% at a mean age of 4.7±2.7 years. After two years of GH treatment, a significant increase in height SDS was observed. However, body mass index (BMI) standard deviation (SDS) remained unchanged. CONCLUSION The most frequent complaints were hypotonia and feeding difficulty at first presentation. Obesity was the initial finding in 44.2%. GH treatment was started in less than half of the patients. While GH treatment significantly increased height SDS, BMI SDS remained unchanged, possibly due to the relatively older age at GH start.
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Affiliation(s)
- Aydilek Dağdeviren Çakır
- İstanbul University-Cerrahpaşa, Cerrahpaşa Faculty of Medicine, Department of Pediatric Endocrinology, İstanbul, Turkey
| | - Firdevs Baş
- İstanbul University, İstanbul Faculty of Medicine, Department of Pediatric Endocrinology, İstanbul, Turkey
| | - Onur Akın
- University of Health Sciences Turkey, Gülhane Training and Research Hospital, Clinic of Pediatric Endocrinology, Ankara, Turkey
| | - Zeynep Şıklar
- Ankara University, Faculty of Medicine, Department of Pediatric Endocrinology, Ankara, Turkey
| | - Bahar Özcabı
- University of Health Sciences Turkey, Zeynep Kamil Training and Research Hospital, Clinic of Pediatric Endocrinology, İstanbul, Turkey
| | - Merih Berberoğlu
- Ankara University, Faculty of Medicine, Department of Pediatric Endocrinology, Ankara, Turkey
| | - Aslı Derya Kardelen
- İstanbul University, İstanbul Faculty of Medicine, Department of Pediatric Endocrinology, İstanbul, Turkey
| | - Elvan Bayramoğlu
- University of Health Sciences Turkey, Ankara Dr. Sami Ulus Obstetrics and Gynecology and Child Health and Diseases Training and Research Hospital, Clinic of Pediatric Endocrinology, Ankara, Turkey
| | - Şükran Poyrazoğlu
- İstanbul University, İstanbul Faculty of Medicine, Department of Pediatric Endocrinology, İstanbul, Turkey
| | - Murat Aydın
- Ondokuz Mayıs University Faculty of Medicine, Department of Pediatric Endocrinology, Samsun, Turkey
| | - Ayça Törel Ergür
- Ufuk University Faculty of Medicine, Department of Pediatric Endocrinology, Ankara, Turkey
| | - Damla Gökşen
- Ege University Faculty of Medicine, Department of Pediatric Endocrinology, İzmir, Turkey
| | - Semih Bolu
- Düzce University Faculty of Medicine, Department of Pediatric Endocrinology, Düzce, Turkey
| | - Zehra Aycan
- University of Health Sciences Turkey, Ankara Dr. Sami Ulus Obstetrics and Gynecology and Child Health and Diseases Training and Research Hospital, Clinic of Pediatric Endocrinology, Ankara, Turkey
| | - Beyhan Tüysüz
- İstanbul University-Cerrahpaşa, Cerrahpaşa Faculty of Medicine, Department of Pediatric Genetics, İstanbul, Turkey
| | - Oya Ercan
- İstanbul University-Cerrahpaşa, Cerrahpaşa Faculty of Medicine, Department of Pediatric Endocrinology, İstanbul, Turkey
| | - Olcay Evliyaoğlu
- İstanbul University-Cerrahpaşa, Cerrahpaşa Faculty of Medicine, Department of Pediatric Endocrinology, İstanbul, Turkey,* Address for Correspondence: İstanbul University-Cerrahpaşa, Cerrahpaşa Faculty of Medicine, Department of Pediatric Endocrinology, İstanbul, Turkey Phone: +90 533 633 15 64 E-mail:
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16
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Savaş-Erdeve Ş, Aycan Z, Çetinkaya S, Öztürk AP, Baş F, Poyrazoğlu Ş, Darendeliler F, Özsu E, Şıklar Z, Demiral M, Unal E, Özbek MN, Gürbüz F, Yüksel B, Evliyaoğlu O, Akyürek N, Berberoğlu M. Clinical Characteristics of 46,XX Males with Congenital Adrenal Hyperplasia. J Clin Res Pediatr Endocrinol 2021; 13:180-186. [PMID: 33374095 PMCID: PMC8186342 DOI: 10.4274/jcrpe.galenos.2020.2020.0216] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/01/2022] Open
Abstract
OBJECTIVE To retrospectively evaluate the follow-up data in patients with 46,XX congenital adrenal hyperplasia (CAH) who were raised male. METHODS A national database was created. The data of patients were asked to be recorded in the data form. RESULTS The median (range) age of diagnosis was three (0.1-18.3) years in 44 patients. Twenty nine cases were diagnosed after the age of two years. Most (95.4%) cases were stage 4-5 virilized. Hysterectomy and bilateral salpingoopherectomy, at a median age of 7.25 (2.4-25.3) years, was performed in 35 cases. Testicular prostheses were placed in 11 (25%) cases at a median age of 11.2 (2.8-17) years. The median final height was 149.2 (132.8-172) cms in 38 patients, including simple virilizing (n=18), salt-wasting (n=6), and 11-beta hydroxylase (n=12). Of the 16 patients above the age of eighteen, university education was completed in 25%. CONCLUSION It was seen that most (65.9%) of the 46,XX CAH cases raised male were diagnosed after two years of age. In these cases, hysterectomy and bilateral salpingoopherectomy, genital corrective surgeries and testicular prosthesis operations were performed in a very wide age rage.
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Affiliation(s)
- Şenay Savaş-Erdeve
- University of Health Sciences Turkey, Dr. Sami Ulus Obstetrics and Gynecology, Children’s Health and Disease Training and Research Hospital, Clinic of Pediatric Endocrinology, Ankara, Turkey,* Address for Correspondence: University of Health Sciences Turkey, Dr. Sami Ulus Obstetrics and Gynecology, Children’s Health and Disease Training and Research Hospital, Clinic of Pediatric Endocrinology, Ankara, Turkey E-mail:
| | - Zehra Aycan
- Ankara University Faculty of Medicine, Department of Pediatric Endocrinology, Ankara, Turkey
| | - Semra Çetinkaya
- University of Health Sciences Turkey, Dr. Sami Ulus Obstetrics and Gynecology, Children’s Health and Disease Training and Research Hospital, Clinic of Pediatric Endocrinology, Ankara, Turkey
| | - Ayşe Pınar Öztürk
- İstanbul University Faculty of Medicine, Department of Pediatric Endocrinology, İstanbul, Turkey
| | - Firdevs Baş
- İstanbul University Faculty of Medicine, Department of Pediatric Endocrinology, İstanbul, Turkey
| | - Şükran Poyrazoğlu
- İstanbul University Faculty of Medicine, Department of Pediatric Endocrinology, İstanbul, Turkey
| | - Feyza Darendeliler
- İstanbul University Faculty of Medicine, Department of Pediatric Endocrinology, İstanbul, Turkey
| | - Elif Özsu
- Ankara University Faculty of Medicine, Department of Pediatric Endocrinology, Ankara, Turkey
| | - Zeynep Şıklar
- Ankara University Faculty of Medicine, Department of Pediatric Endocrinology, Ankara, Turkey
| | - Meliha Demiral
- University of Health Sciences Turkey, Diyarbakır Gazi Yaşargil Training and Research Hospital, Clinic of Pediatric Endocrinology, Diyarbakır, Turkey
| | - Edip Unal
- University of Health Sciences Turkey, Diyarbakır Gazi Yaşargil Training and Research Hospital, Clinic of Pediatric Endocrinology, Diyarbakır, Turkey
| | - Mehmet Nuri Özbek
- University of Health Sciences Turkey, Diyarbakır Gazi Yaşargil Training and Research Hospital, Clinic of Pediatric Endocrinology, Diyarbakır, Turkey
| | - Fatih Gürbüz
- Çukurova University Faculty of Medicine, Department of Pediatric Endocrinology, Adana, Turkey
| | - Bilgin Yüksel
- Çukurova University Faculty of Medicine, Department of Pediatric Endocrinology, Adana, Turkey
| | - Olcay Evliyaoğlu
- İstanbul University-Cerrahpaşa, Cerrahpaşa Faculty of Medicine, Department of Pediatric Endocrinology, İstanbul, Turkey
| | - Nesibe Akyürek
- University of Health Sciences Turkey, Konya Training and Research Hospital, Clinic of Pediatric Endocrinology, Konya, Turkey
| | - Merih Berberoğlu
- Ankara University Faculty of Medicine, Department of Pediatric Endocrinology, Ankara, Turkey
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Uçkun U, Baş F, Poyrazoğlu Ş, Şükür NM, Darendeliler FF, Bundak R. BASELINE CHARACTERISTICS OF PATIENTS WITH GROWTH HORMONE DEFICIENCY. J Istanb Fac Med 2020. [DOI: 10.26650/iuitfd.2019.0105] [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] [Indexed: 11/20/2022] Open
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Güran T, Tezel B, Çakır M, Akıncı A, Orbak Z, Keskin M, Selver Eklioğlu B, Ozon A, Özbek MN, Karagüzel G, Hatipoğlu N, Gürbüz F, Çizmecioğlu FM, Kara C, Şimşek E, Baş F, Aydın M, Darendeliler F. Neonatal Screening for Congenital Adrenal Hyperplasia in Turkey: Outcomes of Extended Pilot Study in 241,083 Infants. J Clin Res Pediatr Endocrinol 2020; 12:287-294. [PMID: 32157855 PMCID: PMC7499135 DOI: 10.4274/jcrpe.galenos.2020.2019.0182] [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] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/01/2022] Open
Abstract
OBJECTIVE Turkish Directorate of Public Health introduced the first pilot screening program for congenital adrenal hyperplasia (CAH) in four Turkish cities in 2017, and in 2018 extended the program, with a slight change in screening strategy, to fourteen cities. To evaluate the performance of the extended study and update previously reported outcomes. METHODS Retrospective, descriptive study. Neonates of ≥32 gestational weeks and ≥1500 gr birth weight from fourteen cities, born between May-December 2018, were included. Screening protocol included one sample, two-tier testing as applied in the previous pilot study. In the first step, 17α-hydroxyprogesterone (17-OHP) was measured by fluoroimmunoassay in dried blood spots (DBS) obtained at 3-5 days of life. Cases with positive initial screening underwent second tier testing by steroid profiling in DBS using liquid chromatographyt-andem mass spectrometry to measure 17-OHP, 21-deoxycortisol (21-S), cortisol (F), 11-deoxycortisol and androstenedione. The babies with a steroid ratio (21-S+17-OHP)/F of ≥0.7 (increased from ≥0.5 in the earlier pilot study) were referred to pediatric endocrinology clinics for diagnostic assessment. RESULTS In the evaluated period, 241,083 newborns were screened. 12,321 (5.11%) required second-tier testing and 880 (0.36%) were referred for clinical assessment, twenty of whom were diagnosed with CAH (10 females, 10 males). Sixteen were diagnosed as classical 21-hydroxylase deficiency (21-OHD) CAH (12 with salt-wasting and four with simple virilising CAH), and four cases were identified with 11β-OHD CAH. No case of salt-wasting CAH was missed by neonatal screening (sensitivity was 100%). The incidence of classical 21-OHD and 11β-OHD in the screened population was 1:15,067 and 1:60,270, respectively. CONCLUSION Turkish neonatal CAH screening effectively led to earlier diagnosis of 21-OHD and 11β-OHD, using steroid profiling as a second-tier test. This will result in improved care of these patients in the future.
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Affiliation(s)
- Tülay Güran
- Marmara University Faculty of Medicine, Department of Paediatric Endocrinology and Diabetes, İstanbul, Turkey,* Address for Correspondence: Marmara University Faculty of Medicine, Department of Paediatric Endocrinology and Diabetes, İstanbul, Turkey Phone: +90 216 625 45 45 E-mail:
| | - Başak Tezel
- Turkish Directorate of Public Health, Ankara, Turkey
| | - Meltem Çakır
- Mersin City Hospital, Clinic of Paediatric Endocrinology and Diabetes, Mersin, Turkey
| | - Ayşehan Akıncı
- İnönü University Faculty of Medicine, Department of Paediatric Endocrinology and Diabetes, Malatya, Turkey
| | - Zerrin Orbak
- Atatürk University Faculty of Medicine, Department of Paediatric Endocrinology and Diabetes, Erzurum, Turkey
| | - Mehmet Keskin
- Gaziantep University Faculty of Medicine, Department of Paediatric Endocrinology and Diabetes, Gaziantep, Turkey
| | - Beray Selver Eklioğlu
- Necmettin Erbakan University, Meram Faculty of Medicine, Department of Paediatric Endocrinology and Diabetes, Konya, Turkey
| | - Alev Ozon
- Hacettepe University Faculty of Medicine, Department of Paediatric Endocrinology and Diabetes, Ankara, Turkey
| | - Mehmet Nuri Özbek
- Gazi Yaşargil Training and Research Hospital, Department of Paediatric Endocrinology and Diabetes, Diyarbakır, Turkey
| | - Gülay Karagüzel
- Karadeniz Techical University Faculty of Medicine, Department of Paediatric Endocrinology and Diabetes, Trabzon, Turkey
| | - Nihal Hatipoğlu
- Erciyes University Faculty of Medicine, Department of Paediatric Endocrinology and Diabetes, Kayseri, Turkey
| | - Fatih Gürbüz
- Çukurova University Faculty of Medicine, Department of Paediatric Endocrinology and Diabetes, Adana, Turkey
| | - Filiz Mine Çizmecioğlu
- Kocaeli University Faculty of Medicine, Department of Paediatric Endocrinology and Diabetes, Kocaeli, Turkey
| | - Cengiz Kara
- Ondokuz Mayıs University Faculty of Medicine, Department of Paediatric Endocrinology and Diabetes, Samsun, Turkey
| | - Enver Şimşek
- Osmangazi University Faculty of Medicine, Department of Paediatric Endocrinology and Diabetes, Eskişehir, Turkey
| | - Firdevs Baş
- İstanbul University İstanbul Faculty of Medicine, Department of Paediatric Endocrinology, İstanbul, Turkey
| | - Murat Aydın
- Ondokuz Mayıs University Faculty of Medicine, Department of Paediatric Endocrinology and Diabetes, Samsun, Turkey
| | - Feyza Darendeliler
- İstanbul University İstanbul Faculty of Medicine, Department of Paediatric Endocrinology, İstanbul, Turkey
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Kardelen Al AD, Poyrazoğlu Ş, Aslanger A, Yeşil G, Ceylaner S, Baş F, Darendeliler F. A Rare Cause of Adrenal Insufficiency - Isolated ACTH Deficiency Due to TBX19 Mutation: Long-Term Follow-Up of Two Cases and Review of the Literature. Horm Res Paediatr 2020; 92:395-403. [PMID: 32344415 DOI: 10.1159/000506740] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/05/2019] [Accepted: 02/21/2020] [Indexed: 11/19/2022] Open
Abstract
INTRODUCTION Isolated adrenocorticotropic hormone (ACTH) deficiency (IAD) is a rare cause of adrenal insufficiency and T-box pituitary restricted transcription factor (TBX19) mutations are responsible for two-thirds of the neonatal onset form of the disease. IAD presents with hypoglycemia and prolonged jaundice in the neonatal period. TBX19 is important for both pro-opiomelanocortin (POMC) gene transcription and differentiation of POMC-expressing cells. We describe 2 patients, 1 with a reported and 1 with a novel TBX19 mutation, and present information about the long-term follow-up of these patients. CASE PRESENTATION Both patients had critical illnesses, recurrent hypoglycemia, convulsions, and neonatal hyperbilirubinemia. They also had low cortisol and ACTH levels, while other pituitary hormones were within the normal range. Pituitary imaging was normal. After hydrocortisone treatment, there was resolution of the hypoglycemia and the convulsions were controlled. Genetic studies of the patients revealed both had inherited a homozygous mutation of the TBX19 gene. The first patient had an alteration of NM_005149.3:c.856C>T (p.R286*) and the second patient had a novel NM_005149.3:c.584C>T (p.T195I) mutation, analyzed by next-generation sequencing. The noteworthy findings of the patients at follow-up were: short stature, microcephaly, and decreased pubic hair in the first, and dysmorphic features, Chiari type 1 malformation, tall stature, and low bone mineral density (BMD) in the second. CONCLUSION Congenital IAD can be life-threatening if it is not recognized and treated early. TBX19 mutations should be considered in the differential diagnosis of IAD. Further cases or functional analyses are needed for genotype-phenotype correlations. Low BMD, dysmorphic features, Chiari type 1 malformation, and sparse pubic hair are some of the important features in these patients.
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Affiliation(s)
- Aslı Derya Kardelen Al
- Department of Pediatric Endocrinology, Istanbul Faculty of Medicine, Istanbul University, Istanbul, Turkey,
| | - Şükran Poyrazoğlu
- Department of Pediatric Endocrinology, Istanbul Faculty of Medicine, Istanbul University, Istanbul, Turkey
| | - Ayça Aslanger
- Department of Medical Genetics, School of Medicine, Bezmialem Vakıf University, Istanbul, Turkey
| | - Gözde Yeşil
- Department of Medical Genetics, School of Medicine, Bezmialem Vakıf University, Istanbul, Turkey
| | | | - Firdevs Baş
- Department of Pediatric Endocrinology, Istanbul Faculty of Medicine, Istanbul University, Istanbul, Turkey
| | - Feyza Darendeliler
- Department of Pediatric Endocrinology, Istanbul Faculty of Medicine, Istanbul University, Istanbul, Turkey
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20
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Şıklar Z, Turan S, Bereket A, Baş F, Güran T, Akberzade A, Abacı A, Demir K, Böber E, Özbek MN, Kara C, Poyrazoğlu Ş, Aydın M, Kardelen A, Tarım Ö, Eren E, Hatipoğlu N, Büyükinan M, Akyürek N, Çetinkaya S, Bayramoğlu E, Selver Eklioğlu B, Uçaktürk A, Abalı S, Gökşen D, Kor Y, Ünal E, Esen İ, Yıldırım R, Akın O, Çayır A, Dilek E, Kırel B, Anık A, Çatlı G, Berberoğlu M. Nationwide Turkish Cohort Study of Hypophosphatemic Rickets. J Clin Res Pediatr Endocrinol 2020; 12:150-159. [PMID: 31514490 PMCID: PMC7291408 DOI: 10.4274/jcrpe.galenos.2019.2019.0098] [Citation(s) in RCA: 6] [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] [Indexed: 12/16/2022] Open
Abstract
OBJECTIVE Hypophosphatemic rickets (HR) is a rare renal phosphate-wasting disorder, which is usually X-linked and is commonly caused by PHEX mutations. The treatment and follow-up of HR is challenging due to imperfect treatment options. METHODS Here we present nationwide initial and follow-up data on HR. RESULTS From 24 centers, 166 patients were included in the study. Genetic analysis (n=75) showed PHEX mutation in 80% of patients. The mean follow-up period was 6.7±2.4 years. During the first 3-years of treatment (n=91), mild increase in phosphate, decrease in alkaline phosphatase and elevation in parathyroid hormone (PTH) levels were detected. The height standard deviation scores were -2.38, -2.77, -2.72, -2.47 at initial, 1st, 2nd and 3rd year of treatment, respectively (p>0.05). On follow-up 36% of the patients showed complete or significant improvement in leg deformities and these patients had similar phosphate levels at presentation with better levels in 1st and 2nd years of treatment; even the treatment doses of phosphate were similar. Furthermore, 27 patients developed nephrocalcinosis (NC), the patients showed no difference in biochemical differences at presentation and follow-up, but 3rd year PTH was higher. However, higher treatment doses of phosphate and calcitriol were found in the NC group. CONCLUSION HR treatment and follow-up is challenging and our results showed higher treatment doses were associated with NC without any change in serum phosphate levels, suggesting that giving higher doses led to increased phosphaturia, probably through stimulation of fibroblast growth factor 23. However, higher calcitriol doses could improve bone deformities. Safer and more efficacious therapies are needed.
