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Ponmani C, Lyttle MD, Barrett M, Hulse T, Nijman RG, Roland D. What does SARS-CoV-2 tell us about the aetiology of environmental triggers for diabetes in children and young people? Acta Paediatr 2023; 112:2462-2464. [PMID: 37694855 DOI: 10.1111/apa.16971] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/25/2023] [Revised: 08/02/2023] [Accepted: 09/01/2023] [Indexed: 09/12/2023]
Affiliation(s)
- Caroline Ponmani
- Department of Paediatric Emergency Medicine, Barking Havering and Redbridge University Hospitals NHS Trust, Romford, UK
| | - Mark D Lyttle
- Emergency Department, Bristol Royal Hospital for Children, Bristol, UK
- Research in Emergency Care Avon Collaborative Hub (REACH), University of the West of England, Bristol, UK
| | - Michael Barrett
- Department of Paediatric Emergency Medicine, Children's Health Ireland, Dublin, Ireland
- Women's and Children's Health, School of Medicine, University College Dublin, Dublin, Ireland
| | - Tony Hulse
- Department of Paediatric Endocrinology, Evelina London Children's Hospital, Guys and St.Thomas' NHS Foundation Trust, London, UK
| | - Ruud G Nijman
- Division of Medicine, Department of Pediatric Emergency Medicine, St. Mary's Hospital-Imperial College NHS Healthcare Trust, London, UK
- Section of Pediatric Infectious Diseases, Department of Infectious Diseases, Faculty of Medicine, Imperial College London, UK Centre for Pediatrics and Child Health, London, UK
| | - Damian Roland
- SAPPHIRE Group, Health Sciences, Leicester University, Leicester, UK
- Paediatric Emergency Medicine Leicester Academic (PEMLA) Group, Children's Emergency Medicine, Leicester Royal Infirmary, Leicester, UK
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Ponmani C, Nijman RG, Roland D, Barrett M, Hulse T, Whittle V, Lyttle MD. Children presenting with diabetes and diabetic ketoacidosis to Emergency Departments during the COVID-19 pandemic in the UK and Ireland: an international retrospective observational study. Arch Dis Child 2023; 108:799-807. [PMID: 37197894 DOI: 10.1136/archdischild-2022-325280] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/26/2022] [Accepted: 05/02/2023] [Indexed: 05/19/2023]
Abstract
OBJECTIVES To describe the incidence of new onset paediatric diabetes mellitus, clinical characteristics and patterns of presentation to emergency departments (ED) during the COVID-19 pandemic, and to assess whether this increase was associated with SARS-CoV-2 infection. DESIGN Retrospective medical record review. SETTING Forty nine paediatric EDs across the UK and Ireland. PATIENTS All children aged 6 months to 16 years presenting to EDs with (1) new onset diabetes or (2) pre-existing diabetes with diabetic ketoacidosis (DKA), during the COVID-19 pandemic (1 March 2020-28 February 2021) and the preceding year (1 March 2019-28 February 2020). RESULTS There were increases in new onset diabetes (1015 to 1183, 17%), compared with background incidence of 3%-5% in the UK over the past 5 years. There were increases in children presenting with new onset diabetes in DKA (395 to 566, 43%), severe DKA (141 to 252, 79%) and admissions to intensive care (38 to 72, 89%). Increased severity was reflected in biochemical and physiological parameters and administration of fluid boluses. Time to presentation from symptom onset for children presenting with new onset diabetes and DKA were similar across both years; healthcare seeking delay did not appear to be the sole contributing factor to DKA during the pandemic. Patterns of presentation changed in the pandemic year and seasonal variation was lost. Children with pre-existing diabetes presented with fewer episodes of decompensation. CONCLUSIONS There were increases in new onset diabetes in children and a higher risk of DKA in the first COVID pandemic year.
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Affiliation(s)
- Caroline Ponmani
- Department of Paediatric Emergency Medicine, Barking Havering and Redbridge University Trust, London, UK
| | - Ruud G Nijman
- Department of Paediatric Emergency Medicine, Division of Medicine, St. Mary's hospital - Imperial College NHS Healthcare Trust, London, UK
- Faculty of Medicine, Department of Infectious Diseases, Section of Paediatric Infectious Diseases, Imperial College, London, UK
| | - Damian Roland
- Paediatric Emergency Medicine Leicester Academic (PEMLA) Group, Children's Emergency Department, University Hospitals of Leicester NHS Trust, Leicester, UK
- SAPPHIRE Group, Health Sciences, University of Leicester, UK
| | - Michael Barrett
- Department of Paediatric Emergency Medicine, Children's Health Ireland, Dublin, Ireland
- Women's and Children's Health, University College, Dublin, Ireland
| | - Tony Hulse
- Department of Paediatric Endocrinology, Evelina London Children's Hospital, Guys and St. Thomas' NHS Foundation Trust, London, UK
| | - Victoria Whittle
- Department of Paediatric and Child Health, South Tyneside and Sunderland NHS foundation trust, Sunderland Royal Hospital, UK
| | - Mark D Lyttle
- Emergency Department, Bristol Royal Hospital for Children, Bristol, UK
- Research in Emergency Care Avon Collaborative Hub (REACH), Bristol, UK
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Winzeler B, Tufton N, S. Lim E, Challis BG, Park S, Izatt L, Carroll PV, Velusamy A, Hulse T, Whitelaw BC, Martin E, Rodger F, Maranian M, Clark GR, A. Akker S, Maher ER, Casey RT. Investigating the role of somatic sequencing platforms for phaeochromocytoma and paraganglioma in a large UK cohort. Clin Endocrinol (Oxf) 2022; 97:448-459. [PMID: 34870338 PMCID: PMC9543043 DOI: 10.1111/cen.14639] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/04/2021] [Revised: 09/24/2021] [Accepted: 10/21/2021] [Indexed: 12/03/2022]
Abstract
