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Feng J, Lin S, Wang W, Chen Q, Wang W, Li J, Wang X. Thyroid hormone resistance resulting from a novel mutation in the THRB gene in a Chinese child: A case report. Medicine (Baltimore) 2023; 102:e33587. [PMID: 37115071 PMCID: PMC10145980 DOI: 10.1097/md.0000000000033587] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/09/2023] [Accepted: 03/31/2023] [Indexed: 04/29/2023] Open
Abstract
INTRODUCTION Thyroid hormone resistance (RTH) (mim # 188570) is a rare autosomal dominant genetic disorder characterized by reduced thyroid hormone response in target tissues. The clinical manifestations of RTH vary from no symptoms to symptoms of thyroid hormone deficiency to symptoms of thyroid hormone excess. PATIENT CONCERN AND CLINICAL FINDINGS A 24-month-old girl presented with growth retardation, tachycardia, and persistently elevated thyroid hormones despite antithyroid treatment. DIAGNOSIS/INTERVENTION/OUTCOMES The patient was diagnosed with RTH, after whole exon gene sequencing, found a de novo missense mutation (c.1375T > G,p.Phe459Val) in a novel locus of the thyroid hormone receptor beta gene. She had only mild growth retardation, so the decision was made to monitor her development without intervention. At her last follow-up at 5 years and 8 months of age, she continued to show growth retardation (-2 standard deviation below age-appropriate levels), in addition to delayed language development. Her comprehension ability and heart rate have remained normal. CONCLUSIONS We report a mild case of RTH caused by a novel thyroid hormone receptor beta gene mutation. RTH should be considered in the differential diagnosis of abnormal serum thyroxine levels during neonatal screening.
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Affiliation(s)
- Jinhua Feng
- Diagnosis and Treatment Center for Children, The Affiliated Hospital of Changchun University of Chinese Medicine, Changchun, Jilin Province, China
| | - Shuangzhu Lin
- Diagnosis and Treatment Center for Children, The Affiliated Hospital of Changchun University of Chinese Medicine, Changchun, Jilin Province, China
| | - Wei Wang
- Diagnosis and Treatment Center for Children, The Affiliated Hospital of Changchun University of Chinese Medicine, Changchun, Jilin Province, China
| | - Qiandui Chen
- College of Integrated Chinese and Western Medicine, Changchun University of Chinese Medicine, Changchun, Jilin Province, China
| | - Wanqi Wang
- Pediatrics of Traditional Chinese Medicine, College of Traditional Chinese Medicine, Changchun University of Chinese Medicine, Changchun, Jilin Province, China
| | - Jiayi Li
- Pediatrics of Traditional Chinese Medicine, College of Traditional Chinese Medicine, Changchun University of Chinese Medicine, Changchun, Jilin Province, China
| | - Xinyao Wang
- College of Integrated Chinese and Western Medicine, Changchun University of Chinese Medicine, Changchun, Jilin Province, China
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Gonsalves R, Aleck K, Newbern D, Shaibi G, Kapadia C, Oatman O. Severe early onset obesity and hypopituitarism in a child with a novel SIM1 gene mutation. Endocrinol Diabetes Metab Case Rep 2020; 2020:EDM200042. [PMID: 33434169 PMCID: PMC7576654 DOI: 10.1530/edm-20-0042] [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] [Subscribe] [Scholar Register] [Received: 07/14/2020] [Accepted: 08/11/2020] [Indexed: 11/08/2022] Open
Abstract
SUMMARY Single-minded homolog 1 (SIM1) is a transcription factor that plays a role in the development of both the hypothalamus and pituitary. SIM1 gene mutations are known to cause obesity in humans, and chromosomal deletions encompassing SIM1 and other genes necessary for pituitary development can cause a Prader-Willi-like syndrome with obesity and hypopituitarism. There have been no reported cases of hypopituitarism linked to a single SIM1 mutation. A 21-month-old male presented to endocrinology clinic with excessive weight gain and severe obesity. History was also notable for excessive drinking and urination. Endocrine workup revealed central hypothyroidism, partial diabetes insipidus, and central adrenal insufficiency. Genetic evaluation revealed a novel mutation in the SIM1 gene. No other genetic abnormalities to account for his obesity and hypopituitarism were identified. While we cannot definitively state this mutation is pathogenic, it is notable that SIM1 plays a role in the development of all three of the patient's affected hormone axes. He is now 6 years old and remains on treatment for his pituitary hormone deficiencies and continues to exhibit excessive weight gain despite lifestyle interventions. LEARNING POINTS Mutations in SIM1 are a well-recognized cause of monogenic human obesity, and there have been case reports of Prader-Willi-like syndrome and hypopituitarism in patients with chromosomal deletions that contain the SIM1 gene. SIM1 is expressed during the development of the hypothalamus, specifically in neuroendocrine lineages that give rise to the hormones oxytocin, arginine vasopressin, thyrotropin-releasing hormone, corticotropin-releasing hormone, and somatostatin. Pituitary testing should be considered in patients with severe obesity and a known genetic abnormality affecting the SIM1 gene, particularly in the pediatric population.