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Affiliation(s)
- Zeynep Şıklar
- Ankara University Faculty of Medicine, Department of Pediatric Endocrinology, Ankara, Turkey,* Address for Correspondence: Ankara University Faculty of Medicine, Department of Pediatric Endocrinology, Ankara, Turkey Phone: +90 505 342 21 69 E-mail:
| | - Serap Turan
- Marmara University Pendik Training and Reseach Hospital, Clinic of Pediatric Endocrinology, İstanbul, Turkey
| | - Abdullah Bereket
- Marmara University Pendik Training and Reseach Hospital, Clinic of Pediatric Endocrinology, İstanbul, Turkey
| | - Firdevs Baş
- İstanbul University Faculty of Medicine, Department of Pediatric Endocrinology, İstanbul, Turkey
| | - Tülay Güran
- Marmara University Pendik Training and Reseach Hospital, Clinic of Pediatric Endocrinology, İstanbul, Turkey
| | - Azad Akberzade
- Marmara University Pendik Training and Reseach Hospital, Clinic of Pediatric Endocrinology, İstanbul, Turkey
| | - Ayhan Abacı
- Dokuz Eylül University Faculty of Medicine, Department of Pediatric Endocrinology, İzmir, Turkey
| | - Korcan Demir
- Dokuz Eylül University Faculty of Medicine, Department of Pediatric Endocrinology, İzmir, Turkey
| | - Ece Böber
- Dokuz Eylül University Faculty of Medicine, Department of Pediatric Endocrinology, İzmir, Turkey
| | - Mehmet Nuri Özbek
- University of Health Sciences Turkey, Gazi Yaşargil Training and Research Hospital, Clinic of Pediatric Endocrinology, Diyarbakır, Turkey
| | - Cengiz Kara
- Ondokuz Mayıs University Faculty of Medicine, Department of Pediatric Endocrinology, Samsun, Turkey
| | - Şükran Poyrazoğlu
- İstanbul University Faculty of Medicine, Department of Pediatric Endocrinology, İstanbul, Turkey
| | - Murat Aydın
- Ondokuz Mayıs University Faculty of Medicine, Department of Pediatric Endocrinology, Samsun, Turkey
| | - Aslı Kardelen
- İstanbul University Faculty of Medicine, Department of Pediatric Endocrinology, İstanbul, Turkey
| | - Ömer Tarım
- Uludağ University Faculty of Medicine, Department of Pediatric Endocrinology, Bursa, Turkey
| | - Erdal Eren
- Uludağ University Faculty of Medicine, Department of Pediatric Endocrinology, Bursa, Turkey
| | - Nihal Hatipoğlu
- Erciyes University Faculty of Medicine, Department of Pediatric Endocrinology, Kayseri, Turkey
| | - Muammer Büyükinan
- Konya Training and Research Hospital, Clinic of Pediatric Endocrinology, Konya, Turkey
| | - Nesibe Akyürek
- Konya Training and Research Hospital, Clinic of Pediatric Endocrinology, Konya, Turkey
| | - Semra Çetinkaya
- University of Health Sciences Turkey, Ankara Dr. Sami Ulus Obstetrics and Pediatrics Training and Research Hospital, Clinic of Pediatric Endocrinology, Ankara, Turkey
| | - Elvan Bayramoğlu
- University of Health Sciences Turkey, Ankara Dr. Sami Ulus Obstetrics and Pediatrics Training and Research Hospital, Clinic of Pediatric Endocrinology, Ankara, Turkey
| | - Beray Selver Eklioğlu
- Necmettin Erbakan University, Meram Faculty of Medicine, Department of Pediatric Endocrinology, Konya, Turkey
| | - Ahmet Uçaktürk
- Ankara City Hospital, Children’s Hospital, Clinic of Pediatric Endocrinology, Ankara, Turkey
| | - Saygın Abalı
- İstanbul Kartal Dr. Lütfi Kırdar Training and Research Hospital, Clinic of Pediatric Endocrinology, İstanbul, Turkey
| | - Damla Gökşen
- Ege University Faculty of Medicine, Department of Pediatric Endocrinology, İzmir, Turkey
| | - Yılmaz Kor
- University of Health Sciences Turkey, Adana Numune Training and Research Hospital, Clinic of Pediatric Endocrinology, Adana, Turkey
| | - Edip Ünal
- Dicle University Faculty of Medicine, Department of Pediatric Endocrinology, Diyarbakır, Turkey
| | - İhsan Esen
- Fırat University Faculty of Medicine, Department of Pediatric Endocrinology, Elazığ, Turkey
| | - Ruken Yıldırım
- Diyarbakır Children Hospital, Clinic of Pediatric Endocrinology, Diyarbakır, Turkey
| | - Onur Akın
- University of Health Sciences Turkey, Gülhane Training and Research Hospital, Clinic of Pediatric Endocrinology, Ankara, Turkey
| | - Atilla Çayır
- Erzurum Training and Research Hospital, Clinic of Pediatric Endocrinology, Erzurum, Turkey
| | - Emine Dilek
- Trakya University Faculty of Medicine, Department of Pediatric Endocrinology, Edirne, Turkey
| | - Birgül Kırel
- Eskişehir Osmangazi University Faculty of Medicine, Department of Pediatric Endocrinology, Eskişehir, Turkey
| | - Ahmet Anık
- Aydın Adnan Menderes University Faculty of Medicine, Department of Pediatric Endocrinology, Aydın, Turkey
| | - Gönül Çatlı
- İzmir Katip Çelebi Faculty of Medicine, Department of Pediatric Endocrinology, İzmir, Turkey
| | - Merih Berberoğlu
- Ankara University Faculty of Medicine, Department of Pediatric Endocrinology, Ankara, Turkey
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Abstract
Acid-labile subunit (ALS) forms ternary complexes with insulin like growth factor-1 (IGF-1) and IGF-binding protein-3 (IGFBP-3) and is essential for normal circulating IGF-1 levels. The IGFALS gene encodes the ALS and mutations in IGFALS cause ALS deficiency. We describe a patient with ALS deficiency with a novel homozygous frameshift mutation in IGFALS presenting with short stature and delayed puberty but ultimately achieving an adult height (AH) comparable to his target height (TH). A 15.25 year old boy presented with short stature (149.9 cm, -3.04 standard deviation score). The patient had a low circulating IGF-1 concentration, extremely low IGFBP-3 concentration, insulin resistance and osteopenia. The peak growth hormone (GH) response to GH stimulation test was high (31.6 ng/mL). Sequencing of IGFALS revealed a novel, homozygous, frameshift mutation (p.Ser555Thrfs.19). His mother and elder sister were heterozygous carriers. Although he had delayed puberty and short stature at the onset of puberty, he reached his TH and an AH similar to those of his heterozygous mother and sister. The heterozygous carriers had normal or low IGF-1 concentrations and low IGFBP-3 concentrations but not as markedly low as that of the patient. They had normally timed puberty, insulin metabolism and bone mineral density (BMD). The phenotype of ALS deficiency is quite variable. Despite short stature and delayed puberty, patients can achieve normal pubertal growth and AH. ALS deficiency may cause osteopenia and hyperinsulinemia. Heterozygous carriers may have normal prenatal growth, puberty, insulin metabolism and BMD.
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Affiliation(s)
- Şükran Poyrazoğlu
- İstanbul University İstanbul Faculty of Medicine, Unit of Pediatric Endocrinology, İstanbul, Turkey,* Address for Correspondence: İstanbul University İstanbul Faculty of Medicine, Unit of Pediatric Endocrinology, İstanbul, Turkey Phone: +90 212 414 20 00 E-mail:
| | - Vivian Hwa
- Cincinnati Children’s Hospital Medical Center, University of Cincinnati College of Medicine, Cincinnati Center for Growth Disorders, Cincinnati, Division of Endocrinology, Ohio, USA
| | - Firdevs Baş
- İstanbul University İstanbul Faculty of Medicine, Unit of Pediatric Endocrinology, İstanbul, Turkey
| | - Andrew Dauber
- Children’s National Healthy System, Division of Endocrinology, Washington, USA
| | - Ron Rosenfeld
- Cincinnati Children’s Hospital Medical Center, University of Cincinnati College of Medicine, Cincinnati Center for Growth Disorders, Cincinnati, Division of Endocrinology, Ohio, USA
| | - Feyza Darendeliler
- İstanbul University İstanbul Faculty of Medicine, Unit of Pediatric Endocrinology, İstanbul, Turkey
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Yetim Şahin A, Baş F, Yetim Ç, Uçar A, Poyrazoğlu Ş, Bundak R, Darendeliler F. Determination of insulin resistance and its relationship with hyperandrogenemia,anti-Müllerian hormone, inhibin A, inhibin B, and insulin-like peptide-3 levels in adolescent girls with polycystic ovary syndrome. Turk J Med Sci 2019; 49:1117-1125. [PMID: 31286756 PMCID: PMC7018291 DOI: 10.3906/sag-1808-52] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023] Open
Abstract
Background/aim This study aims to investigate the association between polycystic ovary syndrome (PCOS) and obesity and insulin resistance (IR) with respect to anti-Müllerian hormone (AMH), inhibin A (INH-A), inhibin B (INH-B), and insulin-like peptide 3 (INSL3) levels, all factors which may have an impact on IR. Materials and methods In this cross sectional study, 52 adolescent girls diagnosed with PCOS[groups: nonobese (NO), n = 23; overweight/obese (OW/O), n = 29] were included. Blood samples were obtained to measure AMH, INH-B, INH-A, and INSL3 levels, together with hormonal and biochemical assessments. Oral glucose tolerance test (OGTT) was performed and the indexes of IR [homeostasis model assessment: insulin resistance (HOMA-IR) and Matsuda index] were calculated. Results Insulin resistance was 56.5% with OGTT and 30.4% with HOMA-IR in nonobese-PCOS girls. There was a correlation between INH-A and HOMA-IR even when controlled for body mass index (BMI). INH-B and FAI also had correlations with HOMA-IR which disappeared when controlled for BMI. In regression analyses, AMH (odds ratio = [0.903, P = 0.015) and FAI (odds ratio = 1.353, P = 0.023) are found to be contributors to IR. Their effect was BMI-independent. In ROC analysis, the cutoff value for FAI was 5.93 (sensitivity 71%) to define IR in PCOS girls. Conclusion AMH and FAI may contribute to IR (defined by OGTT) in PCOS. FAI might be used as a supporting IR marker (defined by OGTT) in adolescent girls with PCOS.
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Affiliation(s)
- Aylin Yetim Şahin
- Division of Adolescent Medicine, Department of Pediatrics, İstanbul School of Medicine, İstanbul University, İstanbul, Turkey
| | - Firdevs Baş
- Division of Adolescent Medicine, Department of Pediatrics, İstanbul School of Medicine, İstanbul University, İstanbul, Turkey,Division of Pediatric Endocrinology and Diabetes, Department of Pediatrics,İstanbul School of Medicine, İstanbul University, İstanbul, Turkey
| | - Çağcıl Yetim
- Department of Gynecology and Obstetrics, School of Medicine, Biruni University, İstanbul, Turkey
| | - Ahmet Uçar
- Division of Pediatric Endocrinology and Diabetes, Department of Pediatrics, Şişli Etfal Training and Research Hospital, İstanbul, Turkey
| | - Şükran Poyrazoğlu
- Division of Pediatric Endocrinology and Diabetes, Department of Pediatrics,İstanbul School of Medicine, İstanbul University, İstanbul, Turkey
| | - Rüveyde Bundak
- Division of Pediatric Endocrinology and Diabetes, Department of Pediatrics,İstanbul School of Medicine, İstanbul University, İstanbul, Turkey
| | - Feyza Darendeliler
- Division of Adolescent Medicine, Department of Pediatrics, İstanbul School of Medicine, İstanbul University, İstanbul, Turkey,Division of Pediatric Endocrinology and Diabetes, Department of Pediatrics,İstanbul School of Medicine, İstanbul University, İstanbul, Turkey
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Yetim A, Aygün E, Yetim Ç, Ucar A, Karakaş Z, Gökçay G, Demirkol M, Ömer B, Gökçay G, Baş F, Erginöz E, Dağoğlu T. Measurement of serum vitamin B12-related metabolites in newborns: implications for new cutoff values to detect B12 deficiency. J Matern Fetal Neonatal Med 2019; 34:1260-1268. [PMID: 31204544 DOI: 10.1080/14767058.2019.1633301] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [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: 10/26/2022]
Abstract
OBJECTIVE Our aim was to determine the prevalence of maternal and neonatal vitamin B12 (vit-B12) and folate deficiencies, a new cutoff value of serum vit-B12 in newborns using vit-B12-related metabolites and also cutoff values of homocysteine (Hcy), propionyl (C3) carnitine, and methyl malonic acid (MMA) in newborns using a vit-B12 cutoff value of 200 pg/mL. METHODS Healthy pregnant women (without iron deficiency) and 98 healthy, term, singleton babies were included. Blood samples were obtained from women 0-8 h before birth and from cord blood during birth for hemogram and to measure serum vit-B12, folate, and Hcy levels. Maternal and cord blood serum vit-B12 levels were classified as low < 200 pg/mL, marginal 200-300 pg/mL, and normal ≥ 300 pg/mL. Neonatal urine MMA levels were analyzed in mothers with a vit-B12 concentration < 300 pg/mL. C3 carnitine levels of newborns were acquired from extended newborn screening. Receiver operating characteristics curve (ROC) analysis was used for serum vit-B12, urine MMA, C3 carnitine, and Hcy. RESULTS Of total, 98 pregnant women (28.6 ± 5.5-year-old) and 98 newborn were included. Vit-B12 level was lower than 300 pg/mL in 93% of the pregnant women and 61% of cord blood samples. Folate deficiency was not found in either group. There was statistically significant negative correlation between baby C3 carnitine, cord blood folate (r = -0.265, p = .008) and cord blood vit-B12 (r = -0.220, p = .029). In backward stepwise linear regression analysis, maternal vit-B12 level exerted the most marked effect on cord blood vit-B12 level (adjusted R2 = 0.457). In ROC analysis, the Hcy cutoff value was 4.77 µmol/L (68.4% sensitivity, 58.3% specificity, p = .012) for the detection of vit-B12 deficiency. CONCLUSION Vit-B12 deficiency remains an important health issue for pregnant women and newborns. Our study revealed a cutoff value for Hcy for the detection of nutritional vit-B12 deficiency that could be used in practice for newborns.
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Affiliation(s)
- Aylin Yetim
- Department of Pediatrics, Istanbul School of Medicine, Istanbul University, Fatih, Turkey
| | - Erhan Aygün
- Division of Neonatology, Department of Pediatrics, Istanbul School of Medicine, Istanbul University, Fatih, Turkey
| | - Çağcıl Yetim
- Department of Gynecology and Obstetrics, Istinye University, Istanbul, Turkey
| | - Ahmet Ucar
- Department of Pediatric Endocrinology and Diabetes, Sisli Hamidiye Etfal Training and Research Hospital, Istanbul, Turkey
| | - Zeynep Karakaş
- Department of Pediatric Hematology and Oncology, Istanbul University, Fatih, Turkey
| | - Gülden Gökçay
- Department of Pediatric Nutrition and Metabolism, Istanbul School of Medicine, Istanbul University, Fatih, Turkey
| | - Mübeccel Demirkol
- Department of Pediatric Nutrition and Metabolism, Istanbul School of Medicine, Istanbul University, Fatih, Turkey
| | - Beyhan Ömer
- Department of Biochemistry, Istanbul School of Medicine, Istanbul University, Fatih, Turkey
| | - Gülbin Gökçay
- Child Health Institute, Istanbul University, Fatih, Turkey
| | - Firdevs Baş
- Department of Pediatric Endocrinology and Diabetes, Istanbul School of Medicine, Istanbul University, Fatih, Turkey
| | - Ethem Erginöz
- Department of Public Health, Faculty of Medicine, Cerrahpaşa School of Medicine, Istanbul University Cerrahpasa, Istanbul, Turkey
| | - Türkan Dağoğlu
- Division of Neonatology, Department of Pediatrics, Istanbul School of Medicine, Istanbul University, Fatih, Turkey
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Aliefendioğlu D, Çoban A, Hatipoğlu N, Ecevit A, Arısoy AE, Yeşiltepe G, Baş F, Bideci A, Özek E. Management of hypoglycemia in newborn: Turkish Neonatal and Pediatric Endocrinology and Diabetes Societies consensus report. Turk Arch Pediatr 2019; 53:S224-S233. [PMID: 31236035 PMCID: PMC6568301 DOI: 10.5152/turkpediatriars.2018.01820] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
Hypoglycemia is one of the most important and most common metabolic problems of the newborn because it poses a risk of neurological injury, if it is prolonged and recurs. Therefore, newborns who carry a risk of hypoglycemia should be fed immediately after delivery and the blood glucose level should be measured with intervals of 2-3 hours from the 30th minute after feeding. The threshold value for hypoglycemia is 40 mg/dL for the first 24 hours in symptomatic babies. In asymptomatic babies, this value is considered 25 mg/dL for 0-4 hours, 35 mg/dl for 4-24 hours, 50 mg/dL after 24 hours and 60 mg/dL after 48 hours. Screening should be performed with bed-side test sticks. When values near the limit value are obtained, confirmation with laboratory method should be done and treatment should be initiated, if necessary. The level targeted with treatment is considered 50 mg/dL in the postnatal first 48 hours before feeding, 60 mg/dL after 48 hours in babies with high risk and above 70 mg/dL in babies with permanent hypoglycemia. In cases in which the blood glucose level is below the threshold value and can not be increased by feeding, a glucose infusion of 6-8 mg/kg/min should be initiated. If symptoms accompany, a mini bolus of 10% dextrose (2 ml/kg/min) should accompany. Incements (2 mg/kg/min) should be performed, if the target level can not be achieved and decrements (2 ml/kg/ min) should be performed, if nutrition and stabilization is provided. The infusion should be discontinued, if the infusion rate decreases to 3-5 mg/ kg/min. If necessary, blood samples should be obtained during hypoglycemia in terms of differential diagnosis and the investigation should be performed following a 6-hour fasting period in babies fed enterally and at any time when the plasma glucose is <50 mg/dL in babies receiving parenteral infusion. The hypoglycemic babies in the risk group whose infusions have been terminated can be discharged, if the plasma glucose level is found to be at the target level for two times before feeding and babies with permanent, severe or resistant hypoglycemia can be discharged, if the plasma glucose level is >60 mg/dL following a 6-hour fast.