OBJECTIVES Phaeochromocytomas and paragangliomas (PPGL) are rare neuroendocrine tumours with malignant potential and a hereditary basis in almost 40% of patients. Germline genetic testing has transformed the management of PPGL enabling stratification of surveillance approaches, earlier diagnosis and predictive testing of at-risk family members. Recent studies have identified somatic mutations in a further subset of patients, indicating that molecular drivers at either a germline or tumour level can be identified in up to 80% of PPGL cases. The aim of this study was to investigate the clinical utility of somatic sequencing in a large cohort of patients with PPGL in the United Kingdom. DESIGN AND PATIENTS Prospectively collected matched germline and tumour samples (development cohort) and retrospectively collected tumour samples (validation cohort) of patients with PPGL were investigated. MEASUREMENTS Clinical characteristics of patients were assessed and tumour and germline DNA was analysed using a next-generation sequencing strategy. A screen for variants within 'mutation hotspots' in 68 human cancer genes was performed. RESULTS Of 141 included patients, 45 (32%) had a germline mutation. In 37 (26%) patients one or more driver somatic variants were identified including 26 likely pathogenic or pathogenic variants and 19 variants of uncertain significance. Pathogenic somatic variants, observed in 25 (18%) patients, were most commonly identified in the VHL, NF1, HRAS and RET genes. Pathogenic somatic variants were almost exclusively identified in patients without a germline mutation (all but one), suggesting that somatic sequencing is likely to be most informative for those patients with negative germline genetic test results. CONCLUSIONS Somatic sequencing may further stratify surveillance approaches for patients without a germline genetic driver and may also inform targeted therapeutic strategies for patients with metastatic disease.
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Affiliation(s)
- Bettina Winzeler
- Department of Endocrinology, Diabetology and MetabolismUniversity Hospital BaselBaselSwitzerland
- Department of Clinical ResearchUniversity of BaselBaselSwitzerland
- Department of Medical Genetics, and Cancer Research, UK Cambridge Centre, University of CambridgeCambridge Biomedical CampusCambridgeUK
| | - Nicola Tufton
- Department of EndocrinologySt. Bartholomew's Hospital, Barts Health NHS TrustLondonUK
- Department of Endocrinology, William Harvey Research InstituteQueen Mary University of LondonLondon
| | - Eugenie S. Lim
- Department of EndocrinologySt. Bartholomew's Hospital, Barts Health NHS TrustLondonUK
- Department of Endocrinology, William Harvey Research InstituteQueen Mary University of LondonLondon
| | - Ben G. Challis
- Department of Endocrinology, Cambridge University HospitalNHS Foundation TrustCambridgeUK
| | - Soo‐Mi Park
- Department of Clinical Genetics, Cambridge University HospitalNHS Foundation TrustCambridgeUK
| | - Louise Izatt
- Department of Clinical GeneticsGuy's and St. Thomas' NHS Foundation TrustLondonUK
| | - Paul V. Carroll
- Department of EndocrinologyGuy's and St. Thomas' NHS Foundation TrustLondonUK
| | - Anand Velusamy
- Department of EndocrinologyGuy's and St. Thomas' NHS Foundation TrustLondonUK
| | - Tony Hulse
- Department of Paediatric EndocrinologyEvelina London Children's Hospital, Guy's and St. Thomas' NHS Foundation TrustLondonUK
| | | | - Ezequiel Martin
- Department of Medical Genetics, and Cancer Research, UK Cambridge Centre, University of CambridgeCambridge Biomedical CampusCambridgeUK
- Oncology Department, Cancer Molecular Diagnostics LaboratoryUniversity of CambridgeCambridgeUK
| | - Fay Rodger
- Department of Medical Genetics, and Cancer Research, UK Cambridge Centre, University of CambridgeCambridge Biomedical CampusCambridgeUK
| | - Melanie Maranian
- Department of Medical Genetics, and Cancer Research, UK Cambridge Centre, University of CambridgeCambridge Biomedical CampusCambridgeUK
| | - Graeme R. Clark
- Department of Medical Genetics, and Cancer Research, UK Cambridge Centre, University of CambridgeCambridge Biomedical CampusCambridgeUK
| | - Scott A. Akker
- Department of EndocrinologySt. Bartholomew's Hospital, Barts Health NHS TrustLondonUK
- Department of Endocrinology, William Harvey Research InstituteQueen Mary University of LondonLondon
| | - Eamonn R. Maher
- Department of Medical Genetics, and Cancer Research, UK Cambridge Centre, University of CambridgeCambridge Biomedical CampusCambridgeUK
| | - Ruth T. Casey
- Department of Medical Genetics, and Cancer Research, UK Cambridge Centre, University of CambridgeCambridge Biomedical CampusCambridgeUK
- Department of Endocrinology, Cambridge University HospitalNHS Foundation TrustCambridgeUK
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Ponmani C, Hulse T. Beware of the jolly toddler who has not read the right textbooks. J Paediatr Child Health 2022; 58:929. [PMID: 35499941 DOI: 10.1111/jpc.15972] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/09/2022] [Revised: 03/24/2022] [Accepted: 03/27/2022] [Indexed: 11/30/2022]
Affiliation(s)
- Caroline Ponmani
- Department of Paediatric Emergency Medicine, Barking, Havering and Redbridge NHS Foundation Trust, Romford, United Kingdom
| | - Tony Hulse
- Department of Endocrinology and Diabetes, Evelina London Children's Hospital, London, United Kingdom
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Shankar A, Kurzawinski T, Ross E, Stoneham S, Beale T, Proctor I, Hulse T, Simpson K, Gaze MN, Cattaneo E, Gevers E, Marshall L, Hubbard JG, Brain C. Treatment outcome with a selective RET tyrosine kinase inhibitor selpercatinib in children with multiple endocrine neoplasia type 2 and advanced medullary thyroid carcinoma. Eur J Cancer 2021; 158:38-46. [PMID: 34649088 DOI: 10.1016/j.ejca.2021.09.012] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2021] [Revised: 09/03/2021] [Accepted: 09/11/2021] [Indexed: 11/20/2022]
Abstract