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Affiliation(s)
- Rob Gonsalves
- Division of Endocrinology, Phoenix Children’s Hospital, Phoenix, Arizona, USA
| | - Kirk Aleck
- Division of Genetics, Phoenix Children’s Hospital, Phoenix, Arizona, USA
| | - Dorothee Newbern
- Division of Endocrinology, Phoenix Children’s Hospital, Phoenix, Arizona, USA
| | - Gabriel Shaibi
- Division of Endocrinology, Phoenix Children’s Hospital, Phoenix, Arizona, USA
| | - Chirag Kapadia
- Division of Endocrinology, Phoenix Children’s Hospital, Phoenix, Arizona, USA
| | - Oliver Oatman
- Division of Endocrinology, Phoenix Children’s Hospital, Phoenix, Arizona, USA
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Nakao T, Takeshima K, Ariyasu H, Kurimoto C, Uraki S, Morita S, Furukawa Y, Iwakura H, Akamizu T. Thyroid storm with delayed hyperbilirubinemia and severe heart failure: indication and contraindication of plasma exchange. Endocrinol Diabetes Metab Case Rep 2020; 2020:EDM200036. [PMID: 33434181 PMCID: PMC7487178 DOI: 10.1530/edm-20-0036] [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] [Subscribe] [Scholar Register] [Received: 06/27/2020] [Accepted: 08/11/2020] [Indexed: 11/22/2022] Open
Abstract
SUMMARY Thyroid storm (TS) is a life-threatening condition that may suffer thyrotoxic patients. Therapeutic plasma exchange (TPE) is a rescue approach for TS with acute hepatic failure, but it should be initiated with careful considerations. We present a 55-year-old male patient with untreated Graves' disease who developed TS. Severe hyperthyroidism and refractory atrial fibrillation with congestive heart failure aggregated to multiple organ failure. The patient was recovered by intensive multimodal therapy, but we had difficulty in introducing TPE treatment considering the risk of exacerbation of congestive heart failure due to plasma volume overload. In addition, serum total bilirubin level was not elevated in the early phase to the level of indication for TPE. The clinical course of this patient instructed delayed elevation of bilirubin until the level of indication for TPE in some patients and also demonstrated the risk of exacerbation of congestive heart failure by TPE. LEARNING POINTS Our patient with thyroid storm could be diagnosed and treated promptly using Japan Thyroid Association guidelines for thyroid storm. Delayed elevation of serum bilirubin levels could make the decision of introducing therapeutic plasma exchange difficult in cases of thyroid storm with acute hepatic failure. The risk of worsening congestive heart failure should be considered carefully when performing therapeutic plasma exchange.