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Affiliation(s)
- Didem Aliefendioğlu
- Division of Neonatology, Department of Pediatrics, Kırıkkale University, Faculty of Medicine, Kırıkkale, Turkey
| | - Asuman Çoban
- Division of Neonatology, Department of Pediatrics, İstanbul University, İstanbul Faculty of Medicine, İstanbul, Turkey
| | - Nihal Hatipoğlu
- Division of Pediatric Endocrinology, Department of Pediatrics, Erciyes University, Faculty of Medicine, Kayseri, Turkey
| | - Ayşe Ecevit
- Division of Neonatology, Department of Pediatrics, Başkent University, Faculty of Medicine, Ankara, Turkey
| | - Ayşe Engin Arısoy
- Division of Neonatology, Department of Pediatrics, Kocaeli University, Faculty of Medicine, Kocaeli, Turkey
| | - Gül Yeşiltepe
- Division of Pediatric Endocrinology, Department of Pediatrics, Koç University, Faculty of Medicine, İstanbul, Turkey
| | - Firdevs Baş
- Division of Pediatric Endocrimnology, Department of Pediatrics, İstanbul University, İstanbul Faculty of Medicine, İstanbul, Turkey
| | - Aysun Bideci
- Division of Pediatric Endocrinology, Department of Pediatrics, Gazi University, Faculty of Medicine, Ankara, Turkey
| | - Eren Özek
- Division of Neonatology, Department of Pediatrics, Marmara University, Faculty of Medicine, İstanbul, Turkey
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Eren E, Törel Ergür A, İşgüven ŞP, Çelebi Bitkin E, Berberoğlu M, Şıklar Z, Baş F, Yel S, Baş S, Söbü E, Bereket A, Turan S, Sağlam H, Atay Z, Ercan O, Güran T, Atabek ME, Korkmaz HA, Kılınç Uğurlu A, Akıncı A, Döğer E, Şimşek E, Akbaş ED, Abacı A, Gül Ü, Acar S, Mengen Uçaktürk E, Yıldız M, Ünal E, Tarım Ö. Clinical and Laboratory Characteristics of Hyperprolactinemia in Children and Adolescents: National Survey. J Clin Res Pediatr Endocrinol 2019; 11:149-156. [PMID: 30396878 PMCID: PMC6571533 DOI: 10.4274/jcrpe.galenos.2018.2018.0206] [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] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/01/2022] Open
Abstract
OBJECTIVE We aimed to report the characteristics at admission, diagnosis, treatment, and follow-up of cases of pediatric hyperprolactinemia in a large multicenter study. METHODS We reviewed the records of 233 hyperprolactinemic patients, under 18 years of age, who were followed by different centers. The patients were divided as having microadenomas, macroadenomas, drug-induced hyperprolactinemia and idiopathic hyperprolactinemia. Complaints of the patients, their mode of treatment (medication and/or surgery) and outcomes were evaluated in detail. RESULTS The mean age of the patients with hyperprolactinemia was 14.5 years, and 88.4% were females. In terms of etiology, microadenomas were observed in 32.6%, macroadenomas in 27%, idiopathic hyperprolactinemia in 22.7% and drug-induced hyperprolactinemia in 6.4%. Other causes of hyperprolactinemia were defined in 11.3%. Common complaints in females (n=206) were sorted into menstrual irregularities, headaches, galactorrhea, primary or secondary amenorrhea and weight gain, whereas headache, gynecomastia, short stature and blurred vision were common in males (n=27). Median prolactin levels were 93.15 ng/mL, 241.8 ng/mL, 74.5 ng/mL, 93.2 ng/mL, and 69 ng/mL for microadenomas, macroadenomas, idiopathic hyperprolactinemia, drug-induced hyperprolactinemia, and other causes of hyperprolactinemia, respectively. Of 172 patients with hyperprolactinemia, 77.3% were treated with cabergoline and 13.4% with bromocriptine. 20.1% of the patients with pituitary adenomas underwent pituitary surgery. CONCLUSION We present the largest cohort of children and adolescents with hyperprolactinemia in the literature to date. Hyperprolactinemia is more common in females and cabergoline is highly effective and practical to use in adolescents, due to its biweekly dosing. Indications for surgery in pediatric cases need to be revised.
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Affiliation(s)
- Erdal Eren
- Uludağ University Faculty of Medicine, Department of Pediatric Endocrinology, Bursa, Turkey,* Address for Correspondence: Uludağ University Faculty of Medicine, Department of Pediatric Endocrinology, Bursa, Turkey Phone: +90 505 768 69 47 E-mail:
| | - Ayça Törel Ergür
- Kırıkkale University Faculty of Medicine, Department of Pediatric Endocrinology, Kırıkkale, Turkey
| | - Şükriye Pınar İşgüven
- Sakarya University Faculty of Medicine, Department of Pediatric Endocrinology, Sakarya, Turkey
| | - Eda Çelebi Bitkin
- Ondokuz Mayıs University Faculty of Medicine, Department of Pediatric Endocrinology, Samsun, Turkey
| | - Merih Berberoğlu
- Ankara University Faculty of Medicine, Department of Pediatric Endocrinology, Ankara, Turkey
| | - Zeynep Şıklar
- Ankara University Faculty of Medicine, Department of Pediatric Endocrinology, Ankara, Turkey
| | - Firdevs Baş
- İstanbul University Faculty of Medicine, Department of Pediatric Endocrinology and Diabetes, İstanbul, Turkey
| | - Servet Yel
- Yüzüncü Yıl University Faculty of Medicine, Department of Pediatric Endocrinology, Van, Turkey
| | - Serpil Baş
- Marmara University Faculty of Medicine, Department of Pediatric Endocrinology, İstanbul, Turkey
| | - Elif Söbü
- Uludağ University Faculty of Medicine, Department of Pediatric Endocrinology, Bursa, Turkey
| | - Abdullah Bereket
- Marmara University Faculty of Medicine, Department of Pediatric Endocrinology, İstanbul, Turkey
| | - Serap Turan
- Marmara University Faculty of Medicine, Department of Pediatric Endocrinology, İstanbul, Turkey
| | - Halil Sağlam
- Uludağ University Faculty of Medicine, Department of Pediatric Endocrinology, Bursa, Turkey
| | - Zeynep Atay
- Marmara University Faculty of Medicine, Department of Pediatric Endocrinology, İstanbul, Turkey
| | - Oya Ercan
- İstanbul University Cerrahpaşa Faculty of Medicine, Department of Pediatric Endocrinology, İstanbul, Turkey
| | - Tülay Güran
- Marmara University Faculty of Medicine, Department of Pediatric Endocrinology, İstanbul, Turkey
| | - Mehmet Emre Atabek
- Necmettin Erbakan University Faculty of Medicine, Department of Pediatric Endocrinology, Konya, Turkey
| | - Hüseyin Anıl Korkmaz
- Balıkesir Atatürk State Hospital, Clinic of Pediatric Endocrinology, Balıkesir, Turkey
| | - Aylin Kılınç Uğurlu
- Gazi University Faculty of Medicine, Department of Pediatric Endocrinology, Ankara, Turkey
| | - Ayşehan Akıncı
- İnönü University Faculty of Medicine, Department of Pediatric Endocrinology, Malatya, Turkey
| | - Esra Döğer
- Gazi University Faculty of Medicine, Department of Pediatric Endocrinology, Ankara, Turkey
| | - Enver Şimşek
- Osmangazi University Faculty of Medicine, Department of Pediatric Endocrinology and Diabetes, Eskişehir, Turkey
| | - Emine Demet Akbaş
- Gazi University Faculty of Medicine, Department of Pediatric Endocrinology, Ankara, Turkey
| | - Ayhan Abacı
- Dokuz Eylül University Faculty of Medicine, Department of Pediatric Endocrinology, İzmir, Turkey
| | - Ülkü Gül
- Erciyes University Faculty of Medicine, Department of Pediatric Endocrinology, Kayseri, Turkey
| | - Sezer Acar
- Dokuz Eylül University Faculty of Medicine, Department of Pediatric Endocrinology, İzmir, Turkey
| | - Eda Mengen Uçaktürk
- Çukurova University Faculty of Medicine, Department of Pediatric Endocrinology, Adana, Turkey
| | - Melek Yıldız
- Kanuni Sultan Süleyman Training and Research Hospital, Clinic of Pediatric Endocrinology, İstanbul, Turkey
| | - Edip Ünal
- Dicle University Faculty of Medicine, Department of Pediatric Endocrinology, Diyarbakır, Turkey
| | - Ömer Tarım
- Uludağ University Faculty of Medicine, Department of Pediatric Endocrinology, Bursa, Turkey
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Abacı A, Çatlı G, Kırbıyık Ö, Şahin NM, Abalı ZY, Ünal E, Şıklar Z, Mengen E, Özen S, Güran T, Kara C, Yıldız M, Eren E, Nalbantoğlu Ö, Güven A, Çayır A, Akbaş ED, Kor Y, Çürek Y, Aycan Z, Baş F, Darcan Ş, Berberoğlu M. Genotype-phenotype correlation, gonadal malignancy risk, gender preference, and testosterone/dihydrotestosterone ratio in steroid 5-alpha-reductase type 2 deficiency: a multicenter study from Turkey. J Endocrinol Invest 2019; 42:453-470. [PMID: 30132287 DOI: 10.1007/s40618-018-0940-y] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/07/2018] [Accepted: 08/06/2018] [Indexed: 01/09/2023]
Abstract
BACKGROUND Studies regarding genetic and clinical characteristics, gender preference, and gonadal malignancy rates for steroid 5-alpha-reductase type 2 deficiency (5α-RD2) are limited and they were conducted on small number of patients. OBJECTIVE To present genotype-phenotype correlation, gonadal malignancy risk, gender preference, and diagnostic sensitivity of serum testosterone/dihydrotestosterone (T/DHT) ratio in patients with 5α-RD2. MATERIALS AND METHODS Patients with variations in the SRD5A2 gene were included in the study. Demographic characteristics, phenotype, gender assignment, hormonal tests, molecular genetic data, and presence of gonadal malignancy were evaluated. RESULTS A total of 85 patients were included in the study. Abnormality of the external genitalia was the most dominant phenotype (92.9%). Gender assignment was male in 58.8% and female in 29.4% of the patients, while it was uncertain for 11.8%. Fourteen patients underwent bilateral gonadectomy, and no gonadal malignancy was detected. The most frequent pathogenic variants were p.Ala65Pro (30.6%), p.Leu55Gln (16.5%), and p.Gly196Ser (15.3%). The p.Ala65Pro and p.Leu55Gln showed more undervirilization than the p.Gly196Ser. The diagnostic sensitivity of stimulated T/DHT ratio was higher than baseline serum T/DHT ratio, even in pubertal patients. The cut-off values yielding the best sensitivity for stimulated T/DHT ratio were ≥ 8.5 for minipuberty, ≥ 10 for prepuberty, and ≥ 17 for puberty. CONCLUSION There is no significant genotype-phenotype correlation in 5α-RD2. Gonadal malignancy risk seems to be low. If genetic analysis is not available at the time of diagnosis, stimulated T/DHT ratio can be useful, especially if different cut-off values are utilized in accordance with the pubertal status.
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Affiliation(s)
- A Abacı
- Department of Pediatric Endocrinology, Faculty of Medicine, Dokuz Eylül University, Balcova, 35340, Izmir, Turkey.
| | - G Çatlı
- Department of Pediatric Endocrinology, Faculty of Medicine, İzmir Katip Çelebi University, Izmir, Turkey
| | - Ö Kırbıyık
- Division of Genetics, Tepecik Training and Research Hospital, Sağlık Bilimleri University, Izmir, Turkey
| | - N M Şahin
- Department of Pediatric Endocrinology, Faculty of Medicine and Dr Sami Ulus Woman Health and Children Research Hospital, Yıldırım Beyazıt University, Ankara, Turkey
| | - Z Y Abalı
- Department of Pediatric Endocrinology, Faculty of Medicine, İstanbul University, İstanbul, Turkey
| | - E Ünal
- Department of Pediatric Endocrinology, Faculty of Medicine, Dicle University, Diyarbakır, Turkey
| | - Z Şıklar
- Department of Pediatric Endocrinology, Faculty of Medicine, Ankara University, Ankara, Turkey
| | - E Mengen
- Department of Pediatric Endocrinology, Faculty of Medicine, Çukurova University, Adana, Turkey
| | - S Özen
- Department of Pediatric Endocrinology, Faculty of Medicine, Ege University, Izmir, Turkey
| | - T Güran
- Department of Pediatric Endocrinology, Faculty of Medicine, Marmara University, İstanbul, Turkey
| | - C Kara
- Department of Pediatric Endocrinology, Faculty of Medicine, Ondokuz Mayıs University, Samsun, Turkey
| | - M Yıldız
- Division of Pediatric Endocrinology, Kanuni Sultan Süleyman Training and Research Hospital, İstanbul, Turkey
| | - E Eren
- Department of Pediatric Endocrinology, Faculty of Medicine, Uludağ University, Bursa, Turkey
| | - Ö Nalbantoğlu
- Division of Pediatric Endocrinology, Dr. Behcet Uz Children's Hospital, Izmir, Turkey
| | - A Güven
- Department of Pediatric Endocrinology, Göztepe Training and Research Hospital, İstanbul, Turkey
- Department of Pediatric Endocrinology, Faculty of Medicine, Amasya University, Amasya, Turkey
| | - A Çayır
- Division of Pediatric Endocrinology, Erzurum Training and Research Hospital, Erzurum, Turkey
| | - E D Akbaş
- Department of Pediatric Endocrinology, Faculty of Medicine, Gazi University, Ankara, Turkey
| | - Y Kor
- Department of Pediatric Endocrinology, Numune Training and Research Hospital, Sağlık Bilimleri University, Adana, Turkey
| | - Y Çürek
- Department of Pediatric Endocrinology, Sağlık Bilimleri University Antalya Training and Research Hospital, Antalya, Turkey
| | - Z Aycan
- Department of Pediatric Endocrinology, Faculty of Medicine and Dr Sami Ulus Woman Health and Children Research Hospital, Yıldırım Beyazıt University, Ankara, Turkey
| | - F Baş
- Department of Pediatric Endocrinology, Faculty of Medicine, İstanbul University, İstanbul, Turkey
| | - Ş Darcan
- Department of Pediatric Endocrinology, Faculty of Medicine, Ege University, Izmir, Turkey
| | - M Berberoğlu
- Department of Pediatric Endocrinology, Faculty of Medicine, Ankara University, Ankara, Turkey
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Güran T, Tezel B, Gürbüz F, Selver Eklioğlu B, Hatipoğlu N, Kara C, Şimşek E, Çizmecioğlu FM, Ozon A, Baş F, Aydın M, Darendeliler F. Neonatal Screening for Congenital Adrenal Hyperplasia in Turkey: A Pilot Study with 38,935 Infants. J Clin Res Pediatr Endocrinol 2019; 11:13-23. [PMID: 30111524 PMCID: PMC6398187 DOI: 10.4274/jcrpe.galenos.2018.2018.0117] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/15/2018] [Accepted: 08/10/2018] [Indexed: 12/01/2022] Open
Abstract
Objective Congenital adrenal hyperplasia (CAH) is the most common form of primary adrenal insufficiency in children. Neonatal screening for CAH is effective in detecting the salt-wasting (SW) form and in reducing mortality. In this study, our aim was to estimate the incidence of CAH in Turkey and to assess the characteristics and efficacy of the adopted newborn CAH screening strategy. Methods A pilot newborn CAH screening study was carried out under the authority of the Turkish Directorate of Public Health. Newborn babies of ≥32 gestational weeks and ≥1500 gr birth weight from four cities, born between March 27-September 15, 2017 were included in the study. Screening protocol included one sample two-tier testing. In the first step, 17α-hydroxyprogesterone (17-OHP) was measured by fluoroimmunoassay in dried blood spots (DBS) obtained at 3-5 days of life. The cases with positive initial screening were tested by steroid profiling in DBS using a liquid chromatography-tandem mass spectrometry method to measure 17-OHP, 21-deoxycortisol (21-S), cortisol (F), 11-deoxycortisol and androstenedione as a second-tier test. The babies with a steroid ratio (21-S+17-OHP)/F of ≥0.5 were referred to pediatric endocrinology clinics for diagnostic assessment. Results 38,935 infants were tested, 2265 (5.82%) required second-tier testing and 212 (0.54%) were referred for clinical assessment, six of whom were diagnosed with CAH (four males, two females). Four cases were identified as SW 21-hydroxylase deficiency (21-OHD) (two males, two females). One male baby had simple virilizing 21-OHD and one male baby had 11-OHD CAH. The incidence of classical 21-OHD in the screened population was 1:7,787. Conclusion The incidence of CAH due to classical 21-OHD is higher in Turkey compared to previous reports. We, therefore, suggest that CAH be added to the newborn screening panel in Turkey. The use of steroid profiling as a second-tier test was found to improve the efficacy of the screening and reduce the number of false-positives.
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Affiliation(s)
- Tülay Güran
- Marmara University Faculty of Medicine, Department of Paediatric Endocrinology and Diabetes, İstanbul, Turkey
| | - Başak Tezel
- Turkish Directorate of Public Health, Ankara, Turkey
| | - Fatih Gürbüz
- Çukurova University Faculty of Medicine, Department of Paediatric Endocrinology and Diabetes, Adana, Turkey
| | - Beray Selver Eklioğlu
- Necmettin Erbakan University Meram Faculty of Medicine, Department of Paediatric Endocrinology and Diabetes, Konya, Turkey
| | - Nihal Hatipoğlu
- Erciyes University Faculty of Medicine, Department of Paediatric Endocrinology and Diabetes, Kayseri, Turkey
| | - Cengiz Kara
- Ondokuz Mayıs University Faculty of Medicine, Department of Paediatric Endocrinology and Diabetes, Samsun, Turkey
| | - Enver Şimşek
- Osmangazi University Faculty of Medicine, Department of Paediatric Endocrinology and Diabetes, Eskişehir, Turkey
| | - Filiz Mine Çizmecioğlu
- Kocaeli University Faculty of Medicine, Department of Paediatric Endocrinology and Diabetes, Kocaeli, Turkey
| | - Alev Ozon
- Hacettepe University Faculty of Medicine, Department of Paediatric Endocrinology and Diabetes, Ankara, Turkey
| | - Firdevs Baş
- İstanbul University İstanbul Faculty of Medicine, Department of Paediatric Endocrinology and Diabetes, İstanbul, Turkey
| | - Murat Aydın
- Ondokuz Mayıs University Faculty of Medicine, Department of Paediatric Endocrinology and Diabetes, Samsun, Turkey
| | - Feyza Darendeliler
- İstanbul University İstanbul Faculty of Medicine, Department of Paediatric Endocrinology and Diabetes, İstanbul, Turkey
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Şimşek DG, Ecevit A, Hatipoğlu N, Çoban A, Arısoy AE, Baş F, Mutlu GY, Bideci A, Özek E. Neonatal Hyperglycemia, which threshold value, diagnostic approach and treatment?: Turkish Neonatal and Pediatric Endocrinology and Diabetes Societies consensus report. Turk Pediatri Ars 2018; 53:S234-S238. [PMID: 31236036 PMCID: PMC6568286 DOI: 10.5152/turkpediatriars.2018.01821] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
Hyperglycemia has become an important risk factor for mortality and morbidity in the neonatal period, especially with increased survival rates of very low birth weight neonates. Hyperglycemia in the neonatal period develops as a result of various mechanisms including iatrogenic causes, inability to supress hepatic glucose production, insulin resistance or glucose intolerance, specifically in preterm neonates. Initiation of parenteral or enteral feeding in the early period in preterm babies increases insulin production and sensitivity. The plasma glucose is targeted to be kept between 70 and 150 mg/dL in the newborn baby. While a blood glucose value above 150 mg/dL is defined as hyperglycemia, blood glucose values measured with an interval of 4 hours of >180-200 mg/dL and +2 glucosuria require treatment. Although glucose infusion rate is reduced in treatment, use of insulin is recommended, if two blood glucose values measured with an interval of 4 hours are >250 mg/dL and glucosuria is present in two separate urine samples.