BACKGROUND Medullary thyroid carcinoma (MTC) in the context of multiple endocrine neoplasia type 2 (MEN2) is caused by mutations in the RET proto-oncogene. Therefore, in children with MEN2 and advanced MTC, the RET tyrosine kinase (TK) pathway is a target for treatment with selpercatinib, a selective RET TK inhibitor. PATIENTS AND METHODS A retrospective review of the clinical, genetic, biochemical (calcitonin and carcinoembryonic antigen [CEA]) and imaging data of six medically untreated children with MEN2 and recurrent and or progressive MTC. The main parameters were safety and objective treatment response to selpercatinib. RESULTS Six children (three males and three females, aged 3-12 years), four with MEN2B and two MEN2A, are reported. All had initial total thyroidectomy and extensive neck dissections but subsequently developed recurrent and progressive disease. All experienced an improvement in clinical symptoms with a concomitant biochemical response evidenced by significant fall in serum calcitonin and CEA concentrations. The fall in serum calcitonin was evident within 2 weeks of the start of selpercatinib, and responses were ongoing at a median follow-up of 13 months (range, 11-22 months). Four children with measurable radiological disease had good volume reduction. The most common adverse effects were transient but reversible grade 1 or 2 increase in alanine aminotransferase, serum bilirubin and constipation. No child required a dose modification or had to discontinue selpercatinib because of a drug-related adverse event. CONCLUSION Selpercatinib has shown excellent therapeutic efficacy with minimal toxicity in children with MEN2 and progressive metastatic RET-mutated MTC.
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Affiliation(s)
- Ananth Shankar
- Children and Young People's Cancer Services, University College London Hospitals NHS Foundation Trust, London, UK.
| | - Tom Kurzawinski
- Department of Endocrine Surgery, University College London Hospitals NHS Foundation Trust, London, UK
| | - Emma Ross
- Department of Paediatric Oncology, University Hospitals of Leicester NHS Trust, Leicester, UK
| | - Sara Stoneham
- Children and Young People's Cancer Services, University College London Hospitals NHS Foundation Trust, London, UK
| | - Tim Beale
- Department of Head and Neck Radiology, University College London Hospitals NHS Foundation Trust, London, UK
| | - Ian Proctor
- Department of Cellular Pathology, University College London Hospitals NHS Foundation Trust, London, UK
| | - Tony Hulse
- Department of Paediatric Endocrinology, Guy's and St Thomas' NHS Foundation Trust, London, UK
| | - Kate Simpson
- Department of Pharmacy, University College London Hospitals NHS Foundation Trust, London, UK
| | - Mark N Gaze
- Department of Oncology, University College London Hospitals NHS Foundation Trust, National Institute for Health Research University College London Hospitals Biomedical Research Centre, London, UK
| | - Elene Cattaneo
- Children's and Adolescent Services, East Suffolk and North Essex NHS Foundation Trust, Colchester, UK
| | - Evelien Gevers
- Centre for Endocrinology, William Harvey Research Institute, Queen Mary University of London and Department of Paediatric Endocrinology, Barts Health NHS Trust, London, UK
| | - Lynley Marshall
- Department of Paediatric and Adolescent Oncology, The Royal Marsden NHS Foundation Trust, Sutton and The Institute of Cancer Research, London, UK
| | | | - Caroline Brain
- Department of Paediatric Endocrinology, Great Ormond Street Hospital for Children NHS Foundation Trust, London, UK
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Buonocore F, Maharaj A, Qamar Y, Koehler K, Suntharalingham JP, Chan LF, Ferraz-de-Souza B, Hughes CR, Lin L, Prasad R, Allgrove J, Andrews ET, Buchanan CR, Cheetham TD, Crowne EC, Davies JH, Gregory JW, Hindmarsh PC, Hulse T, Krone NP, Shah P, Shaikh MG, Roberts C, Clayton PE, Dattani MT, Thomas NS, Huebner A, Clark AJ, Metherell LA, Achermann JC. Genetic Analysis of Pediatric Primary Adrenal Insufficiency of Unknown Etiology: 25 Years' Experience in the UK. J Endocr Soc 2021; 5:bvab086. [PMID: 34258490 PMCID: PMC8266051 DOI: 10.1210/jendso/bvab086] [Citation(s) in RCA: 21] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/19/2021] [Indexed: 01/13/2023] Open
Abstract
CONTEXT Although primary adrenal insufficiency (PAI) in children and young people is often due to congenital adrenal hyperplasia (CAH) or autoimmunity, other genetic causes occur. The relative prevalence of these conditions is poorly understood. OBJECTIVE We investigated genetic causes of PAI in children and young people over a 25 year period. DESIGN SETTING AND PARTICIPANTS Unpublished and published data were reviewed for 155 young people in the United Kingdom who underwent genetic analysis for PAI of unknown etiology in three major research centers between 1993 and 2018. We pre-excluded those with CAH, autoimmune, or metabolic causes. We obtained additional data from NR0B1 (DAX-1) clinical testing centers. INTERVENTION AND OUTCOME MEASUREMENTS Genetic analysis involved a candidate gene approach (1993 onward) or next generation sequencing (NGS; targeted panels, exomes) (2013-2018). RESULTS A genetic diagnosis was reached in 103/155 (66.5%) individuals. In 5 children the adrenal insufficiency resolved and no genetic cause was found. Pathogenic variants occurred in 11 genes: MC2R (adrenocorticotropin receptor; 30/155, 19.4%), NR0B1 (DAX-1; 7.7%), CYP11A1 (7.7%), AAAS (7.1%), NNT (6.5%), MRAP (4.5%), TXNRD2 (4.5%), STAR (3.9%), SAMD9 (3.2%), CDKN1C (1.3%), and NR5A1/steroidogenic factor-1 (SF-1; 0.6%). Additionally, 51 boys had NR0B1 variants identified through clinical testing. Although age at presentation, treatment, ancestral background, and birthweight can provide diagnostic clues, genetic testing was often needed to define the cause. CONCLUSIONS PAI in children and young people often has a genetic basis. Establishing the specific etiology can influence management of this lifelong condition. NGS approaches improve the diagnostic yield when many potential candidate genes are involved.
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Affiliation(s)
- Federica Buonocore
- Genetics and Genomic Medicine Research and Teaching Department, UCL Great Ormond Street Institute of Child Health, University College London, London, UK
| | - Avinaash Maharaj
- Centre for Endocrinology, William Harvey Research Institute, Queen Mary University of London, London, UK
| | - Younus Qamar
- Centre for Endocrinology, William Harvey Research Institute, Queen Mary University of London, London, UK
| | - Katrin Koehler
- Children’s Hospital, Universitätsklinikum Dresden, Technische Universität Dresden, Dresden, Germany
| | - Jenifer P Suntharalingham
- Genetics and Genomic Medicine Research and Teaching Department, UCL Great Ormond Street Institute of Child Health, University College London, London, UK
| | - Li F Chan
- Centre for Endocrinology, William Harvey Research Institute, Queen Mary University of London, London, UK
| | - Bruno Ferraz-de-Souza
- Genetics and Genomic Medicine Research and Teaching Department, UCL Great Ormond Street Institute of Child Health, University College London, London, UK
| | - Claire R Hughes
- Centre for Endocrinology, William Harvey Research Institute, Queen Mary University of London, London, UK
- The Royal London Childrens Hospital, Barts Health NHS Trust, London, UK
| | - Lin Lin
- Genetics and Genomic Medicine Research and Teaching Department, UCL Great Ormond Street Institute of Child Health, University College London, London, UK
| | - Rathi Prasad
- Centre for Endocrinology, William Harvey Research Institute, Queen Mary University of London, London, UK
| | - Jeremy Allgrove
- The Royal London Childrens Hospital, Barts Health NHS Trust, London, UK
| | - Edward T Andrews
- Department of Paediatric Endocrinology, University Hospital Southampton NHS Foundation Trust, Southampton, UK
| | - Charles R Buchanan
- Department of Child Health, King’s College Hospital NHS Foundation Trust, London, UK
| | - Tim D Cheetham
- Newcastle University and Great North Children’s Hospital, Newcastle upon Tyne, UK
| | - Elizabeth C Crowne
- Bristol Royal Hospital for Children, University Hospitals Bristol, NHS Foundation Trust, Bristol, UK
| | - Justin H Davies
- Department of Paediatric Endocrinology, University Hospital Southampton NHS Foundation Trust, Southampton, UK
- Faculty of Medicine, University of Southampton, Southampton, SO17 1BJ, UK
| | - John W Gregory
- Division of Population Medicine, School of Medicine, Cardiff University, Cardiff, UK
| | - Peter C Hindmarsh
- Departments of Paediatrics, University College London Hospitals, London, UK
| | - Tony Hulse
- Paediatric Endocrinology, Evelina London Children’s Hospital, Guy’s and St Thomas’ NHS Trust, London, UK
| | - Nils P Krone
- Department of Oncology and Metabolism, University of Sheffield, Sheffield Children’s Hospital, Sheffield, UK
| | - Pratik Shah
- Centre for Endocrinology, William Harvey Research Institute, Queen Mary University of London, London, UK
- The Royal London Childrens Hospital, Barts Health NHS Trust, London, UK
| | - M Guftar Shaikh
- Department of Paediatric Endocrinology, Royal Hospital for Children, NHS Greater Glasgow and Clyde, Glasgow, UK
| | - Catherine Roberts
- Northern Genetics Service, International Centre for Life, Newcastle, UK
| | - Peter E Clayton
- Developmental Biology & Medicine, Faculty of Biology, Medicine & Health, University of Manchester, and the Royal Manchester Children’s Hospital, Manchester University Hospital NHS Foundation Trust, Manchester, UK
| | - Mehul T Dattani
- Genetics and Genomic Medicine Research and Teaching Department, UCL Great Ormond Street Institute of Child Health, University College London, London, UK
| | - N Simon Thomas
- Wessex Regional Genetics Laboratory, Salisbury District Hospital, Salisbury, UK
| | - Angela Huebner
- Children’s Hospital, Universitätsklinikum Dresden, Technische Universität Dresden, Dresden, Germany
| | - Adrian J Clark
- Centre for Endocrinology, William Harvey Research Institute, Queen Mary University of London, London, UK
| | - Louise A Metherell
- Centre for Endocrinology, William Harvey Research Institute, Queen Mary University of London, London, UK
| | - John C Achermann
- Genetics and Genomic Medicine Research and Teaching Department, UCL Great Ormond Street Institute of Child Health, University College London, London, UK
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Arya VB, Aylwin SJB, Hulse T, Ajzensztejn M, Kalitsi J, Kalogirou N, Bodi I, Thomas N, Hampton T, Kapoor RR, Buchanan CR. Prolactinoma in childhood and adolescence-Tumour size at presentation predicts management strategy: Single centre series and a systematic review and meta-analysis. Clin Endocrinol (Oxf) 2021; 94:413-423. [PMID: 33340135 DOI: 10.1111/cen.14394] [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] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/08/2020] [Revised: 12/09/2020] [Accepted: 12/09/2020] [Indexed: 12/17/2022]
Abstract