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Affiliation(s)
- Damla Gökşen Şimşek
- Division of Pediatric Endocrinology, Department of Pediatrics, Ege University, Faculty of Medicine, İzmir, Turkey
| | - Ayşe Ecevit
- Division of Neonatology, Department of Pediatrics, Başkent University, Faculty of Medicine, Ankara, Turkey
| | - Nihal Hatipoğlu
- Division of Pediatric Endocrinology, Department of Pediatrics, Erciyes University, Faculty of Medicine, Kayseri, Turkey
| | - Asuman Çoban
- Division of Neonatology, Department of Pediatrics, İstanbul University, İstanbul Faculty of Medicine, İstanbul, Turkey
| | - Ayşe Engin Arısoy
- Division of Neonatology, Department of Pediatrics, Kocaeli University, Faculty of Medicine, Kocaeli, Turkey
| | - Firdevs Baş
- Division of Pediatric Endocrinology, Department of Pediatrics, İstanbul Üniversitesi, İstanbul Faculty of Medicine, İstanbul, Turkey
| | - Gül Yeşiltepe Mutlu
- Division Pediatric Endocrinology, Department of Pediatrics, Koç University, Faculty of Medicine, İstanbul, Turkey
| | - Aysun Bideci
- Division Pediatric Endocrinology, Department of Pediatrics, Gazi University, Faculty of Medicine, Ankara, Turkey
| | - Eren Özek
- Division of Neonatology, Department of Pediatrics, Marmara University, Faculty of Medicine, İstanbul, Turkey
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Baş F, Abalı ZY, Toksoy G, Poyrazoğlu Ş, Bundak R, Güleç Ç, Uyguner ZO, Darendeliler F. Precocious or early puberty in patients with combined pituitary hormone deficiency due to POU1F1 gene mutation: case report and review of possible mechanisms. Hormones (Athens) 2018; 17:581-588. [PMID: 30460459 DOI: 10.1007/s42000-018-0079-4] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [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: 07/12/2018] [Accepted: 11/05/2018] [Indexed: 11/25/2022]
Abstract
Central precocious puberty (CPP) or early puberty (EP) is a rare entity in combined pituitary hormone deficiency (CPHD), the latter caused by mutations in pituitary transcription factor genes. The early onset of puberty in two patients with CPHD with POU1F1 gene mutation was evaluated. A 3-month-old boy was diagnosed with central hypothyroidism, and L-thyroxine was commenced. He was referred for the evaluation of short stature at 20 months of age. Anthropometric evaluation revealed severe short stature (- 6.1 SDS), and growth hormone (GH) and prolactin deficiencies were diagnosed. Homozygous POU1F1 gene mutation (c.731T>G, p. I244S) was also detected. Testicular enlargement and high luteinizing hormone (LH) levels were observed at 7 years and 9 months of age while he was on GH and L-thyroxine treatment. Due to rapid progression of puberty, gonadotropin-releasing hormone analogue (GnRHa) was initiated at 11.3 years of age. This patient recently turned 19.2 years old, and his final height was - 2.3 SDS. The second patient, a 6-month-old boy, was also referred for growth retardation. His height was - 2.7 SDS, and GH and thyroid-stimulating hormone (TSH) deficiencies were diagnosed. He also had homozygous (c.10C>T, p.Q4*) POU1F1 gene mutation. Onset of puberty was relatively early, at 10 years, with advanced bone age. He was on GnRHa treatment between 11.5 and 12.5 years of age. Recent evaluation of the patient was at 13.6 years of age, and he is still on levothyroxine and GH treatment. The relationship between the POU1F1 genotype and CPP or EP has not as yet been firmly established in humans. Animal studies have revealed that the Pou1f1 gene has a major effect on regulation of GnRH receptor function and the Gata2 gene. It has also been demonstrated that this gene controls gonadotrope evolution and prevents excess gonadotropin levels. Further studies are, however, needed to elucidate the relation between POU1F1 function and CPP.
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Affiliation(s)
- Firdevs Baş
- Istanbul Faculty of Medicine, Department of Pediatrics, Pediatric Endocrinology Unit, Istanbul University, Çapa 34093, Istanbul, Turkey
| | - Zehra Yavaş Abalı
- Istanbul Faculty of Medicine, Department of Pediatrics, Pediatric Endocrinology Unit, Istanbul University, Çapa 34093, Istanbul, Turkey.
| | - Güven Toksoy
- Istanbul Faculty of Medicine, Department of Medical Genetics, Istanbul University, Istanbul, Turkey
| | - Şükran Poyrazoğlu
- Istanbul Faculty of Medicine, Department of Pediatrics, Pediatric Endocrinology Unit, Istanbul University, Çapa 34093, Istanbul, Turkey
| | - Rüveyde Bundak
- Istanbul Faculty of Medicine, Department of Pediatrics, Pediatric Endocrinology Unit, Istanbul University, Çapa 34093, Istanbul, Turkey
| | - Çağrı Güleç
- Istanbul Faculty of Medicine, Department of Medical Genetics, Istanbul University, Istanbul, Turkey
| | - Zehra Oya Uyguner
- Istanbul Faculty of Medicine, Department of Medical Genetics, Istanbul University, Istanbul, Turkey
| | - Feyza Darendeliler
- Istanbul Faculty of Medicine, Department of Pediatrics, Pediatric Endocrinology Unit, Istanbul University, Çapa 34093, Istanbul, Turkey
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Poyrazoğlu Ş, Bundak R, Yavaş Abalı Z, Önal H, Sarıkaya S, Akgün A, Baş S, Abalı S, Bereket A, Eren E, Tarım Ö, Güven A, Yıldız M, Karaman Aksakal D, Yüksel A, Seymen Karabulut G, Hatun Ş, Özgen T, Cesur Y, Azizoğlu M, Dilek E, Tütüncüler F, Papatya Çakır E, Özcabı B, Evliyaoğlu O, Karadeniz S, Dursun F, Bolu S, Arslanoğlu İ, Yeşiltepe Mutlu G, Kırmızıbekmez H, İşgüven P, Üstyol A, Adal E, Uçar A, Cebeci N, Bezen D, Binay Ç, Semiz S, Korkmaz HA, Memioğlu N, Sağsak E, Peltek HN, Yıldız M, Akçay T, Turan S, Güran T, Atay Z, Akcan N, Çizmecioğlu F, Ercan O, Dağdeviren A, Baş F, İşsever H, Darendeliler F. Incidence of Type 1 Diabetes in Children Aged Below 18 Years during 2013-2015 in Northwest Turkey. J Clin Res Pediatr Endocrinol 2018; 10:336-342. [PMID: 29789274 PMCID: PMC6280322 DOI: 10.4274/jcrpe.0025] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/22/2018] [Accepted: 05/22/2018] [Indexed: 02/07/2023] Open
Abstract
Objective To assess the incidence of type 1 diabetes mellitus (T1DM) in children under 18 years of age in the northwest region of Turkey during 2013-2015. Methods All newly diagnosed T1DM cases were recorded prospectively during 2013-2015. Total, as well as gender and age group specific (0-4, 5-9, 10-14 and 15-17 age) mean incidences per 100,000 per year were calculated. Results There were 1,773 patients diagnosed during 2013-2015 (588 cases in 2013, 592 cases in 2014, 593 cases in 2015). Of these, 862 (48.6%) were girls and 911 (51.4%) were boys. The mean age at diagnosis was 9.2±4.2 years and it was not significantly different between girls (9.0±4.1 years) and boys (9.4±4.4 years) (p=0.052). The crude mean incidence was 8.99/100.000 confidence interval (CI) (95% CI: 8.58-9.42). Although mean incidence was similar between boys [8.98/100.000 (CI: 8.40 to 9.58)] and girls [9.01/100.000 (CI: 8.42 to 9.63)], there was male predominance in all groups except for 5-9 year age group. The standardized mean incidence was 9.02/100.000 according to the World Health Organization standard population. The mean incidence for the 0-4, 5-9, 10-14 and 15-17 age groups was 6.13, 11.68, 11.7 and 5.04/100.000 respectively. The incidence of T1DM was similar over the course of three years (p=0.95). A significant increase in the proportion of cases diagnosed was observed in the autumn-winter seasons. Conclusion The northwest region of Turkey experienced an intermediate incidence of T1DM over the period of the study.
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Affiliation(s)
- Şükran Poyrazoğlu
- İstanbul University İstanbul Faculty of Medicine, Department of Pediatric Endocrinology, İstanbul, Turkey
| | - Rüveyde Bundak
- İstanbul University İstanbul Faculty of Medicine, Department of Pediatric Endocrinology, İstanbul, Turkey
- University of Kyrenia Faculty of Medicine, Department of Pediatric Endocrinology, Kyrenia, Turkish Republic of North Cyprus
| | - Zehra Yavaş Abalı
- İstanbul University İstanbul Faculty of Medicine, Department of Pediatric Endocrinology, İstanbul, Turkey
| | - Hasan Önal
- Kanuni Sultan Süleyman Training and Research Hospital, Clinic of Pediatric Endocrinology and Metabolic Disease, İstanbul, Turkey
| | - Sevil Sarıkaya
- Kanuni Sultan Süleyman Training and Research Hospital, Clinic of Pediatric Endocrinology and Metabolic Disease, İstanbul, Turkey
| | - Abdurrahman Akgün
- Kanuni Sultan Süleyman Training and Research Hospital, Clinic of Pediatric Endocrinology and Metabolic Disease, İstanbul, Turkey
| | - Serpil Baş
- Marmara University Faculty of Medicine, Department of Pediatric Endocrinology, İstanbul, Turkey
| | - Saygın Abalı
- Marmara University Faculty of Medicine, Department of Pediatric Endocrinology, İstanbul, Turkey
- Kartal Training and Research Hospital, Clinic of Pediatric Endocrinology, İstanbul, Turkey
| | - Abdullah Bereket
- Marmara University Faculty of Medicine, Department of Pediatric Endocrinology, İstanbul, Turkey
| | - Erdal Eren
- Uludağ University Faculty of Medicine, Department of Pediatric Endocrinology, Bursa, Turkey
| | - Ömer Tarım
- Uludağ University Faculty of Medicine, Department of Pediatric Endocrinology, Bursa, Turkey
| | - Ayla Güven
- Amasya University Faculty of Medicine, Department of Pediatric Endocrinology, Amasya, Turkey
- Göztepe Training and Research Hospital, Clinic of Pediatric Endocrinology, İstanbul, Turkey
| | - Metin Yıldız
- Göztepe Training and Research Hospital, Clinic of Pediatric Endocrinology, İstanbul, Turkey
| | - Derya Karaman Aksakal
- Göztepe Training and Research Hospital, Clinic of Pediatric Endocrinology, İstanbul, Turkey
| | - Ayşegül Yüksel
- Kocaeli University Faculty of Medicine, Department of Pediatric Endocrinology, Kocaeli, Turkey
| | - Gülcan Seymen Karabulut
- Kocaeli University Faculty of Medicine, Department of Pediatric Endocrinology, Kocaeli, Turkey
| | - Şükrü Hatun
- Kocaeli University Faculty of Medicine, Department of Pediatric Endocrinology, Kocaeli, Turkey
- Koç University Faculty of Medicine, Department of Pediatric Endocrinology, İstanbul, Turkey
| | - Tolga Özgen
- Bezmialem Vakıf University Faculty of Medicine, Department of Pediatric Endocrinology, İstanbul, Turkey
| | - Yaşar Cesur
- Bezmialem Vakıf University Faculty of Medicine, Department of Pediatric Endocrinology, İstanbul, Turkey
| | - Mehmet Azizoğlu
- Trakya University Faculty of Medicine, Department of Pediatric Endocrinology, Edirne, Turkey
| | - Emine Dilek
- Trakya University Faculty of Medicine, Department of Pediatric Endocrinology, Edirne, Turkey
| | - Filiz Tütüncüler
- Trakya University Faculty of Medicine, Department of Pediatric Endocrinology, Edirne, Turkey
| | - Esra Papatya Çakır
- Bakırköy Dr. Sadi Konuk Training and Research Hospital, Clinic of Pediatric Endocrinology, İstanbul, Turkey
- Şevket Yılmaz Training and Research Hospital, Clinic of Pediatric Endocrinology, Bursa, Turkey
| | - Bahar Özcabı
- İstanbul University Cerrahpaşa Faculty of Medicine, Department of Pediatric Endocrinology, İstanbul, Turkey
- Zeynep Kamil Women’s and Children’s Disease Training and Research Hospital, Clinic of Pediatric Endocrinology, İstanbul, Turkey
| | - Olcay Evliyaoğlu
- İstanbul University Cerrahpaşa Faculty of Medicine, Department of Pediatric Endocrinology, İstanbul, Turkey
| | - Songül Karadeniz
- İstanbul University Cerrahpaşa Faculty of Medicine, Department of Pediatric Endocrinology, İstanbul, Turkey
| | - Fatma Dursun
- Ümraniye Training and Research Hospital, Clinic of Pediatric Endocrinology, İstanbul, Turkey
| | - Semih Bolu
- Düzce University Faculty of Medicine, Department of Pediatric Endocrinology, İstanbul, Turkey
| | - İlknur Arslanoğlu
- Düzce University Faculty of Medicine, Department of Pediatric Endocrinology, İstanbul, Turkey
| | - Gül Yeşiltepe Mutlu
- Kocaeli University Faculty of Medicine, Department of Pediatric Endocrinology, Kocaeli, Turkey
- Zeynep Kamil Women’s and Children’s Disease Training and Research Hospital, Clinic of Pediatric Endocrinology, İstanbul, Turkey
| | - Heves Kırmızıbekmez
- Zeynep Kamil Women’s and Children’s Disease Training and Research Hospital, Clinic of Pediatric Endocrinology, İstanbul, Turkey
| | - Pınar İşgüven
- Sakarya University Faculty of Medicine, Department of Pediatric Endocrinology, Sakarya, Turkey
| | - Ala Üstyol
- Haseki Training and Research Hospital, Clinic of Pediatric Endocrinology, İstanbul, Turkey
| | - Erdal Adal
- Medipol University Faculty of Medicine, Department of Pediatric Endocrinology, İstanbul, Turkey
| | - Ahmet Uçar
- Şişli Etfal Training and Research Hospital, Clinic of Pediatric Endocrinology, İstanbul, Turkey
| | - Nurcan Cebeci
- Derince Training and Research Hospital, Clinic of Pediatric Endocrinology, Kocaeli, Turkey
| | - Didem Bezen
- Okmeydanı Training and Research Hospital, Clinic of Pediatric Endocrinology, İstanbul, Turkey
| | - Çiğdem Binay
- Çorlu State Hospital, Clinic of Pediatric Endocrinology, Tekirdağ, Turkey
| | - Serap Semiz
- Acıbadem University Faculty of Medicine, Clinic of Pediatric Endocrinology, İstanbul, Turkey
| | - Hüseyin Anıl Korkmaz
- Balıkesir Atatürk State Hospital, Clinic of Pediatric Endocrinology, Balıkesir, Turkey
| | - Nihal Memioğlu
- American Hospital, Clinic of Pediatric Endocrinology, İstanbul, Turkey
| | - Elif Sağsak
- Gaziosmanpaşa Taksim Training and Research Hospital, Clinic of Pediatric Endocrinology, İstanbul, Turkey
| | - Havva Nur Peltek
- Edirne Sultan 1. Murat State Hospital, Clinic of Pediatric Endocrinology, Edirne, Turkey
| | - Melek Yıldız
- Kanuni Sultan Süleyman Training and Research Hospital, Clinic of Pediatric Endocrinology and Metabolic Disease, İstanbul, Turkey
| | - Teoman Akçay
- Medical Park Gaziosmanpaşa Hospital, Clinic of Pediatric Endocrinology, İstanbul, Turkey
| | - Serap Turan
- Marmara University Faculty of Medicine, Department of Pediatric Endocrinology, İstanbul, Turkey
| | - Tülay Güran
- Marmara University Faculty of Medicine, Department of Pediatric Endocrinology, İstanbul, Turkey
| | - Zeynep Atay
- Marmara University Faculty of Medicine, Department of Pediatric Endocrinology, İstanbul, Turkey
- Medipol University Faculty of Medicine, Department of Pediatric Endocrinology, İstanbul, Turkey
| | - Neşe Akcan
- Göztepe Training and Research Hospital, Clinic of Pediatric Endocrinology, İstanbul, Turkey
- University of Near East Faculty of Medicine, Department of Pediatric Endocrinology, Nicosia, Turkish Republic of North Cyprus
| | - Filiz Çizmecioğlu
- Kocaeli University Faculty of Medicine, Department of Pediatric Endocrinology, Kocaeli, Turkey
| | - Oya Ercan
- İstanbul University Cerrahpaşa Faculty of Medicine, Department of Pediatric Endocrinology, İstanbul, Turkey
| | - Aydilek Dağdeviren
- İstanbul University Cerrahpaşa Faculty of Medicine, Department of Pediatric Endocrinology, İstanbul, Turkey
| | - Firdevs Baş
- İstanbul University İstanbul Faculty of Medicine, Department of Pediatric Endocrinology, İstanbul, Turkey
| | - Halim İşsever
- İstanbul University İstanbul Faculty of Medicine, Department of Public Health, İstanbul, Turkey
| | - Feyza Darendeliler
- İstanbul University İstanbul Faculty of Medicine, Department of Pediatric Endocrinology, İstanbul, Turkey
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Kardelen AD, Toksoy G, Baş F, Yavaş Abalı Z, Gençay G, Poyrazoğlu Ş, Bundak R, Altunoğlu U, Avcı Ş, Najaflı A, Uyguner O, Karaman B, Başaran S, Darendeliler F. A Rare Cause of Congenital Adrenal Hyperplasia: Clinical and Genetic Findings and Follow-up Characteristics of Six Patients with 17-Hydroxylase Deficiency Including Two Novel Mutations. J Clin Res Pediatr Endocrinol 2018; 10:206-215. [PMID: 29595516 PMCID: PMC6083475 DOI: 10.4274/jcrpe.0032] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [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] [Indexed: 01/20/2023] Open
Abstract
OBJECTIVE 17α-hydroxylase/17,20 lyase deficiency (17OHD) is a rare form of congenital adrenal hyperplasia (CAH), characterized by hypertension and varying degrees of ambiguous genitalia and delayed puberty. The disease is associated with bi-allelic mutations in the CYP17A1 gene located on chromosome 10q24.3. We aimed to present clinical and genetic findings and follow-up and treatment outcomes of 17OHD patients. METHODS We evaluated six patients with 17OHD from five families at presentation and at follow up. Standard deviation score of all auxological measurements was calculated according to national data and karyotype status. CYP17A1 gene sequence alterations were investigated in all patients. RESULTS The mean (±standard deviation) age of patients at presentation and follow-up time was 14.6±4.2 and 5.0±2.7 years respectively. Five patients were referred to us because of delayed puberty and primary amenorrhea and four for hypertension. One novel single nucleotide insertion leading to frame shift and another novel variant occurring at an ultra rare position, leading to a missense change, are reported, both of which caused 17OHD deficiency. Steroid replacement was started. The three patients with 46,XY karyotype who were raised as females underwent gonadectomy. Osteoporosis was detected in five patients. Four patients needed antihypertensive treatment. Improvement in osteoporosis was noted with gonadal steroid replacement and supportive therapy. CONCLUSION 17OHD, a rare cause of CAH, should be kept in mind in patients with pubertal delay and/or hypertension. Patients with 46,XY who are raised as females require gonadectomy. Due to late diagnosis, psychological problems, gender selection, hypertension and osteoporosis are important health problems affecting a high proportion of these patients.