OBJECTIVE To report the clinical presentation, management and outcomes of young patients with prolactinomas (<20 years) and conduct a systematic review and meta-analysis. PATIENTS AND DESIGN Clinical, biochemical and radiological data (1996-2018) were collected from our centre. A systematic review and meta-analysis of published literature (1994-2019) on prolactinoma (age <20 years) were conducted. Both random and fixed effects meta-analysis were used to pool outcomes across studies. RESULTS 1 CASE SERIES: Twenty-two patients (14 females) were identified; median age at diagnosis 15.7 years (range 13-19); 12 patients (6 females) had a macroprolactinoma. Seven patients (macroprolactinoma-6) had associated pituitary hormone deficiencies at presentation. Five patients (4 males) underwent surgical resection due to poor response to cabergoline or apoplexy. Patients undergoing surgery had larger tumours (p < .02) and higher serum prolactin concentration (p < .005). All patients with macroprolactinoma >20 mm required surgical intervention. RESULTS 2 SYSTEMATIC REVIEW AND META-ANALYSIS: We selected 11 studies according to strict inclusion criteria describing 275 patients. Macroprolactinoma was more common in girls (78.7% [95% CI 70.5-85.9]) than boys and was more frequent than microprolactinoma (56.6% [95% CI 48.4-64.5]). In males, only 6/57 (10.5%) of tumours were microprolactinoma as compared to 102/198 (51.5%) microprolactinoma in females (risk difference -0.460; [95% CI -0.563 to -0.357]; p < .001). Surgery was first-line therapy in 18.9% patients, with another 15.4% requiring it as a second line (overall 31.3%). CONCLUSIONS Macroprolactinoma, particularly if >20 mm, usually requires multimodal therapy including surgical intervention. While overall prolactinomas in <20 years age group are more common in females, the proportion of macroprolactinoma vs microprolactinoma is greater in males, particularly for large invasive tumours. Microprolactinoma is a rare diagnosis in adolescent males.
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Affiliation(s)
- Ved Bhushan Arya
- Paediatric Endocrinology, Variety Club Children's Hospital, King's College Hospital NHS Foundation Trust, London, UK
| | - Simon J B Aylwin
- Endocrinology, King's College Hospital NHS Foundation Trust, London, UK
| | - Tony Hulse
- Paediatric Endocrinology, Evelina London Children's Hospital, Guy's and St Thomas' NHS Trust, London, UK
| | - Michal Ajzensztejn
- Paediatric Endocrinology, Evelina London Children's Hospital, Guy's and St Thomas' NHS Trust, London, UK
| | - Jennifer Kalitsi
- Paediatric Endocrinology, Variety Club Children's Hospital, King's College Hospital NHS Foundation Trust, London, UK
| | - Nicolas Kalogirou
- Paediatric Endocrinology, Variety Club Children's Hospital, King's College Hospital NHS Foundation Trust, London, UK
| | - Istvan Bodi
- Neuropathology, King's College Hospital NHS Foundation Trust, London, UK
| | - Nick Thomas
- Neurosurgery, King's College Hospital NHS Foundation Trust, London, UK
| | - Tim Hampton
- Neuroradiology, King's College Hospital NHS Foundation Trust, London, UK
| | - Ritika R Kapoor
- Paediatric Endocrinology, Variety Club Children's Hospital, King's College Hospital NHS Foundation Trust, London, UK
- Faculty of Medicine and Life Sciences, King's College London, London, UK
| | - Charles R Buchanan
- Paediatric Endocrinology, Variety Club Children's Hospital, King's College Hospital NHS Foundation Trust, London, UK
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8
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Arya VB, Chawla G, Nambisan AKR, Muhi-Iddin N, Vamvakiti E, Ajzensztejn M, Hulse T, Ferreira Pinto C, Lahiri N, Bint S, Buchanan CR, Kapoor RR. Xq27.1 Duplication Encompassing SOX3: Variable Phenotype and Smallest Duplication Associated with Hypopituitarism to Date - A Large Case Series of Unrelated Patients and a Literature Review. Horm Res Paediatr 2020; 92:382-389. [PMID: 31678974 DOI: 10.1159/000503784] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [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: 06/05/2019] [Accepted: 09/28/2019] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Xq27.1 duplication encompassing SOX3 has been implicated in the aetiology of X-linked hypopituitarism associated with intellectual disability and neural tube defects. We describe the largest case series to date of 5 unrelated patients with SOX3 duplication with a variable clinical phenotype, including the smallest reported SOX3 duplication. CASE REPORTS Five male patients who presented with congenital hypopituitarism (CH) were identified to have Xq27.1 duplication encompassing SOX3. The size of the duplication ranged from 323.8 kb to 11 Mb. The duplication was maternally inherited or de novo in 2 patients each (and of unknown inheritance in 1 patient). The age at presentation was variable. Three patients had multiple pituitary hormone deficiencies, whereas 2 patients had isolated growth hormone deficiency. All patients had micropenis and/or small undescended testes. Structural pituitary and/or other midline cranial abnormalities (callosal hypogenesis/absence of the septum pellucidum) were present in all patients. Two patients had a neural tube defect in addition to CH. CONCLUSIONS This is the largest series reported to date of unrelated patients with CH in association with Xq27.1 duplication encompassing SOX3. The clinical phenotype is variable, which may be due to genetic redundancy or other unknown aetiological factors. We have expanded the phenotypic spectrum through description of the smallest Xq27.1 duplication (323.8 kb) with CH reported to date, as well as a second family with CH and a neural tube defect.
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Affiliation(s)
- Ved Bhushan Arya
- Department of Paediatric Endocrinology, King's College Hospital NHS Foundation Trust, London, United Kingdom,
| | - Garima Chawla
- Department of Paediatric Endocrinology, King's College Hospital NHS Foundation Trust, London, United Kingdom
| | - Aparna K R Nambisan
- Department of Paediatric Endocrinology, King's College Hospital NHS Foundation Trust, London, United Kingdom
| | - Nadia Muhi-Iddin
- Department of Paediatrics, East Sussex Healthcare NHS Trust, Eastbourne, United Kingdom
| | - Ekaterini Vamvakiti
- Department of Paediatrics, Western Sussex Hospitals NHS Foundation Trust, Worthing, United Kingdom
| | - Michal Ajzensztejn
- Department of Paediatric Endocrinology, Guy's and St Thomas' NHS Foundation Trust, London, United Kingdom
| | - Tony Hulse
- Department of Paediatric Endocrinology, Guy's and St Thomas' NHS Foundation Trust, London, United Kingdom
| | - Clare Ferreira Pinto
- South West Thames Regional Genetics Laboratory, St George's University Hospitals NHS Foundation Trust, London, United Kingdom
| | - Nayana Lahiri
- Clinical Genetics Department, St George's University Hospitals NHS Foundation Trust, London, United Kingdom
| | - Susan Bint
- Viapath Genetics Laboratories, Guy's Hospital, London, United Kingdom
| | - Charles R Buchanan
- Department of Paediatric Endocrinology, King's College Hospital NHS Foundation Trust, London, United Kingdom
| | - Ritika R Kapoor
- Department of Paediatric Endocrinology, King's College Hospital NHS Foundation Trust, London, United Kingdom
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9
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Arya VB, Ajzensztejn M, Appleby G, Oddy S, Halsall D, Chatterjee K, Moran C, Hulse T. High-dose biotin in infants mimics biochemical hyperthyroidism with some commercial assays. Clin Endocrinol (Oxf) 2018; 88:507-510. [PMID: 29314108 DOI: 10.1111/cen.13547] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Affiliation(s)
- Ved Bhushan Arya
- Department of Paediatric Endocrinology and Diabetes, Evelina London Children Hospital, Guy's and St Thomas' NHS Foundation Trust, London, UK
| | - Michal Ajzensztejn
- Department of Paediatric Endocrinology and Diabetes, Evelina London Children Hospital, Guy's and St Thomas' NHS Foundation Trust, London, UK
| | - Gayle Appleby
- Department of Paediatric Endocrinology and Diabetes, Evelina London Children Hospital, Guy's and St Thomas' NHS Foundation Trust, London, UK
| | - Sue Oddy
- Department of Clinical Biochemistry, Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK
| | - David Halsall
- Department of Clinical Biochemistry, Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK
| | - Krishna Chatterjee
- MRC Institute of Metabolic Science, Wellcome Trust, University of Cambridge, Cambridge, UK
| | - Carla Moran
- MRC Institute of Metabolic Science, Wellcome Trust, University of Cambridge, Cambridge, UK
| | - Tony Hulse
- Department of Paediatric Endocrinology and Diabetes, Evelina London Children Hospital, Guy's and St Thomas' NHS Foundation Trust, London, UK
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10
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Jin X, Masterson L, Patel A, Hook L, Nicholson J, Jefferies S, Gaze M, Nassif R, Eller R, Hulse T, Jani P. Conservative or radical surgery for pediatric papillary thyroid carcinoma: A systematic review of the literature. Int J Pediatr Otorhinolaryngol 2015; 79:1620-4. [PMID: 26300408 DOI: 10.1016/j.ijporl.2015.08.004] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [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: 05/30/2015] [Revised: 08/02/2015] [Accepted: 08/03/2015] [Indexed: 10/23/2022]
Abstract
BACKGROUND Pediatric papillary thyroid carcinoma (PTC) is characterized by an aggressive clinical course. Early diagnosis is a challenge and treatment consists principally of partial or total thyroidectomy±neck dissection and radioactive iodine therapy. Due to the rarity of PTC in children, there is no consensus on optimal surgical treatment. METHODS AND RESULTS A literature search was carried out using PubMed, Embase, Medline, Cochrane and Web of Science. Seven studies (489 patients) investigating the outcome of surgically managed pediatric PTC were identified. No clear advantage in survival or recurrence rate was found for total thyroidectomy compared to other surgical approaches. CONCLUSION Despite the aggressive behavior of PTC, prognosis is good, with low mortality. After removal of disease and prevention of recurrence, reduction of iatrogenic complications are a priority in this age group. Due to the paucity of available evidence, this review cannot recommend conservative or radical surgery for pediatric papillary thyroid carcinoma. To answer this question, we recommend the establishment of a randomized controlled trial with adequately matched baseline variables.