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Affiliation(s)
- Aslı Derya Kardelen
- İstanbul University İstanbul Faculty of Medicine, Department of Pediatrics, Pediatric Endocrinology Unit, İstanbul, Turkey,* Address for Correspondence: İstanbul University İstanbul Faculty of Medicine, Department of Pediatrics, Pediatric Endocrinology Unit, İstanbul, Turkey Phone: +90 5308701984 E-mail:
| | - Güven Toksoy
- İstanbul University İstanbul Faculty of Medicine, Department of Medical Genetics, İstanbul, Turkey
| | - Firdevs Baş
- İstanbul University İstanbul Faculty of Medicine, Department of Pediatrics, Pediatric Endocrinology Unit, İstanbul, Turkey
| | - Zehra Yavaş Abalı
- İstanbul University İstanbul Faculty of Medicine, Department of Pediatrics, Pediatric Endocrinology Unit, İstanbul, Turkey
| | - Genco Gençay
- İstanbul University İstanbul Faculty of Medicine, Department of Pediatrics, İstanbul, Turkey
| | - Şükran Poyrazoğlu
- İstanbul University İstanbul Faculty of Medicine, Department of Pediatrics, Pediatric Endocrinology Unit, İstanbul, Turkey
| | - Rüveyde Bundak
- İstanbul University İstanbul Faculty of Medicine, Department of Pediatrics, Pediatric Endocrinology Unit, İstanbul, Turkey
| | - Umut Altunoğlu
- İstanbul University İstanbul Faculty of Medicine, Department of Medical Genetics, İstanbul, Turkey
| | - Şahin Avcı
- İstanbul University İstanbul Faculty of Medicine, Department of Medical Genetics, İstanbul, Turkey
| | - Adam Najaflı
- İstanbul University İstanbul Faculty of Medicine, Department of Medical Genetics, İstanbul, Turkey
| | - Oya Uyguner
- İstanbul University İstanbul Faculty of Medicine, Department of Medical Genetics, İstanbul, Turkey
| | - Birsen Karaman
- İstanbul University İstanbul Faculty of Medicine, Department of Medical Genetics, İstanbul, Turkey
| | - Seher Başaran
- İstanbul University İstanbul Faculty of Medicine, Department of Medical Genetics, İstanbul, Turkey
| | - Feyza Darendeliler
- İstanbul University İstanbul Faculty of Medicine, Department of Pediatrics, Pediatric Endocrinology Unit, İstanbul, Turkey
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Baş F, Toksoy G, Ergun-Longmire B, Uyguner ZO, Abalı ZY, Poyrazoğlu Ş, Karaman V, Avcı Ş, Altunoğlu U, Bundak R, Karaman B, Başaran S, Darendeliler F. Prevalence, clinical characteristics and long-term outcomes of classical 11 β-hydroxylase deficiency (11BOHD) in Turkish population and novel mutations in CYP11B1 gene. J Steroid Biochem Mol Biol 2018; 181:88-97. [PMID: 29626607 DOI: 10.1016/j.jsbmb.2018.04.001] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/20/2017] [Revised: 03/12/2018] [Accepted: 04/03/2018] [Indexed: 10/17/2022]
Abstract
UNLABELLED Congenital adrenal hyperplasia (CAH) due to 11β-hydroxylase deficiency (11BOHD) is a rare autosomal recessive disorder and the second most common form of CAH. AIM To investigate genotype-phenotype correlation and to evaluate clinical characteristics and long-term outcomes of patients with 11BOHD. METHODS A total of 28 patients (n = 14, 46,XX; n = 14, 46,XY) with classical 11BOHD from 25 unrelated families were included in this study. Screening of CYP11B1 is performed by Sanger sequencing. Pathogenic features of novel variants are investigated by the use of multiple in silico prediction tools and with family based co-segregation studies. Protein simulations were investigated for two novel coding region alterations. RESULTS The age at diagnosis ranged from 6 days to 12.5 years. Male patients received diagnose at older ages than female patients. The rate of consanguinity was high (71.4%). Five out of nine 46,XX patients were diagnosed late (age 2-8.7 years) and were assigned as male due to severe masculinization. Twenty one patients have reached adult height and sixteen were ultimately short due to delayed diagnosis. Two male patients had testicular microlithiasis and 5 (35.7%) patients had testicular adrenal rest tumor during follow up. Four patients (28.6%) had gynecomastia. Mutation analyses in 25 index patients revealed thirteen different mutations in CYP11B1 gene, 4 of which were novel (c.393 + 3A > G, c.428G > C, c.1398 + 2T > A, c.1449_1451delGGT). The most frequent mutations were c.896T > C with 32%, c.954G > A with 16% and c.1179_1180dupGA with 12% in frequency. There was not a good correlation between genotype and phenotype; phenotypic variability was observed among the patients with same mutation. CONCLUSION This study presents the high allelic heterogeneity of CYP11B1 mutations in CAH patients from Turkey. Three dimensional protein simulations may provide additional support for the pathogenicity of the genetic alterations. Our results provide reliable information for genetic counseling, preventive and therapeutic strategies for the families.
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Affiliation(s)
- Firdevs Baş
- Istanbul University, Istanbul Faculty of Medicine, Department of Pediatrics, Pediatric Endocrinology Unit, Istanbul, 34093, Turkey.
| | - Güven Toksoy
- Istanbul University, Istanbul Faculty of Medicine, Department of Medical Genetics, Istanbul, 34093, Turkey
| | - Berrin Ergun-Longmire
- The University of Florida, The Studer Family Children's Hospital at Sacred Heart, Pensacola, FL, 32504, United States
| | - Zehra Oya Uyguner
- Istanbul University, Istanbul Faculty of Medicine, Department of Medical Genetics, Istanbul, 34093, Turkey
| | - Zehra Yavaş Abalı
- Istanbul University, Istanbul Faculty of Medicine, Department of Pediatrics, Pediatric Endocrinology Unit, Istanbul, 34093, Turkey
| | - Şükran Poyrazoğlu
- Istanbul University, Istanbul Faculty of Medicine, Department of Pediatrics, Pediatric Endocrinology Unit, Istanbul, 34093, Turkey
| | - Volkan Karaman
- Istanbul University, Istanbul Faculty of Medicine, Department of Medical Genetics, Istanbul, 34093, Turkey
| | - Şahin Avcı
- Istanbul University, Istanbul Faculty of Medicine, Department of Medical Genetics, Istanbul, 34093, Turkey
| | - Umut Altunoğlu
- Istanbul University, Istanbul Faculty of Medicine, Department of Medical Genetics, Istanbul, 34093, Turkey
| | - Ruveyde Bundak
- Istanbul University, Istanbul Faculty of Medicine, Department of Pediatrics, Pediatric Endocrinology Unit, Istanbul, 34093, Turkey
| | - Birsen Karaman
- Istanbul University, Istanbul Faculty of Medicine, Department of Medical Genetics, Istanbul, 34093, Turkey
| | - Seher Başaran
- Istanbul University, Istanbul Faculty of Medicine, Department of Medical Genetics, Istanbul, 34093, Turkey
| | - Feyza Darendeliler
- Istanbul University, Istanbul Faculty of Medicine, Department of Pediatrics, Pediatric Endocrinology Unit, Istanbul, 34093, Turkey
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Abstract
OBJECTIVE Klinefelter syndrome (KS) is the most common (1/500–1/1000) chromosomal disorder in males, but only 10% of cases are identified in childhood. This study aimed to review the data of children with KS to assess the age and presenting symptoms for diagnosis, clinical and laboratory findings, together with the presence of comorbidities. METHODS Twenty-three KS patients were analyzed retrospectively. Age at admission, presenting symptoms, comorbid problems, height, weight, pubertal status, biochemical findings, hormone profiles, bone mineral density and karyotype were evaluated. Molecular analysis was also conducted in patients with ambiguous genitalia. RESULTS The median age of patients at presentation was 3.0 (0.04-16.3) years. Most of the cases were diagnosed prenatally (n=15, 65.2%). Other reasons for admission were scrotal hypospadias (n=3, 14.3%), undescended testis (n=2, 9.5%), short stature (n=1, 4.8%), isolated micropenis (n=1, 4.8%) and a speech disorder (n=1, 4.8%). The most frequent clinical findings were neurocognitive disorders, speech impairment, social and behavioral problems and undescended testes. All except two patients were prepubertal at admission. Most of the patients (n=20, 86.9%) showed the classic 47,XXY karyotype. Steroid 5 alpha-reductase 2 gene and androgen receptor gene mutations were detected in two of the three cases with genital ambiguity. CONCLUSION Given the large number of underdiagnosed KS patients before adolescence, pediatricians need to be aware of the phenotypic variability of KS in childhood. Genetic analysis in KS patients may reveal mutations associated with other forms of disorders of sex development besides KS.
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Affiliation(s)
- Neşe Akcan
- Near East University Faculty of Medicine, Department of Pediatric Endocrinology, Nicosia, Cyprus,* Address for Correspondence: Near East University Faculty of Medicine, Department of Pediatric Endocrinology, Nicosia, Cyprus Phone: +90 392 675 10 00 E-mail:
| | - Şükran Poyrazoğlu
- İstanbul University İstanbul Faculty of Medicine, Department of Pediatric Endocrinology, İstanbul, Turkey
| | - Firdevs Baş
- İstanbul University İstanbul Faculty of Medicine, Department of Pediatric Endocrinology, İstanbul, Turkey
| | - Rüveyde Bundak
- University of Kyrenia Faculty of Medicine, Department of Pediatric Endocrinology, Kyrenia, Cyprus
| | - Feyza Darendeliler
- İstanbul University İstanbul Faculty of Medicine, Department of Pediatric Endocrinology, İstanbul, Turkey
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Çetinkaya S, Poyrazoğlu Ş, Baş F, Ercan O, Yıldız M, Adal E, Bereket A, Abalı S, Aycan Z, Erdeve ŞS, Berberoğlu M, Şıklar Z, Tayfun M, Darcan Ş, Mengen E, Bircan İ, Jones FMÇ, Şimşek E, Papatya ED, Özbek MN, Bolu S, Abacı A, Büyükinan M, Darendeliler F. Response to growth hormone treatment in very young patients with growth hormone deficiencies and mini-puberty. J Pediatr Endocrinol Metab 2018; 31:175-184. [PMID: 29353264 DOI: 10.1515/jpem-2017-0123] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/29/2017] [Accepted: 11/28/2017] [Indexed: 11/15/2022]
Abstract
BACKGROUND The aim of the study was to assess the response to growth hormone (GH) treatment in very young patients with GH deficiency (GHD) through a national, multi-center study. Possible factors affecting growth response were assessed (especially mini-puberty). METHODS Medical reports of GHD patients in whom treatment was initiated between 0 and 3 years of age were retrospectively evaluated. RESULTS The cohort numbered 67. The diagnosis age was 12.4±8.6 months, peak GH stimulation test response (at diagnosis) as 1.0±1.4 ng/mL. The first and second years length gain was 15.0±4.3 and 10.4±3.4 cm. Weight gain had the largest effect on first year growth response; whereas weight gain and GH dose were both important factors affecting second year growth response. In the multiple pituitary hormone deficiency (MPHD) group (n=50), first year GH response was significantly greater than in the isolated GH deficiency (IGHD) group (n=17) (p=0.030). In addition first year growth response of infants starting GH between 0 and 12 months of age (n=24) was significantly greater than those who started treatment between 12 and 36 months of age (n=43) (p<0.001). These differences were not seen in the second year. Δ Length/height standard deviation score (SDS), Δ body weight SDS, length/height SDS, weight SDS in MPHD without hypogonadism for the first year of the GH treatment were found as significantly better than MPHD with hypogonadism. CONCLUSIONS Early onsets of GH treatment, good weight gain in the first year of the treatment and good weight gain-GH dose in the second year of the treatment are the factors that have the greatest effect on length gain in early onset GHD. The presence of the sex steroid hormones during minipubertal period influence growth pattern positively under GH treatment (closer to the normal percentage according to age and gender).
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Affiliation(s)
- Semra Çetinkaya
- Health Sciences University, Dr Sami Ulus Obstetrics and Gynecology, Children's Health and Disease, Health Implementation and Research Center, Department of Pediatric Endocrinology, Ankara, Turkey
| | - Şükran Poyrazoğlu
- Istanbul University, Faculty of Medicine, Institute of Child Health, Department of Pediatric Endocrinology, Istanbul, Turkey
| | - Firdevs Baş
- Istanbul University, Faculty of Medicine, Institute of Child Health, Department of Pediatric Endocrinology, Istanbul, Turkey
| | - Oya Ercan
- Istanbul University, Cerrahpasa Medical Faculty, Department of Pediatric Endocrinology, Istanbul, Turkey
| | - Metin Yıldız
- Göztepe Training and Research Hospital, Clinics of Pediatric Endocrinology, Istanbul, Turkey
| | - Erdal Adal
- Istanbul Medipol University, Department of Pediatric Endocrinology, Istanbul, Turkey
| | - Abdullah Bereket
- Marmara University, Faculty of Medicine, Department of Pediatric Endocrinology, Istanbul, Turkey
| | - Saygın Abalı
- Marmara University, Faculty of Medicine, Department of Pediatric Endocrinology, Istanbul, Turkey
| | - Zehra Aycan
- Dr Sami Ulus Obstetrics and Gynecology, Children's Health and Disease Training and Research Hospital, Department of Pediatric Endocrinology, Ankara, Turkey.,Yıldırım Beyazıt University, Faculty of Medicine, Ankara, Turkey
| | - Şenay Savaş Erdeve
- Health Sciences University, Dr Sami Ulus Obstetrics and Gynecology, Children's Health and Disease, Health Implementation and Research Center, Department of Pediatric Endocrinology, Ankara, Turkey
| | - Merih Berberoğlu
- Ankara University School of Medicine, Department of Pediatric Endocrinology, Ankara, Turkey
| | - Zeynep Şıklar
- Ankara University School of Medicine, Department of Pediatric Endocrinology, Ankara, Turkey
| | - Meltem Tayfun
- Ankara Children's Hematology and Oncology Research and Training Hospital, Department of Pediatric Endocrinology, Ankara, Turkey
| | - Şükran Darcan
- Ege University, Faculty of Medicine, Department of Pediatric Endocrinology, Izmir, Turkey
| | - Eda Mengen
- Cukurova University Faculty of Medicine, Department of Pediatric Endocrinology, Adana, Turkey
| | - İffet Bircan
- Akdeniz University Faculty of Medicine, Department of Pediatric Endocrinology, Antalya, Turkey
| | | | - Enver Şimşek
- Osmangazi University Faculty of Medicine, Department of Pediatric Endocrinology, Eskişehir, Turkey
| | - Esra Deniz Papatya
- Bakırköy Dr Sadi Konuk Education and Research Hospital, Clinics of Pediatric Endocrinology, İstanbul, Turkey
| | - Mehmet Nuri Özbek
- Health Sciences University, Gazi Yaşargil Education and Training Hospital, Clinics of Pediatric Endocrinology, Diyarbakır, Turkey
| | - Semih Bolu
- Düzce University, Faculty of Medicine, Department of Pediatric Endocrinology, Konuralp, Düzce, Turkey
| | - Ayhan Abacı
- Dokuz Eylül University Faculty of Medicine, Department of Pediatric Endocrinology, İzmir, Turkey
| | - Muammer Büyükinan
- Konya Education and Research Hospital, Clinics of Pediatric Endocrinology, Konya, Turkey
| | - Feyza Darendeliler
- Istanbul University, Faculty of Medicine, Institute of Child Health, Department of Pediatric Endocrinology, Istanbul, Turkey
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Yetim A, Alikaşifoğlu M, Baş F, Eliaçık K, Çığ G, Erginöz E, Ercan O, Bundak R. Glycemic control and health behaviors in adolescents with type 1 diabetes. TurkJPediatr 2018; 60:244-254. [DOI: 10.24953/turkjped.2018.03.003] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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Aygün D, Aygün F, Nişli K, Baş F, Çıtak A. Electrocardiographic changes in children with diabetic ketoacidosis and ketosis. Turk Arch Pediatr 2017; 52:194-201. [PMID: 29483798 DOI: 10.5152/turkpediatriars.2017.4917] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2016] [Accepted: 06/21/2017] [Indexed: 11/22/2022]
Abstract
Aim We aimed to study electrocardiographic changes in children with diabetic ketoacidosis and ketosis and to evaluate the relation of the changes with serum electrolyte levels and ketosis. Material and Methods This study was performed in Istanbul Medical Faculty, Pediatric Emergency and Intensive Care Department between May 2008 and May 2009. The electrocardiographic parameters and QT length of children with diabetic ketoacidosis and ketosis were evaluated at diagnosis and after the treatment. Results Forty patients were included in the study; 16 (40%) were diagnosed as having diabetic ketosis and 24 (60%) had diabetic ketoacidosis. Twenty-four (60%) patients were male and 16 (40%) were female and the mean age was 9.21±4.71 years (range, 1-16 years). Twelve (30%) cases of diabetic ketoacidosis were mild, three (7.5%) were moderate, and nine (22.5%) were severe. One patient had premature ventricular beats, and four had ST depression. The electrocardiographic parameters were all normal beyond the QTC length prolongation. The mean QTC length was 447±45 ms (380-560 ms) at diagnosis and 418±32 ms (350-500 ms) after treatment. The change in the QTC length was statistically significant. None of the patients had significant electrolyte disturbance and the prolongation of QTc length was not correlated with serum electrolyte levels. The prolongation of QTc length was statistically correlated with anion gap (r=0.33, p=0.03). Conclusions In our study, we showed QTc length prolongation and the importance of performing electrocardiography during the diagnosis of diabetic ketoacidosis and ketosis. We also demonstrated that ketosis was responsible for the prolongation of QTc length.
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Affiliation(s)
- Deniz Aygün
- Istanbul University, Istanbul Faculty of Medicine, Department of Pediatrics, Istanbul, Turkey
| | - Fatih Aygün
- Istanbul University, Istanbul Faculty of Medicine, Department of Pediatrics, Istanbul, Turkey
| | - Kemal Nişli
- Istanbul University, Istanbul Faculty of Medicine, Department of Pediatrics, Division of Pediatric Cardiology, Istanbul, Turkey
| | - Firdevs Baş
- Istanbul University, Istanbul Faculty of Medicine, Department of Pediatrics, Division of Pediatric Endocrinology, Istanbul, Turkey
| | - Agop Çıtak
- Istanbul University, Istanbul Faculty of Medicine, Department of Pediatrics, Division of Pediatric Intensive Care, Istanbul, Turkey
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Taylan F, Yavaş Abalı Z, Jäntti N, Güneş N, Darendeliler F, Baş F, Poyrazoğlu Ş, Tamçelik N, Tüysüz B, Mäkitie O. Two novel mutations in XYLT2 cause spondyloocular syndrome. Am J Med Genet A 2017; 173:3195-3200. [PMID: 28884924 DOI: 10.1002/ajmg.a.38470] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2017] [Revised: 08/12/2017] [Accepted: 08/12/2017] [Indexed: 01/24/2023]
Abstract
We report on two new patients with spondyloocular syndrome. Both patients harbor novel homozygous mutations in the XYLT2 gene. The patients present severe generalized osteoporosis, multiple fractures, short stature, cataract, and mild hearing impairment. XYLT2 mutations have been identified in spondyloocular syndrome, however only five mutations have been reported previously. These two patients with novel mutations extend the phenotypic and genotypic spectrum of spondyloocular syndrome.