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Affiliation(s)
- Xi Jin
- Department of Otolaryngology, Head and Neck Surgery, Addenbrooke's Hospital, Cambridge CB2 0QQ, UK
| | - Liam Masterson
- Department of Otolaryngology, Head and Neck Surgery, Addenbrooke's Hospital, Cambridge CB2 0QQ, UK.
| | - Anant Patel
- Department of Otolaryngology, Head and Neck Surgery, Addenbrooke's Hospital, Cambridge CB2 0QQ, UK
| | - Liz Hook
- Department of Pathology, Addenbrooke's Hospital, Cambridge CB2 0QQ, UK
| | - James Nicholson
- Department of Pediatric Oncology, Addenbrooke's Hospital, Cambridge CB2 0QQ, UK
| | - Sarah Jefferies
- Department of Clinical Oncology, Addenbrooke's Hospital, Cambridge CB2 0QQ, UK
| | - Mark Gaze
- Department of Oncology, University College Hospital, London NW1 2PG, UK
| | - Ramez Nassif
- Department of Head & Neck Oncology, Norfolk & Norwich University Hospital, Norwich NR4 7UY, UK
| | - Robert Eller
- US Air Force and Army Voice Center, San Antonio, TX, USA
| | - Tony Hulse
- Department of Paediatric Endocrinology, Guy's & St Thomas' Hospital, London SE1 7UH, UK
| | - Piyush Jani
- Department of Otolaryngology, Head and Neck Surgery, Addenbrooke's Hospital, Cambridge CB2 0QQ, UK
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11
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Hannan FM, Howles SA, Rogers A, Cranston T, Gorvin CM, Babinsky VN, Reed AA, Thakker CE, Bockenhauer D, Brown RS, Connell JM, Cook J, Darzy K, Ehtisham S, Graham U, Hulse T, Hunter SJ, Izatt L, Kumar D, McKenna MJ, McKnight JA, Morrison PJ, Mughal MZ, O'Halloran D, Pearce SH, Porteous ME, Rahman M, Richardson T, Robinson R, Scheers I, Siddique H, Van't Hoff WG, Wang T, Whyte MP, Nesbit MA, Thakker RV. Adaptor protein-2 sigma subunit mutations causing familial hypocalciuric hypercalcaemia type 3 (FHH3) demonstrate genotype-phenotype correlations, codon bias and dominant-negative effects. Hum Mol Genet 2015; 24:5079-92. [PMID: 26082470 PMCID: PMC4550820 DOI: 10.1093/hmg/ddv226] [Citation(s) in RCA: 58] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2015] [Accepted: 06/12/2015] [Indexed: 12/05/2022] Open
Abstract
The adaptor protein-2 sigma subunit (AP2σ2) is pivotal for clathrin-mediated endocytosis of plasma membrane constituents such as the calcium-sensing receptor (CaSR). Mutations of the AP2σ2 Arg15 residue result in familial hypocalciuric hypercalcaemia type 3 (FHH3), a disorder of extracellular calcium (Ca2+o) homeostasis. To elucidate the role of AP2σ2 in Ca2+o regulation, we investigated 65 FHH probands, without other FHH-associated mutations, for AP2σ2 mutations, characterized their functional consequences and investigated the genetic mechanisms leading to FHH3. AP2σ2 mutations were identified in 17 probands, comprising 5 Arg15Cys, 4 Arg15His and 8 Arg15Leu mutations. A genotype–phenotype correlation was observed with the Arg15Leu mutation leading to marked hypercalcaemia. FHH3 probands harboured additional phenotypes such as cognitive dysfunction. All three FHH3-causing AP2σ2 mutations impaired CaSR signal transduction in a dominant-negative manner. Mutational bias was observed at the AP2σ2 Arg15 residue as other predicted missense substitutions (Arg15Gly, Arg15Pro and Arg15Ser), which also caused CaSR loss-of-function, were not detected in FHH probands, and these mutations were found to reduce the numbers of CaSR-expressing cells. FHH3 probands had significantly greater serum calcium (sCa) and magnesium (sMg) concentrations with reduced urinary calcium to creatinine clearance ratios (CCCR) in comparison with FHH1 probands with CaSR mutations, and a calculated index of sCa × sMg/100 × CCCR, which was ≥ 5.0, had a diagnostic sensitivity and specificity of 83 and 86%, respectively, for FHH3. Thus, our studies demonstrate AP2σ2 mutations to result in a more severe FHH phenotype with genotype–phenotype correlations, and a dominant-negative mechanism of action with mutational bias at the Arg15 residue.
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Affiliation(s)
- Fadil M Hannan
- Academic Endocrine Unit, Radcliffe Department of Medicine, University of Oxford, Oxford, UK
| | - Sarah A Howles
- Academic Endocrine Unit, Radcliffe Department of Medicine, University of Oxford, Oxford, UK
| | - Angela Rogers
- Academic Endocrine Unit, Radcliffe Department of Medicine, University of Oxford, Oxford, UK
| | - Treena Cranston
- Oxford Molecular Genetics Laboratory, Churchill Hospital, Oxford, UK
| | - Caroline M Gorvin
- Academic Endocrine Unit, Radcliffe Department of Medicine, University of Oxford, Oxford, UK
| | - Valerie N Babinsky
- Academic Endocrine Unit, Radcliffe Department of Medicine, University of Oxford, Oxford, UK
| | - Anita A Reed
- Academic Endocrine Unit, Radcliffe Department of Medicine, University of Oxford, Oxford, UK
| | - Clare E Thakker
- Academic Endocrine Unit, Radcliffe Department of Medicine, University of Oxford, Oxford, UK
| | - Detlef Bockenhauer
- Renal Unit, Great Ormond Street Hospital for Children NHS Foundation Trust and UCL Institute of Child Health, London, UK
| | - Rosalind S Brown
- Division of Endocrinology, Boston Children's Hospital, Boston, MA, USA
| | - John M Connell
- School of Medicine, Ninewells Hospital, University of Dundee, Dundee, UK
| | - Jacqueline Cook
- Clinical Genetics Department, Sheffield Children's Hospital NHS Foundation Trust, Sheffield, UK
| | - Ken Darzy
- Queen Elizabeth II Hospital, Welwyn Garden City, UK
| | - Sarah Ehtisham
- Department of Paediatric Endocrinology, Royal Manchester Children's Hospital, Manchester, UK
| | - Una Graham
- Regional Centre for Endocrinology and Diabetes, Royal Victoria Hospital, Belfast, UK
| | - Tony Hulse
- Department of Paediatrics, Evelina London Children's Hospital, St. Thomas' Hospital, London, UK
| | - Steven J Hunter
- Regional Centre for Endocrinology and Diabetes, Royal Victoria Hospital, Belfast, UK
| | - Louise Izatt
- Department of Clinical Genetics, Guy's Hospital, London, UK
| | - Dhavendra Kumar
- Institute of Cancer and Genetics, University Hospital of Wales, Cardiff, UK
| | - Malachi J McKenna
- Department of Endocrinology, St. Vincent's University Hospital, Dublin, Ireland
| | - John A McKnight
- Metabolic Unit, Western General Hospital, NHS Lothian and University of Edinburgh, Edinburgh, UK
| | - Patrick J Morrison
- Centre for Cancer Research and Cell Biology, Queens University of Belfast, Belfast, UK, Department of Genetic Medicine, Belfast HSC Trust, Belfast, UK
| | - M Zulf Mughal
- Department of Paediatric Endocrinology, Royal Manchester Children's Hospital, Manchester, UK
| | | | - Simon H Pearce
- Institute of Genetic Medicine, Newcastle University, Newcastle upon Tyne, UK
| | - Mary E Porteous
- SE Scotland Genetic Service, Western General Hospital, Edinburgh, UK
| | - Mushtaqur Rahman
- Department of Endocrinology, Northwick Park Hospital, London, UK
| | - Tristan Richardson
- Diabetes and Endocrine Centre, Royal Bournemouth Hospital, Bournemouth, UK
| | - Robert Robinson
- Department of Endocrinology, Chesterfield Royal Hospital NHS Foundation Trust, Derbyshire, UK
| | - Isabelle Scheers
- Pediatric Gastroenterology, Hepatology and Nutrition Unit, Cliniques Universitaires Saint-Luc, Brussels, Belgium
| | - Haroon Siddique
- Department of Endocrinology, Russells Hall Hospital, Dudley, UK
| | - William G Van't Hoff
- Renal Unit, Great Ormond Street Hospital for Children NHS Foundation Trust and UCL Institute of Child Health, London, UK
| | - Timothy Wang
- Department of Clinical Biochemistry, Frimley Park Hospital, Surrey, UK and
| | - Michael P Whyte
- Center for Metabolic Bone Disease and Molecular Research, Shriners Hospital for Children, St. Louis, Missouri, USA
| | - M Andrew Nesbit
- Academic Endocrine Unit, Radcliffe Department of Medicine, University of Oxford, Oxford, UK
| | - Rajesh V Thakker
- Academic Endocrine Unit, Radcliffe Department of Medicine, University of Oxford, Oxford, UK,
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12
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McCabe MJ, Gaston-Massuet C, Gregory LC, Alatzoglou KS, Tziaferi V, Sbai O, Rondard P, Masumoto KH, Nagano M, Shigeyoshi Y, Pfeifer M, Hulse T, Buchanan CR, Pitteloud N, Martinez-Barbera JP, Dattani MT. Variations in PROKR2, but not PROK2, are associated with hypopituitarism and septo-optic dysplasia. J Clin Endocrinol Metab 2013; 98:E547-57. [PMID: 23386640 PMCID: PMC3612801 DOI: 10.1210/jc.2012-3067] [Citation(s) in RCA: 46] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
CONTEXT Loss-of-function mutations in PROK2 and PROKR2 have been implicated in Kallmann syndrome (KS), characterized by hypogonadotropic hypogonadism and anosmia. Recent data suggest overlapping phenotypes/genotypes between KS and congenital hypopituitarism (CH), including septo-optic dysplasia (SOD). OBJECTIVE We screened a cohort of patients with complex forms of CH (n = 422) for mutations in PROK2 and PROKR2. RESULTS We detected 5 PROKR2 variants in 11 patients with SOD/CH: novel p.G371R and previously reported p.A51T, p.R85L, p.L173R, and p.R268C-the latter 3 being known functionally deleterious variants. Surprisingly, 1 patient with SOD was heterozygous for the p.L173R variant, whereas his phenotypically unaffected mother was homozygous for the variant. We sought to clarify the role of PROKR2 in hypothalamopituitary development through analysis of Prokr2(-/-) mice. Interestingly, these revealed predominantly normal hypothalamopituitary development and terminal cell differentiation, with the exception of reduced LH; this was inconsistent with patient phenotypes and more analogous to the healthy mother, although she did not have KS, unlike the Prokr2(-/-) mice. CONCLUSIONS The role of PROKR2 in the etiology of CH, SOD, and KS is uncertain, as demonstrated by no clear phenotype-genotype correlation; loss-of-function variants in heterozygosity or homozygosity can be associated with these disorders. However, we report a phenotypically normal parent, homozygous for p.L173R. Our data suggest that the variants identified herein are unlikely to be implicated in isolation in these disorders; other genetic or environmental modifiers may also impact on the etiology. Given the phenotypic variability, genetic counseling may presently be inappropriate.
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Affiliation(s)
- Mark J McCabe
- Developmental Endocrinology Research Group, Clinical and Molecular Genetics Unit, University College London (UCL)-Institute of Child Health, London WC1N 1EH, United Kingdom
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14
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Haining RG, Hulse T, Labbe RF. Rapid porphyrin screening of urine, stool, and blood. Clin Chem 1969; 15:460-6. [PMID: 5786802] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/16/2023]
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