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Affiliation(s)
- Fulya Taylan
- Department of Molecular Medicine and Surgery, Center for Molecular Medicine, Karolinska Institute, Stockholm, Sweden
| | - Zehra Yavaş Abalı
- Department of Pediatric Endocrinology, Istanbul Faculty of Medicine, Istanbul University, Istanbul, Turkey
| | - Nina Jäntti
- Department of Molecular Medicine and Surgery, Center for Molecular Medicine, Karolinska Institute, Stockholm, Sweden
| | - Nilay Güneş
- Department of Pediatric Genetics, Cerrahpasa Medicine School, Istanbul University, Istanbul, Turkey
| | - Feyza Darendeliler
- Department of Pediatric Endocrinology, Istanbul Faculty of Medicine, Istanbul University, Istanbul, Turkey
| | - Firdevs Baş
- Department of Pediatric Endocrinology, Istanbul Faculty of Medicine, Istanbul University, Istanbul, Turkey
| | - Şükran Poyrazoğlu
- Department of Pediatric Endocrinology, Istanbul Faculty of Medicine, Istanbul University, Istanbul, Turkey
| | - Nevbahar Tamçelik
- Department of Ophthalmology, Cerrahpasa Medicine School, Istanbul University, Istanbul, Turkey
| | - Beyhan Tüysüz
- Department of Pediatric Genetics, Cerrahpasa Medicine School, Istanbul University, Istanbul, Turkey
| | - Outi Mäkitie
- Department of Molecular Medicine and Surgery, Center for Molecular Medicine, Karolinska Institute, Stockholm, Sweden
- Department of Clinical Genetics, Karolinska University Hospital, Stockholm, Sweden
- Folkhälsan Institute of Genetics, Helsinki, Finland
- Children's Hospital, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
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Poyrazoğlu Ş, Bundak R, Baş F, Yeğen G, Şanlı Y, Darendeliler F. Clinicopathological Characteristics of Papillary Thyroid Cancer in Children with Emphasis on Pubertal Status and Association with BRAF V600E Mutation. J Clin Res Pediatr Endocrinol 2017; 9:185-193. [PMID: 28077340 PMCID: PMC5596798 DOI: 10.4274/jcrpe.3873] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/01/2023] Open
Abstract
OBJECTIVE Papillary thyroid cancer (PTC) may behave differently in prepubertal children as compared to pubertal children and adults. BRAF gene activating mutations may associate with PTC by creating aberrant activation. We aimed to evaluate the clinicopathological characteristics of PTC patients with emphasis on the pubertal status and also to investigate the association of BRAFV600E mutation with disease characteristics. METHODS The medical records of 75 patients with PTC were reviewed retrospectively. BRAFV600E mutation status was available only in the medical records of 56 patients. RESULTS Mean age at diagnosis was 12.4±3.8 years. There was no difference in sex, initial signs, tumor histopathology, and pathological evidence of tumor aggressiveness between prepubertal and pubertal children. Although not statistically significant, lateral neck nodal metastasis and lung metastasis at diagnosis were more prevalent in prepubertal children. After excluding patients with microcarcinoma, prepubertal children were found to require lateral neck dissection and further doses of radioactive iodine more frequently than pubertal patients. Recurrence was also more frequent in prepubertal children (p=0.016). Frequency of BRAFV600E mutation was similar in prepubertal and pubertal patients. BRAFV600E mutation was found in 14/56 (25%) patients and was high in the classic variant PTC (p=0.004). Multicentricity was high in BRAFV600E mutation (p=0.01). There was no relation between BRAFV600E mutation and lymph node and pulmonary metastasis at diagnosis, or between BRAFV600E mutation and pathological evidence of tumor aggressiveness. CONCLUSION PTC is more disseminated in prepubertal children. BRAFV600E mutation does not correlate with a more extensive or aggressive disease. BRAFV600E mutation is not the cause of the differences in the biological behavior of PTC in prepubertal and pubertal children.
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Affiliation(s)
- Şükran Poyrazoğlu
- İstanbul University Istanbul Faculty of Medicine, Department of Pediatric Endocrinology, İstanbul, Turkey
,* Address for Correspondence: İstanbul University Istanbul Faculty of Medicine, Department of Pediatric Endocrinology, İstanbul, Turkey Phone: +90 212 414 20 00 E-mail:
| | - Rüveyde Bundak
- İstanbul University Istanbul Faculty of Medicine, Department of Pediatric Endocrinology, İstanbul, Turkey
| | - Firdevs Baş
- İstanbul University Istanbul Faculty of Medicine, Department of Pediatric Endocrinology, İstanbul, Turkey
| | - Gülçin Yeğen
- İstanbul University İstanbul Faculty of Medicine, Department of Pathology, İstanbul, Turkey
| | - Yasemin Şanlı
- İstanbul University İstanbul Faculty of Medicine, Department of Nuclear Medicine, İstanbul, Turkey
| | - Feyza Darendeliler
- İstanbul University Istanbul Faculty of Medicine, Department of Pediatric Endocrinology, İstanbul, Turkey
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Savaş-Erdeve Ş, Çetinkaya S, Abalı ZY, Poyrazoğlu Ş, Baş F, Berberoğlu M, Sıklar Z, Korkmaz Ö, Buluş D, Akbaş ED, Güran T, Böber E, Akın O, Yılmaz GC, Aycan Z. Clinical, biochemical and genetic features with nonclassical 21-hydroxylase deficiency and final height. J Pediatr Endocrinol Metab 2017; 30:759-766. [PMID: 28672743 DOI: 10.1515/jpem-2017-0088] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/01/2017] [Accepted: 06/02/2017] [Indexed: 12/15/2022]
Abstract
BACKGROUND The clinical, laboratory, genetic properties and final height of a large cohort of patients with nonclassical 21-hydroxylase deficiency (NC21OHD) in Turkey were analyzed. METHODS This multicenter, nationwide web-based study collected data. RESULTS The mean age was 9.79±4.35 years (229 girls, 29 boys). The most common symptoms were premature pubarche (54.6%) and hirsutism (28.6%). The peak cortisol was found below 18 μg/dL in three (15.45%) patients. A mutation was detected in the CYP21A2 gene of 182 (87.5%) patients. The most common mutation was V281L. Final height in female patients who were diagnosed and treated before attaining final height or near final height was found to be shorter than the final height in female patients who were diagnosed after attaining final height or near final height. CONCLUSIONS The final height of the patients who were treated during childhood was found to be shorter than the final height of patients during the adolescent period.
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Abstract
INTRODUCTION The most common cause of poor outcome following lumbar disc surgery is recurrent herniation. Recurrence has been noted in 5% to 15% of patients with surgically treated primary lumbar disc herniation. There have been many studies designed to determine the risk factors for recurrent lumbar disc herniation. In this study, we retrospectively analysed the influence of disc degeneration, endplate changes, surgical technique, and patient's clinical characteristics on recurrent lumbar disc herniation. METHODS Patients who underwent primary single-level L4-L5 lumbar discectomy and who were reoperated on for recurrent L4-L5 disc herniation were retrospectively reviewed. All these operations were performed between August 2004 and September 2009 at the Neurosurgery Department of Ataturk Education and Research Hospital in Ankara, Turkey. RESULTS During the study period, 126 patients were reviewed, with 101 patients underwent primary single-level L4-L5 lumbar discectomy and 25 patients were reoperated on for recurrent L4-L5 disc herniation. Preoperative higher intervertebral disc height (P<0.001) and higher body mass index (P=0.042) might be risk factors for recurrence. Modic endplate changes were statistically significantly greater in the recurrent group than in the non-recurrent group (P=0.032). CONCLUSION Our study suggests that patients who had recurrent lumbar disc herniation had preoperative higher disc height and higher body mass index. Modic endplate changes had a higher tendency for recurrence of lumbar disc herniation. Well-planned and well-conducted large-scale prospective cohort studies are needed to confirm this and enable convenient treatment modalities to prevent recurrent disc pathology.
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Affiliation(s)
- M E Yaman
- Department of Neurosurgery, Memorial Ankara Hospital, Ankara, Turkey
| | - A Kazancı
- Department of Neurosurgery, Ataturk Education and Research Hospital, Ankara, Turkey
| | - N D Yaman
- Ankara University School of Medicine, Ankara, Turkey
| | - F Baş
- Hacettepe University Graduate School of Health Sciences, Ankara, Turkey
| | - G Ayberk
- Department of Neurosurgery, Ataturk Education and Research Hospital, Ankara, Turkey
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Şıklar Z, Genens M, Poyrazoğlu Ş, Baş F, Darendeliler F, Bundak R, Aycan Z, Savaş Erdeve Ş, Çetinkaya S, Güven A, Abalı S, Atay Z, Turan S, Kara C, Can Yılmaz G, Akyürek N, Abacı A, Çelmeli G, Sarı E, Bolu S, Korkmaz HA, Şimşek E, Çatlı G, Büyükinan M, Çayır A, Evliyaoğlu O, İşgüven P, Özgen T, Hatipoğlu N, Elhan AH, Berberoğlu M. The Growth Characteristics of Patients with Noonan Syndrome: Results of Three Years of Growth Hormone Treatment: A Nationwide Multicenter Study. J Clin Res Pediatr Endocrinol 2016; 8:305-12. [PMID: 27125300 PMCID: PMC5096494 DOI: 10.4274/jcrpe.3013] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/01/2022] Open
Abstract
OBJECTIVE Noonan syndrome (NS) is a multisystem disorder, and short stature is its most striking manifestation. Optimal growth hormone (GH) treatment for NS is still controversial. In this study, using a nationwide registration system, we aimed to evaluate the growth characteristics and the clinical features of NS patients in Turkey and their growth response to GH treatment. METHODS Children and adolescents with a diagnosis of NS were included inthe study. Laboratory assessment including standard GH stimulation test results were evaluated. Height increment of patients with or without GH treatment were analyzed after three years of therapy. RESULTS A total of 124 NS patients from different centers were entered in the web-based system. Short stature and typical face appearance were the most frequently encountered diagnostic features of our patients. Of the 84 patients who were followed long-term, 47 hadreceived recombinant human GH (rhGH). In this group of 47 patients, height standard deviation score (HSDS) increased from -3.62±1.14 to -2.85±0.96 after three years of therapy, indicating significant differences from the patients who did not receive GH treatment. PTPN11 gene was analyzed in 61 patients, and 64% of these patients were found to have a mutation. HSDS at admission was similar in patients with or without PTPN11 gene mutation. CONCLUSION A diagnosis of NS should be kept in mind in all patients with short stature showing systemic clinical findings. GH therapy is effective for improvement of short stature especially in the first two years of treatment. Further studies are needed for optimisation of GH therapy and evaluation of final height data in NS patients.
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Affiliation(s)
- Zeynep Şıklar
- Ankara University Faculty of Medicine, Department of Pediatric Endocrinology, Ankara, Turkey, Phone: +90 312 595 66 35 E-mail:
| | - Mikayir Genens
- İstanbul University Istanbul Faculty of Medicine, Department of Pediatric Endocrinology, İstanbul, Turkey
| | - Şükran Poyrazoğlu
- İstanbul University Istanbul Faculty of Medicine, Department of Pediatric Endocrinology, İstanbul, Turkey
| | - Firdevs Baş
- İstanbul University Istanbul Faculty of Medicine, Department of Pediatric Endocrinology, İstanbul, Turkey
| | - Feyza Darendeliler
- İstanbul University Istanbul Faculty of Medicine, Department of Pediatric Endocrinology, İstanbul, Turkey
| | - Rüveyde Bundak
- İstanbul University Istanbul Faculty of Medicine, Department of Pediatric Endocrinology, İstanbul, Turkey
| | - Zehra Aycan
- Dr. Sami Ulus Child Health and Disease Training and Research Hospital, Clinic of Pediatric Endocrinology, Ankara, Turkey
| | - Şenay Savaş Erdeve
- Dr. Sami Ulus Child Health and Disease Training and Research Hospital, Clinic of Pediatric Endocrinology, Ankara, Turkey
| | - Semra Çetinkaya
- Dr. Sami Ulus Child Health and Disease Training and Research Hospital, Clinic of Pediatric Endocrinology, Ankara, Turkey
| | - Ayla Güven
- Göztepe Training and Research Hospital, Clinic of Pediatric Endocrinology, İstanbul, Turkey
| | - Saygın Abalı
- Marmara University Faculty of Medicine, Department of Pediatric Endocrinology, İstanbul, Turkey
| | - Zeynep Atay
- Marmara University Faculty of Medicine, Department of Pediatric Endocrinology, İstanbul, Turkey
| | - Serap Turan
- Marmara University Faculty of Medicine, Department of Pediatric Endocrinology, İstanbul, Turkey
| | - Cengiz Kara
- Ondokuz Mayıs University Faculty of Medicine, Department of Pediatric Endocrinology, Samsun, Turkey
| | - Gülay Can Yılmaz
- Ondokuz Mayıs University Faculty of Medicine, Department of Pediatric Endocrinology, Samsun, Turkey
| | - Nesibe Akyürek
- Konya Training and Research Hospital, Clinic of Pediatric Endocrinology, Konya, Turkey
| | - Ayhan Abacı
- Dokuz Eylül University Faculty of Medicine, Department of Pediatric Endocrinology, İzmir, Turkey
| | - Gamze Çelmeli
- Akdeniz University Faculty of Medicine, Department of Pediatric Endocrinology, Antalya, Turkey
| | - Erkan Sarı
- Gülhane Military Medical Academy, Department of Pediatric Endocrinology, Ankara, Turkey
| | - Semih Bolu
- Düzce University Faculty of Medicine, Department of Pediatric Endocrinology, Düzce, Turkey
| | - Hüseyin Anıl Korkmaz
- Dr. Behçet Uz Children Disease and Surgery Training and Research Hospital, Clinic of Pediatric Endocrinology, İzmir, Turkey
| | - Enver Şimşek
- Osmangazi University Faculty of Medicine, Department of Pediatric Endocrinology, Eskişehir, Turkey
| | - Gönül Çatlı
- Tepecik Training and Research Hospital, Clinic of Pediatric Endocrinology, İzmir, Turkey
| | - Muammer Büyükinan
- Konya Training and Research Hospital, Clinic of Pediatric Endocrinology, Konya, Turkey
| | - Atilla Çayır
- Erzurum Regional Training and Research Hospital, Clinic of Pediatric Endocrinology, Erzurum, Turkey
| | - Olcay Evliyaoğlu
- İstanbul University Cerrahpaşa Faculty of Medicine, Department of Pediatric Endocrinology, İstanbul, Turkey
| | - Pınar İşgüven
- Sakarya University Faculty of Medicine, Department of Pediatric Endocrinology, Sakarya, Turkey
| | - Tolga Özgen
- Bezmialem University Faculty of Medicine, Department of Pediatric Endocrinology, İstanbul, Turkey
| | - Nihal Hatipoğlu
- Erciyes University Faculty of Medicine, Department of Pediatric Endocrinology, Kayseri, Turkey
| | - Atilla Halil Elhan
- Ankara University Faculty of Medicine, Department of Biostatistics, Ankara, Turkey
| | - Merih Berberoğlu
- Ankara University Faculty of Medicine, Department of Pediatric Endocrinology, Ankara, Turkey
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Yetim A, Yetim Ç, Baş F, Erol OB, Çığ G, Uçar A, Darendeliler F. Anti-Müllerian Hormone and Inhibin-A, but not Inhibin-B or Insulin-Like Peptide-3, may be Used as Surrogates in the Diagnosis of Polycystic Ovary Syndrome in Adolescents: Preliminary Results. J Clin Res Pediatr Endocrinol 2016; 8:288-97. [PMID: 27125339 PMCID: PMC5096492 DOI: 10.4274/jcrpe.3253] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/11/2016] [Accepted: 04/28/2016] [Indexed: 01/31/2023] Open
Abstract
OBJECTIVE Polycystic ovary syndrome (PCOS) is a common endocrine problem in adolescents with an increasing prevalence of 30%. Pursuing new biomarkers with high specificity and sensitivity in the diagnosis of PCOS in adolescents is currently an active area of research. We aimed to investigate the diagnostic value of anti-Müllerian hormone (AMH), insulin-like peptide-3 (INSL3), inhibin-A (INH-A), and inhibin-B (INH-B) in adolescents with PCOS and also to determine the association, if any, between these hormones and clinical/laboratory findings related with hyperandrogenism. METHODS The study group comprised 53 adolescent girls aged between 14.5 and 20 years who were admitted to our outpatient clinic with symptoms of hirsutism and/or irregular menses and diagnosed as having PCOS in accordance with the Rotterdam criteria. Twenty-six healthy peers, eumenorrheic for at least two years and body mass index-matched, constituted the controls. Fasting blood samples for hormones [luteinizing hormone (LH), follicle-stimulating hormone (FSH), dehydroepiandrosterone-sulfate (DHEAS), androstenedione (D4-A), total/free testosterone (T/fT), sex hormone binding globulin (SHBG), AMH, INSL3, INH-A, INH-B] were drawn after an overnight fast. RESULTS In the PCOS group, 83% of the subjects were oligomenorrheic/amenorrheic and 87% had hirsutism. The LH, LH/FSH ratio, total T, fT, free androgen-index (FAI), DHEAS levels were significantly higher (p=0.005, p=0.042, p=0.047, p<0.001, p=0.007, p=0.014, respectively) and SHBG was significantly lower (p=0.004) in PCOS patients as compared to the controls. Although the INSL-3 and INH-B levels showed no difference between the groups (p>0.05), AMH and INH-A levels were found to be significantly higher in the PCOS group compared to the controls (p<0.001, p<0.001, respectively). In multiple linear regression analysis, WC SDS (p=0.028), logD4-A (p=0.033), logSHBG (p=0.031), and total ovarian volume (p=0.045) had significant effects on AMH levels, and LH (p=0.003) on INH-A levels. In receiver-operating characteristic analysis, the cut-off values for AMH and INH-A were 6.1 ng/mL (sensitivity 81.1%) and 12.8 pg/mL (sensitivity 86.8%), respectively, to diagnose PCOS. When AMH and INH-A were used in combination, the sensitivity (96.2%) increased. CONCLUSION INSL3 and INH-B were not found to have diagnostic value in adolescents with PCOS. On the other hand, it was shown that INH-A could be used as a new diagnostic biomarker in addition to AMH.
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Affiliation(s)
- Aylin Yetim
- İstanbul University İstanbul Faculty of Medicine, Department of Pediatrics, Division of Adolescent Medicine, İstanbul, Turkey, Phone: +90 505 369 00 35 E-mail:
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Aydın BK, Aycan Z, Sıklar Z, Berberoğlu M, Ocal G, Cetinkaya S, Baş VN, Kendirci HNP, Cetinkaya E, Darcan S, Gökşen D, Evliyaoğlu O, Sükür M, Baş F, Darendeliler F. Adherence to growth hormone therapy: results of a multicenter study. Endocr Pract 2016; 20:46-51. [PMID: 24013997 DOI: 10.4158/ep13194.or] [Citation(s) in RCA: 52] [Impact Index Per Article: 6.5] [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] [Indexed: 11/15/2022]
Abstract
OBJECTIVE To evaluate the adherence to growth hormone (GH) therapy and identify the influencing factors and outcomes in children. METHODS A total of 217 GH-naïve patients in 6 pediatric endocrinology clinics were enrolled in the study. Structured questionnaires were filled out and patients were evaluated at the initiation and 3rd, 6th, and 12th months of therapy. Patients were categorized into 4 adherence segments based on percentage of doses omitted at each evaluation period, classified as excellent if 0%, good if 5%, fair if 5 to 10%, and poor if > 10%. RESULTS There was a decrement in adherence to GH therapy during the study period (P = .006). Patients who showed excellent and good adherence to therapy had better growth velocity and growth velocity standard deviation scores (SDSs) (P = .014 and P = .015, respectively). A negative correlation between growth velocity SDS and number of missed injections was also observed (r = -.412; P = .007). A positive correlation between delta insulin-like growth factor-1 (IGF-1) SDS and growth velocity was demonstrated (r = .239; P = .042). IGF-1 levels were significantly higher in patients who showed excellent and good adherence to therapy (P = .01). Adherence was better in boys than in girls (P = .035), but adherence rates were not associated with age, cause of GH treatment, socioeconomic status, person who administered the injections, type of injection device, or GH product. CONCLUSION Poor adherence to GH therapy was common in our group of patients and was one of the factors underlying suboptimal growth during therapy. Before considering other problems that can affect growth, clinicians should confirm good adherence to therapy.
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Affiliation(s)
- Banu Küçükemre Aydın
- Department of Pediatrics, Pediatric Endocrinology Unit, Istanbul Faculty of Medicine, Istanbul University, Istanbul, Turkey
| | - Zehra Aycan
- Dr. Sami Ulus Obstetrics and Gynecology, Children's Health and Disease Training and Research Hospital, Pediatric Endocrinology Clinic Department of Pediatric Endocrinology, Ankara Children's Hematology and Oncology Training and Research Hospital, Ankara, Turkey
| | - Zeynep Sıklar
- Department of Pediatrics, Pediatric Endocrinology Unit, Faculty of Medicine, Ankara University, Ankara, Turkey
| | - Merih Berberoğlu
- Department of Pediatrics, Pediatric Endocrinology Unit, Faculty of Medicine, Ankara University, Ankara, Turkey
| | - Gönül Ocal
- Department of Pediatrics, Pediatric Endocrinology Unit, Faculty of Medicine, Ankara University, Ankara, Turkey
| | - Semra Cetinkaya
- Dr. Sami Ulus Obstetrics and Gynecology, Children's Health and Disease Training and Research Hospital, Pediatric Endocrinology Clinic
| | - Veysel Nijat Baş
- Dr. Sami Ulus Obstetrics and Gynecology, Children's Health and Disease Training and Research Hospital, Pediatric Endocrinology Clinic
| | - Havva Nur Peltek Kendirci
- Dr. Sami Ulus Obstetrics and Gynecology, Children's Health and Disease Training and Research Hospital, Pediatric Endocrinology Clinic
| | - Ergun Cetinkaya
- Department of Pediatric Endocrinology, Ankara Children's Hematology and Oncology Training and Research Hospital, Ankara, Turkey Endomer Pediatric Endocrinology Center, Ankara, Turkey
| | - Sükran Darcan
- Department of Pediatric Endocrinology and Metabolism, Faculty of Medicine, Ege University, Izmir, Turkey
| | - Damla Gökşen
- Department of Pediatric Endocrinology and Metabolism, Faculty of Medicine, Ege University, Izmir, Turkey
| | - Olcay Evliyaoğlu
- Department of Pediatrics, Pediatric Endocrinology Unit, Cerrahpaşa Faculty of Medicine, Istanbul University, Istanbul, Turkey Department of Pediatrics, Pediatric Endocrinology Unit, Kırıkkale University Faculty of Medicine, Kırıkkale, Turkey
| | - Mine Sükür
- Department of Pediatrics, Pediatric Endocrinology Unit, Istanbul Faculty of Medicine, Istanbul University, Istanbul, Turkey
| | - Firdevs Baş
- Department of Pediatrics, Pediatric Endocrinology Unit, Istanbul Faculty of Medicine, Istanbul University, Istanbul, Turkey
| | - Feyza Darendeliler
- Department of Pediatrics, Pediatric Endocrinology Unit, Istanbul Faculty of Medicine, Istanbul University, Istanbul, Turkey
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Abstract
BACKGROUND Adrenal insufficiency (AI) is a wellknown cause of potentially life-threatening disorders. Defects at each level of the hypothalamic-pituitary-adrenal axis can impair adrenal function, leading to varying degrees of glucocorticoid (GC) deficiency. Iatrogenic AI induced by exogenous GCs is the most common cause of AI. The criteria for the diagnosis and management of iatrogenic AI, neonatal AI, and critical illness-related corticosteroid insufficiency (CIRCI) are not clear. DATA SOURCES We reviewed the recent original publications and classical data from the literature, as well as the clinical, diagnostic and management strategies of pediatric AI. RESULTS Practical points in the diagnosis and management of AI with an emphasis on iatrogenic AI, neonatal AI, and CIRCI are provided. Given the lack of sensitive and practical biochemical tests for diagnosis of subtle AI, GC treatment has to be tailored to highly suggestive clinical symptoms and signs. Treatment of adrenal crisis is well standardized and patients almost invariably respond well to therapy. It is mainly the delay in treatment that is responsible for mortality in adrenal crisis. CONCLUSIONS Education of patients and health care professionals is mandatory for timely interventions for patients with adrenal crisis.
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Affiliation(s)
- Ahmet Uçar
- Growth-Development and Pediatric Endocrine Unit, Istanbul School of Medicine, Istanbul University, Istanbul, Turkey.
| | - Firdevs Baş
- Growth-Development and Pediatric Endocrine Unit, Istanbul School of Medicine, Istanbul University, Istanbul, Turkey
| | - Nurçin Saka
- Growth-Development and Pediatric Endocrine Unit, Istanbul School of Medicine, Istanbul University, Istanbul, Turkey
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Sari E, Bereket A, Yeşilkaya E, Baş F, Bundak R, Aydın BK, Darcan Ş, Dündar B, Büyükinan M, Kara C, Adal E, Akıncı A, Atabek ME, Demirel F, Çelik N, Özkan B, Özhan B, Orbak Z, Ersoy B, Doğan M, Ataş A, Turan S, Gökşen D, Tarım Ö, Yüksel B, Ercan O, Hatun Ş, Şimşek E, Ökten A, Abacı A, Döneray H, Özbek MN, Keskin M, Önal H, Akyürek N, Bulan K, Tepe D, Emeksiz HC, Demir K, Kızılay D, Topaloğlu AK, Eren E, Özen S, Demirbilek H, Abalı S, Akın L, Eklioğlu BS, Kaba S, Anık A, Baş S, Unuvar T, Sağlam H, Bolu S, Özgen T, Doğan D, Çakır ED, Şen Y, Andıran N, Çizmecioğlu F, Evliyaoğlu O, Karagüzel G, Pirgon Ö, Çatlı G, Can HD, Gürbüz F, Binay Ç, Baş VN, Fidancı K, Gül D, Polat A, Acıkel C, Cinaz P, Darendeliler F. Anthropometric findings from birth to adulthood and their relation with karyotpye distribution in Turkish girls with Turner syndrome. Am J Med Genet A 2016; 170A:942-8. [PMID: 26788866 DOI: 10.1002/ajmg.a.37498] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [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: 05/29/2015] [Accepted: 10/06/2015] [Indexed: 11/10/2022]
Abstract
To evaluate the anthropometric features of girls with Turner syndrome (TS) at birth and presentation and the effect of karyotype on these parameters. Data were collected from 842 patients with TS from 35 different centers, who were followed-up between 1984 and 2014 and whose diagnosis age ranged from birth to 18 years. Of the 842 patients, 122 girls who received growth hormone, estrogen or oxandrolone were excluded, and 720 girls were included in the study. In this cohort, the frequency of small for gestational age (SGA) birth was 33%. The frequency of SGA birth was 4.2% (2/48) in preterm and 36% (174/483) in term neonates (P < 0.001). The mean birth length was 1.3 cm shorter and mean birth weight was 0.36 kg lower than that of the normal population. The mean age at diagnosis was 10.1 ± 4.4 years. Mean height, weight and body mass index standard deviation scores at presentation were -3.1 ± 1.7, -1.4 ± 1.5, and 0.4 ± 1.7, respectively. Patients with isochromosome Xq were significantly heavier than those with other karyotype groups (P = 0.007). Age at presentation was negatively correlated and mid-parental height was positively correlated with height at presentation. Mid-parental height and age at presentation were the only parameters that were associated with height of children with TS. The frequency of SGA birth was found higher in preterm than term neonates but the mechanism could not be clarified. We found no effect of karyotype on height of girls with TS, whereas weight was greater in 46,X,i(Xq) and 45,X/46,X,i(Xq) karyotype groups.
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Affiliation(s)
- Erkan Sari
- Department of Pediatric Endocrinology, Gulhane Military Medicine Academy, Turkey
| | - Abdullah Bereket
- Department of Pediatric Endocrinology, Marmara University Faculty of Medicine, Turkey
| | - Ediz Yeşilkaya
- Department of Pediatric Endocrinology, Gulhane Military Medicine Academy, Turkey
| | - Firdevs Baş
- Department of Pediatric Endocrinology, Istanbul University Istanbul Faculty of Medicine, Turkey
| | - Rüveyde Bundak
- Department of Pediatric Endocrinology, Istanbul University Istanbul Faculty of Medicine, Turkey
| | - Banu Küçükemre Aydın
- Department of Pediatric Endocrinology, Istanbul University Istanbul Faculty of Medicine, Turkey
| | - Şükran Darcan
- Department of Pediatric Endocrinology, Ege University Faculty of Medicine, Turkey
| | - Bumin Dündar
- Department of Pediatric Endocrinology, İzmir Katip Çelebi University Faculty of Medicine, Turkey
| | - Muammer Büyükinan
- Department of Pediatric Endocrinology, Konya Training and Research Hospital, Turkey
| | - Cengiz Kara
- Department of Pediatric Endocrinology, 19 Mayıs University Faculty of Medicine, Turkey
| | - Erdal Adal
- Department of Pediatric Endocrinology, Kanuni Sultan Süleyman University Faculty of Medicine, Turkey
| | - Ayşehan Akıncı
- Department of Pediatric Endocrinology, İnönü University Faculty of Medicine, Turkey
| | - Mehmet Emre Atabek
- Department of Pediatric Endocrinology, Necmettin Erbakan University Faculty of Medicine, Turkey
| | - Fatma Demirel
- Department of Pediatric Endocrinology, Yıldırım Beyazıt University, Turkey
| | - Nurullah Çelik
- Department of Pediatric Endocrinology, Gazi University Faculty of Medicine, Turkey
| | - Behzat Özkan
- Department of Pediatric Endocrinology, Dr. Behçet Uz Children Hospital, Turkey
| | - Bayram Özhan
- Department of Pediatric Endocrinology, Pamukkale University Faculty of Medicine, Turkey
| | - Zerrin Orbak
- Department of Pediatric Endocrinology, Atatürk University Faculty of Medicine, Turkey
| | - Betül Ersoy
- Department of Pediatric Endocrinology, Celal Bayar University Faculty of Medicine, Turkey
| | - Murat Doğan
- Department of Pediatric Endocrinology, Yüzüncü Yıl University Faculty of Medicine, Turkey
| | - Ali Ataş
- Department of Pediatric Endocrinology, Harran University Faculty of Medicine, Turkey
| | - Serap Turan
- Department of Pediatric Endocrinology, Marmara University Faculty of Medicine, Turkey
| | - Damla Gökşen
- Department of Pediatric Endocrinology, Ege University Faculty of Medicine, Turkey
| | - Ömer Tarım
- Department of Pediatric Endocrinology, Uludağ University Faculty of Medicine, Turkey
| | - Bilgin Yüksel
- Department of Pediatric Endocrinology, Çukurova University Faculty of Medicine, Turkey
| | - Oya Ercan
- Department of Pediatric Endocrinology, Istanbul University Cerrahpaşa Faculty of Medicine, Turkey
| | - Şükrü Hatun
- Department of Pediatric Endocrinology, Kocaeli University Faculty of Medicine, Turkey
| | - Enver Şimşek
- Department of Pediatric Endocrinology, Osmangazi University Faculty of Medicine, Turkey
| | - Ayşenur Ökten
- Department of Pediatric Endocrinology, Karadeniz Technical University Faculty of Medicine, Turkey
| | - Ayhan Abacı
- Department of Pediatric Endocrinology, 9 Eylül University Faculty of Medicine, Turkey
| | - Hakan Döneray
- Department of Pediatric Endocrinology, Atatürk University Faculty of Medicine, Turkey
| | - Mehmet Nuri Özbek
- Department of Pediatric Endocrinology, Diyarbakır Children's State Hospital, Turkey
| | - Mehmet Keskin
- Department of Pediatric Endocrinology, Gaziantep University Faculty of Medicine, Turkey
| | - Hasan Önal
- Department of Pediatric Endocrinology, Kanuni Sultan Süleyman University Faculty of Medicine, Turkey
| | - Nesibe Akyürek
- Department of Pediatric Endocrinology, Necmettin Erbakan University Faculty of Medicine, Turkey
| | - Kezban Bulan
- Department of Pediatric Endocrinology, Yüzüncü Yıl University Faculty of Medicine, Turkey
| | - Derya Tepe
- Department of Pediatric Endocrinology, Yıldırım Beyazıt University, Turkey
| | - Hamdi Cihan Emeksiz
- Department of Pediatric Endocrinology, Gazi University Faculty of Medicine, Turkey
| | - Korcan Demir
- Department of Pediatric Endocrinology, Dr. Behçet Uz Children Hospital, Turkey
| | - Deniz Kızılay
- Department of Pediatric Endocrinology, Celal Bayar University Faculty of Medicine, Turkey
| | - Ali Kemal Topaloğlu
- Department of Pediatric Endocrinology, Çukurova University Faculty of Medicine, Turkey
| | - Erdal Eren
- Department of Pediatric Endocrinology, Uludağ University Faculty of Medicine, Turkey
| | - Samim Özen
- Department of Pediatric Endocrinology, Ege University Faculty of Medicine, Turkey
| | - Hüseyin Demirbilek
- Department of Pediatric Endocrinology, Diyarbakır Children's State Hospital, Turkey
| | - Saygın Abalı
- Department of Pediatric Endocrinology, Marmara University Faculty of Medicine, Turkey
| | - Leyla Akın
- Department of Pediatric Endocrinology, Kanuni Sultan Süleyman University Faculty of Medicine, Turkey
| | - Beray Selver Eklioğlu
- Department of Pediatric Endocrinology, Necmettin Erbakan University Faculty of Medicine, Turkey
| | - Sultan Kaba
- Department of Pediatric Endocrinology, Yüzüncü Yıl University Faculty of Medicine, Turkey
| | - Ahmet Anık
- Department of Pediatric Endocrinology, 9 Eylül University Faculty of Medicine, Turkey
| | - Serpil Baş
- Department of Pediatric Endocrinology, Marmara University Faculty of Medicine, Turkey
| | - Tolga Unuvar
- Department of Pediatric Endocrinology, Kanuni Sultan Süleyman University Faculty of Medicine, Turkey
| | - Halil Sağlam
- Department of Pediatric Endocrinology, Uludağ University Faculty of Medicine, Turkey
| | - Semih Bolu
- Department of Pediatric Endocrinology, Düzce University Faculty of Medicine, Turkey
| | - Tolga Özgen
- Department of Pediatric Endocrinology, Kanuni Sultan Süleyman University Faculty of Medicine, Turkey
| | - Durmuş Doğan
- Department of Pediatric Endocrinology, Uludağ University Faculty of Medicine, Turkey
| | - Esra Deniz Çakır
- Department of Pediatric Endocrinology, Uludağ University Faculty of Medicine, Turkey
| | - Yaşar Şen
- Department of Pediatric Endocrinology, Selçuk University Faculty of Medicine, Turkey
| | - Nesibe Andıran
- Department of Pediatric Endocrinology, Yıldırım Beyazıt University, Turkey.,Department of Pediatric Endocrinology, Keçiören Training and Research Hospital, Turkey
| | - Filiz Çizmecioğlu
- Department of Pediatric Endocrinology, Kocaeli University Faculty of Medicine, Turkey
| | - Olcay Evliyaoğlu
- Department of Pediatric Endocrinology, Istanbul University Cerrahpaşa Faculty of Medicine, Turkey
| | - Gülay Karagüzel
- Department of Pediatric Endocrinology, Karadeniz Technical University Faculty of Medicine, Turkey
| | - Özgür Pirgon
- Department of Pediatric Endocrinology, Süleyman Demirel University Faculty of Medicine, Turkey
| | - Gönül Çatlı
- Department of Pediatric Endocrinology, 9 Eylül University Faculty of Medicine, Turkey
| | - Hatice Dilek Can
- Department of Pediatric Endocrinology, Uludağ University Faculty of Medicine, Turkey
| | - Fatih Gürbüz
- Department of Pediatric Endocrinology, Çukurova University Faculty of Medicine, Turkey
| | - Çiğdem Binay
- Department of Pediatric Endocrinology, Osmangazi University Faculty of Medicine, Turkey
| | - Veysel Nijat Baş
- Department of Pediatric Endocrinology, Eskisehir Public Hospital, Turkey
| | - Kürşat Fidancı
- Department of Pediatric Endocrinology, Gulhane Military Medicine Academy, Turkey
| | - Davut Gül
- Department of Pediatric Endocrinology, Gulhane Military Medicine Academy, Turkey
| | - Adem Polat
- Department of Pediatric Endocrinology, Gulhane Military Medicine Academy, Turkey
| | - Cengizhan Acıkel
- Department of Pediatric Endocrinology, Gulhane Military Medicine Academy, Turkey
| | - Peyami Cinaz
- Department of Pediatric Endocrinology, Gazi University Faculty of Medicine, Turkey
| | - Feyza Darendeliler
- Department of Pediatric Endocrinology, Istanbul University Istanbul Faculty of Medicine, Turkey
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Neyzi O, Bundak R, Gökçay G, Günöz H, Furman A, Darendeliler F, Baş F. Reference Values for Weight, Height, Head Circumference, and Body Mass Index in Turkish Children. J Clin Res Pediatr Endocrinol 2015; 7:280-93. [PMID: 26777039 PMCID: PMC4805217 DOI: 10.4274/jcrpe.2183] [Citation(s) in RCA: 259] [Impact Index Per Article: 28.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/01/2022] Open
Abstract
OBJECTIVE This study aimed to integrate the existing updated reference standards for the growth of Turkish infants and children and to compare these values with World Health Organization (WHO) reference data, data from some European countries, and also with previous local data. Weight, height, and head circumference measurements were obtained on 2,391 boys and 2,102 girls who were regular attenders of a well child clinic and on 1,100 boys and 1,020 girls attending schools in relatively well-off districts in İstanbul. Mean number of measurements per child was 8.2±3.6 in the age group 0-5 years and 5.5±3.3 in the age group 6-18 years. All children were from well-to-do families and all were healthy. All measurements with the exception of measurements at birth, which were based on reported values, were done by trained personnel. METHODS The LMS method was used in the analyses and in the construction of the percentile charts. There is an increase in weight for age and body mass index values for age starting in prepubertal ages, indicating an increasing trend for obesity. RESULTS Compared to WHO reference data, weight and height values in Turkish children were slightly higher in infants and in children younger than 5 years, while they showed similarity to those reported for children from Norway and Belgium. Head circumference values, which were slightly higher than the WHO references in the first 5 years, were comparable to the data on Belgian and Norwegian children in the first 9 years of life. At older ages, Turkish children showed higher values for head circumference. CONCLUSION The relatively larger head circumference values were interpreted to reflect a genetic characteristic.
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Affiliation(s)
- Olcay Neyzi
- İstanbul University İstanbul Faculty of Medicine, Department of Pediatric Endocrinology, İstanbul, Turkey Phone: +90 533 556 49 67 E-mail:
| | - Rüveyde Bundak
- İstanbul University Istanbul Faculty of Medicine, Department of Pediatric Endocrinology, İstanbul, Turkey
| | - Gülbin Gökçay
- İstanbul University Istanbul Faculty of Medicine, Department of Pediatric Endocrinology, İstanbul, Turkey
| | - Hülya Günöz
- İstanbul University Istanbul Faculty of Medicine, Department of Pediatric Endocrinology, İstanbul, Turkey
| | - Andrzej Furman
- Boğaziçi University, Institute of Environmental Sciences, İstanbul, Turkey
| | - Feyza Darendeliler
- İstanbul University Istanbul Faculty of Medicine, Department of Pediatric Endocrinology, İstanbul, Turkey
| | - Firdevs Baş
- İstanbul University Istanbul Faculty of Medicine, Department of Pediatric Endocrinology, İstanbul, Turkey
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48
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Darendeliler F, Yeşilkaya E, Bereket A, Baş F, Bundak R, Sarı E, Küçükemre Aydın B, Darcan Ş, Dündar B, Büyükinan M, Kara C, Mazıcıoğlu MM, Adal E, Akıncı A, Atabek ME, Demirel F, Çelik N, Özkan B, Özhan B, Orbak Z, Ersoy B, Doğan M, Ataş A, Turan S, Gökşen D, Tarım Ö, Yüksel B, Ercan O, Hatun Ş, Şimşek E, Ökten A, Abacı A, Döneray H, Özbek MN, Keskin M, Önal H, Akyürek N, Bulan K, Tepe D, Emeksiz HC, Demir K, Kızılay D, Topaloğlu AK, Eren E, Özen S, Demirbilek H, Abalı S, Akın L, Eklioğlu BS, Kaba S, Anık A, Baş S, Ünüvar T, Sağlam H, Bolu S, Özgen T, Doğan D, Çakır ED, Şen Y, Andıran N, Çizmecioğlu F, Evliyaoğlu O, Karagüzel G, Pirgon Ö, Çatlı G, Can HD, Gürbüz F, Binay Ç, Baş VN, Sağlam C, Gül D, Polat A, Açıkel C, Cinaz P. Growth curves for Turkish Girls with Turner Syndrome: Results of the Turkish Turner Syndrome Study Group. J Clin Res Pediatr Endocrinol 2015; 7:183-91. [PMID: 26831551 PMCID: PMC4677552 DOI: 10.4274/jcrpe.2023] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/01/2022] Open
Abstract
OBJECTIVE Children with Turner syndrome (TS) have a specific growth pattern that is quite different from that of healthy children. Many countries have population-specific growth charts for TS. Considering national and ethnic differences, we undertook this multicenter collaborative study to construct growth charts and reference values for height, weight and body mass index (BMI) from 3 years of age to adulthood for spontaneous growth of Turkish girls with TS. METHODS Cross-sectional height and weight data of 842 patients with TS, younger than 18 years of age and before starting any therapy, were evaluated. RESULTS The data were processed to calculate the 3rd, 10th, 25th, 50th, 75th, 90th and 97th percentile values for defined ages and to construct growth curves for height-for-age, weight-for-age and BMI-for-age of girls with TS. The growth pattern of TS girls in this series resembled the growth pattern of TS girls in other reports, but there were differences in height between our series and the others. CONCLUSION This study provides disease-specific growth charts for Turkish girls with TS. These disease-specific national growth charts will serve to improve the evaluation of growth and its management with growth-promoting therapeutic agents in TS patients.
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Affiliation(s)
- Feyza Darendeliler
- İstanbul University Istanbul Faculty of Medicine, Department of Pediatric Endocrinology, İstanbul, Turkey
| | - Ediz Yeşilkaya
- Gülhane Military Medicine Academy, Department of Pediatric Endocrinology, Ankara, Turkey Phone: +90 312 304 18 98 E-mail:
| | - Abdullah Bereket
- Marmara University Faculty of Medicine, Department of Pediatric Endocrinology, İstanbul, Turkey
| | - Firdevs Baş
- İstanbul University Istanbul Faculty of Medicine, Department of Pediatric Endocrinology, İstanbul, Turkey
| | - Rüveyde Bundak
- İstanbul University Istanbul Faculty of Medicine, Department of Pediatric Endocrinology, İstanbul, Turkey
| | - Erkan Sarı
- Gülhane Military Medicine Academy, Department of Pediatric Endocrinology, Ankara, Turkey
| | - Banu Küçükemre Aydın
- İstanbul University Istanbul Faculty of Medicine, Department of Pediatric Endocrinology, İstanbul, Turkey
| | - Şükran Darcan
- Ege University Faculty of Medicine, Department of Pediatric Endocrinology, İzmir, Turkey
| | - Bumin Dündar
- Katip Çelebi University Faculty of Medicine, Department of Pediatric Endocrinology, İzmir, Turkey
| | - Muammer Büyükinan
- Konya Training and Research Hospital, Clinic of Pediatric Endocrinology, Konya, Turkey
| | - Cengiz Kara
- On Dokuz Mayıs University Faculty of Medicine, Department of Pediatric Endocrinology, Samsun, Turkey
| | - Mümtaz M. Mazıcıoğlu
- Erciyes University Faculty of Medicine, Department of Pediatric Endocrinology, Kayseri, Turkey
| | - Erdal Adal
- Kanuni Sultan Süleyman Training and Research Hospital, Clinic of Pediatric Endocrinology, İstanbul, Turkey
| | - Ayşehan Akıncı
- Inönü University Faculty of Medicine, Department of Pediatric Endocrinology, Malatya, Turkey
| | - Mehmet Emre Atabek
- Necmettin Erbakan University Faculty of Medicine, Department of Pediatric Endocrinology, Konya, Turkey
| | - Fatma Demirel
- Yıldırım Beyazıt University Faculty of Medicine, Department of Pediatric Endocrinology, Ankara, Turkey
| | - Nurullah Çelik
- Gazi University Faculty of Medicine, Department of Pediatric Endocrinology, Ankara, Turkey
| | - Behzat Özkan
- Dr. Behçet Uz Children Hospital, Clinic of Pediatric Endocrinology, İzmir, Turkey
| | - Bayram Özhan
- Pamukkale University Faculty of Medicine, Department of Pediatric Endocrinology, Denizli, Turkey
| | - Zerrin Orbak
- Atatürk University Faculty of Medicine, Department of Pediatric Endocrinology, Erzurum, Turkey
| | - Betül Ersoy
- Celal Bayar University Faculty of Medicine, Department of Pediatric Endocrinology, Manisa, Turkey
| | - Murat Doğan
- Yüzüncü Yıl University Faculty of Medicine, Department of Pediatric Endocrinology, Van, Turkey
| | - Ali Ataş
- Harran University Faculty of Medicine, Department of Pediatric Endocrinology, Şanlıurfa, Turkey
| | - Serap Turan
- Marmara University Faculty of Medicine, Department of Pediatric Endocrinology, İstanbul, Turkey
| | - Damla Gökşen
- Ege University Faculty of Medicine, Department of Pediatric Endocrinology, İzmir, Turkey
| | - Ömer Tarım
- Uludağ University Faculty of Medicine, Department of Pediatric Endocrinology, Bursa, Turkey
| | - Bilgin Yüksel
- Çukurova University Faculty of Medicine, Department of Pediatric Endocrinology, Adana, Turkey
| | - Oya Ercan
- İstanbul University Cerrahpaşa Faculty of Medicine, Department of Pediatric Endocrinology, İstanbul, Turkey
| | - Şükrü Hatun
- Kocaeli University Faculty of Medicine, Department of Pediatric Endocrinology, Kocaeli, Turkey
| | - Enver Şimşek
- Osmangazi University Faculty of Medicine, Department of Pediatric Endocrinology, Eskişehir, Turkey
| | - Ayşenur Ökten
- Karadeniz Technical University Faculty of Medicine, Department of Pediatric Endocrinology, Trabzon, Turkey
| | - Ayhan Abacı
- Dokuz Eylül University Faculty of Medicine, Department of Pediatric Endocrinology, İzmir, Turkey
| | - Hakan Döneray
- Atatürk University Faculty of Medicine, Department of Pediatric Endocrinology, Erzurum, Turkey
| | - Mehmet Nuri Özbek
- Diyarbakır Training and Research Hospital, Clinic of Pediatric Endocrinology, Diyarbakır, Turkey
| | - Mehmet Keskin
- Gaziantep University Faculty of Medicine, Department of Pediatric Endocrinology, Gaziantep, Turkey
| | - Hasan Önal
- Kanuni Sultan Süleyman Training and Research Hospital, Clinic of Pediatric Endocrinology, İstanbul, Turkey
| | - Nesibe Akyürek
- Necmettin Erbakan University Faculty of Medicine, Department of Pediatric Endocrinology, Konya, Turkey
| | - Kezban Bulan
- Necmettin Erbakan University Faculty of Medicine, Department of Pediatric Endocrinology, Konya, Turkey
| | - Derya Tepe
- Yıldırım Beyazıt University Faculty of Medicine, Department of Pediatric Endocrinology, Ankara, Turkey
| | - Hamdi Cihan Emeksiz
- Gazi University Faculty of Medicine, Department of Pediatric Endocrinology, Ankara, Turkey
| | - Korcan Demir
- Dr. Behçet Uz Children Hospital, Clinic of Pediatric Endocrinology, İzmir, Turkey
| | - Deniz Kızılay
- Celal Bayar University Faculty of Medicine, Department of Pediatric Endocrinology, Manisa, Turkey
| | - Ali Kemal Topaloğlu
- Çukurova University Faculty of Medicine, Department of Pediatric Endocrinology, Adana, Turkey
| | - Erdal Eren
- Uludağ University Faculty of Medicine, Department of Pediatric Endocrinology, Bursa, Turkey
| | - Samim Özen
- Ege University Faculty of Medicine, Department of Pediatric Endocrinology, İzmir, Turkey
| | - Hüseyin Demirbilek
- Diyarbakır Training and Research Hospital, Clinic of Pediatric Endocrinology, Diyarbakır, Turkey
| | - Saygın Abalı
- Marmara University Faculty of Medicine, Department of Pediatric Endocrinology, İstanbul, Turkey
| | - Leyla Akın
- Kanuni Sultan Süleyman Training and Research Hospital, Clinic of Pediatric Endocrinology, İstanbul, Turkey
| | - Beray Selver Eklioğlu
- Necmettin Erbakan University Faculty of Medicine, Department of Pediatric Endocrinology, Konya, Turkey
| | - Sultan Kaba
- Yüzüncü Yıl University Faculty of Medicine, Department of Pediatric Endocrinology, Van, Turkey
| | - Ahmet Anık
- Dokuz Eylül University Faculty of Medicine, Department of Pediatric Endocrinology, İzmir, Turkey
| | - Serpil Baş
- Marmara University Faculty of Medicine, Department of Pediatric Endocrinology, İstanbul, Turkey
| | - Tolga Ünüvar
- Kanuni Sultan Süleyman Training and Research Hospital, Clinic of Pediatric Endocrinology, İstanbul, Turkey
| | - Halil Sağlam
- Uludağ University Faculty of Medicine, Department of Pediatric Endocrinology, Bursa, Turkey
| | - Semih Bolu
- Düzce University Faculty of Medicine, Department of Pediatric Endocrinology, Düzce, Turkey
| | - Tolga Özgen
- Kanuni Sultan Süleyman Training and Research Hospital, Clinic of Pediatric Endocrinology, İstanbul, Turkey
| | - Durmuş Doğan
- Uludağ University Faculty of Medicine, Department of Pediatric Endocrinology, Bursa, Turkey
| | - Esra Deniz Çakır
- Uludağ University Faculty of Medicine, Department of Pediatric Endocrinology, Bursa, Turkey
| | - Yaşar Şen
- Selçuk University Faculty of Medicine, Department of Pediatric Endocrinology, Konya, Turkey
| | - Nesibe Andıran
- Yıldırım Beyazıt University Faculty of Medicine, Department of Pediatric Endocrinology, Ankara, Turkey
,
Keçiören Training and Research Hospital, Clinic of Pediatric Endocrinology, Ankara, Turkey
| | - Filiz Çizmecioğlu
- Kocaeli University Faculty of Medicine, Department of Pediatric Endocrinology, Kocaeli, Turkey
| | - Olcay Evliyaoğlu
- İstanbul University Cerrahpaşa Faculty of Medicine, Department of Pediatric Endocrinology, İstanbul, Turkey
| | - Gülay Karagüzel
- Karadeniz Technical University Faculty of Medicine, Department of Pediatric Endocrinology, Trabzon, Turkey
| | - Özgür Pirgon
- Süleyman Demirel University Faculty of Medicine, Department of Pediatric Endocrinology, Isparta, Turkey
| | - Gönül Çatlı
- Dokuz Eylül University Faculty of Medicine, Department of Pediatric Endocrinology, İzmir, Turkey
| | - Hatice Dilek Can
- Uludağ University Faculty of Medicine, Department of Pediatric Endocrinology, Bursa, Turkey
| | - Fatih Gürbüz
- Çukurova University Faculty of Medicine, Department of Pediatric Endocrinology, Adana, Turkey
| | - Çiğdem Binay
- Osmangazi University Faculty of Medicine, Department of Pediatric Endocrinology, Eskişehir, Turkey
| | - Veysel Nijat Baş
- Kayseri Training and Research Hospital, Clinic of Pediatric Endocrinology, Kayseri, Turkey
| | - Celal Sağlam
- Gülhane Military Medicine Academy, Department of Pediatric Endocrinology, Ankara, Turkey
| | - Davut Gül
- Gülhane Military Medicine Academy, Department of Pediatric Endocrinology, Ankara, Turkey
| | - Adem Polat
- Gülhane Military Medicine Academy, Department of Pediatric Endocrinology, Ankara, Turkey
| | - Cengizhan Açıkel
- Gülhane Military Medicine Academy, Department of Pediatric Endocrinology, Ankara, Turkey
| | - Peyami Cinaz
- Gazi University Faculty of Medicine, Department of Pediatric Endocrinology, Ankara, Turkey
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49
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Baş F, Uyguner ZO, Darendeliler F, Aycan Z, Çetinkaya E, Berberoğlu M, Şiklar Z, Öcal G, Darcan Ş, Gökşen D, Topaloğlu AK, Yüksel B, Özbek MN, Ercan O, Evliyaoğlu O, Çetinkaya S, Şen Y, Atabek E, Toksoy G, Aydin BK, Bundak R. Molecular analysis of PROP1, POU1F1, LHX3, and HESX1 in Turkish patients with combined pituitary hormone deficiency: a multicenter study. Endocrine 2015; 49:479-91. [PMID: 25500790 DOI: 10.1007/s12020-014-0498-1] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/28/2014] [Accepted: 11/28/2014] [Indexed: 10/24/2022]
Abstract
To investigate the specific mutations in PROP1, POU1F1, LHX3, and HESX1 genes in patients with combined pituitary hormone deficiency (CPHD) in Turkey. Seventy-six patients with CPHD were included in this study. Based on clinical, hormonal, and neuro-radiological data, relevant transcription factor genes were evaluated by Sanger sequencing and multiplex ligation-dependent probe amplification. Total frequency of mutations was 30.9 % in patients with CPHD. Frequency was significantly higher in familial patients (p = 0.001). Three different types of mutations in PROP1 gene (complete gene deletion, c.301-302delAG, a novel mutation; IVS1+2T>G) were found in 12 unrelated patients (21.8 %). Mutations in PROP1 gene were markedly higher in familial than in sporadic cases (58.8 vs. 5.3 %, p < 0.001). Homozygous complete gene deletion was the most common mutation in PROP1 gene (8/12) and was identified in six familial patients. Four different homozygous mutations [p.Q4X, novel mutations; exons 1-2 deletion, p.V153F, p.I244S] were detected in POU1F1 gene. Central precocious puberty was firstly observed in a sporadic-male patient with homozygous POU1F1 (p.I244S) mutation. A homozygous mutation in HESX1 gene (p.R160H) was detected in one patient. This study is the first to investigate specific mutations in CPHD patients in Turkey. Complete deletion in PROP1 gene was the most common mutation encountered in patients with CPHD. We believe that the results of this study will contribute to the establishment of genetic screening strategies in Turkey, as well as to the studies on phenotype-genotype correlations and early diagnosis of CPHD patients.
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Affiliation(s)
- Firdevs Baş
- Pediatric Endocrinology, Istanbul Faculy of Medicine, Istanbul University, Çapa, Istanbul, 34093, Turkey,
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Uçar A, Öz F, Baş F, Oflaz H, Nişli K, Tuğrul M, Yetim A, Darendeliler F, Saka N, Poyrazoğlu Ş, Bundak R. Increased arterial stiffness in young normotensive patients with Turner syndrome: associations with vascular biomarkers. Clin Endocrinol (Oxf) 2015; 82:719-27. [PMID: 25284268 DOI: 10.1111/cen.12626] [Citation(s) in RCA: 15] [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: 07/20/2014] [Revised: 09/10/2014] [Accepted: 09/29/2014] [Indexed: 12/12/2022]
Abstract
OBJECTIVES Factors contributing to arteriopathy in patients with Turner syndrome (TS) remain unclear. We assessed arterial stiffness in young, normotensive patients with TS and correlated arterial stiffness with vascular biomarkers, GH treatment and oestrogen exposure. Sixty-one patients with TS (mean age, 12·6 years; range 6·6-21·3 years) were matched for age and sex with 61 healthy peers. Associations between arterial stiffness and high-sensitivity C-reactive protein (hsCRP), B-type natriuretic peptide (BNP), atrial NP (ANP), plasma aldosterone/plasma renin activity (PRA), IGF1 and IGFBP3 were examined after adjusting for well-established confounders of vascular disease. RESULTS Carotid intima media thickness standard deviation score (SDS), arterial stiffness index SDS and incremental modulus of elasticity SDS were higher, and distensibility coefficient SDS was lower in patients with TS. The duration of GH treatment and oestrogen exposure was not associated with indices of arterial stiffness. TS patients had higher hsCRP, BNP and ANP. Plasma aldosterone/PRA, IGF1 and IGFBP3 were similar in patients and controls. Multivariable regression analyses (R(2) = 0·200-0·668, P < 0·01) showed that BNP was associated with all indices of arterial stiffness. We found that hsCRP was associated with distensibility coefficient SDS (β = -0·16, P < 0·01). TS was independently associated with increased arterial stiffness (β = 0·420-3·424, P < 0·001 for all, R(2) = 0·06-0·31). CONCLUSIONS Young, normotensive TS patients had increased arterial stiffness than that of healthy peers. BNP, and possibly hsCRP, was independently associated with arterial stiffness in TS. Further research will determine any causal inference of these relationships.
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Affiliation(s)
- Ahmet Uçar
- Paediatric Endocrine Unit, Istanbul Faculty of Medicine, Istanbul University, Istanbul, Turkey
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