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Affiliation(s)
- Tomomi Nakao
- First Department of Internal Medicine, Wakayama Medical University, Wakayama City, Wakayama, Japan
| | - Ken Takeshima
- First Department of Internal Medicine, Wakayama Medical University, Wakayama City, Wakayama, Japan
| | - Hiroyuki Ariyasu
- First Department of Internal Medicine, Wakayama Medical University, Wakayama City, Wakayama, Japan
| | - Chiaki Kurimoto
- First Department of Internal Medicine, Wakayama Medical University, Wakayama City, Wakayama, Japan
| | - Shinsuke Uraki
- First Department of Internal Medicine, Wakayama Medical University, Wakayama City, Wakayama, Japan
| | - Shuhei Morita
- First Department of Internal Medicine, Wakayama Medical University, Wakayama City, Wakayama, Japan
| | - Yasushi Furukawa
- First Department of Internal Medicine, Wakayama Medical University, Wakayama City, Wakayama, Japan
| | - Hiroshi Iwakura
- First Department of Internal Medicine, Wakayama Medical University, Wakayama City, Wakayama, Japan
| | - Takashi Akamizu
- First Department of Internal Medicine, Wakayama Medical University, Wakayama City, Wakayama, Japan
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Sanz-Sapera E, Sarria-Estrada S, Arikan F, Biagetti B. Acromegaly remission, SIADH and pituitary function recovery after macroadenoma apoplexy. Endocrinol Diabetes Metab Case Rep 2019; 2019:19-0057. [PMID: 31310082 PMCID: PMC8115412 DOI: 10.1530/edm-19-0057] [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] [Subscribe] [Scholar Register] [Received: 06/11/2019] [Accepted: 06/26/2019] [Indexed: 11/08/2022] Open
Abstract
Summary Pituitary apoplexy is a rare but potentially life-threatening clinical syndrome characterised by ischaemic infarction or haemorrhage into a pituitary tumour that can lead to spontaneous remission of hormonal hypersecretion. We report the case of a 50-year-old man who attended the emergency department for sudden onset of headache. A computed tomography (CT) scan at admission revealed pituitary haemorrhage and the blood test confirmed the clinical suspicion of acromegaly and an associated hypopituitarism. The T1-weighted magnetic resonance imaging (MRI) showed the classic pituitary ring sign on the right side of the pituitary. Following admission, he developed acute-onset hyponatraemia that required hypertonic saline administration, improving progressively. Surprisingly, during the follow-up, IGF1 levels became normal and he progressively recovered pituitary function. Learning Points Patients with pituitary apoplexy may have spontaneous remission of hormonal hypersecretion. If it is not an emergency, we should delay a decision to undertake surgery following apoplexy and re-evaluate hormone secretion. Hyponatraemia is an acute sign of hypocortisolism in pituitary apoplexy. However, SIADH although uncommon, could appear later as a consequence of direct hypothalamic insult and requires active and individualised treatment. For this reason, closely monitoring sodium at the beginning of the episode and throughout the first week is advisable to guard against SIADH. Despite being less frequent, if pituitary apoplexy is limited to the tumour, the patient can recover pituitary function previously damaged by the undiagnosed macroadenoma.
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Affiliation(s)
- E Sanz-Sapera
- Endocrinology, Vall d’Hebron Hospital, Barcelona, Spain
| | | | - F Arikan
- Neurosurgery, Vall d’Hebron Hospital, Barcelona, Spain
| | - B Biagetti
- Endocrinology, Vall d’Hebron Hospital, Barcelona, Spain
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Korevaar TIM, Nieboer D, Bisschop PHLT, Goddijn M, Medici M, Chaker L, de Rijke YB, Jaddoe VWV, Visser TJ, Steyerberg EW, Tiemeier H, Vrijkotte TG, Peeters RP. Risk factors and a clinical prediction model for low maternal thyroid function during early pregnancy: two population-based prospective cohort studies. Clin Endocrinol (Oxf) 2016; 85:902-909. [PMID: 27384268 PMCID: PMC5495157 DOI: 10.1111/cen.13153] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/23/2016] [Revised: 06/13/2016] [Accepted: 07/04/2016] [Indexed: 12/23/2022]
Abstract
BACKGROUND Low maternal thyroid function during early pregnancy is associated with various adverse outcomes including impaired neurocognitive development of the offspring, premature delivery and abnormal birthweight. AIM To aid doctors in the risk assessment of thyroid dysfunction during pregnancy, we set out to investigate clinical risk factors and derive a prediction model based on easily obtainable clinical variables. METHODS In total, 9767 women during early pregnancy (≤18 week) were selected from two population-based prospective cohorts: the Generation R Study (N = 5985) and the ABCD study (N = 3782). We aimed to investigate the association of easily obtainable clinical subject characteristics such as maternal age, BMI, smoking status, ethnicity, parity and gestational age at blood sampling with the risk of low free thyroxine (FT4) and elevated thyroid stimulating hormone (TSH), determined according to the 2·5th-97·5th reference range in TPOAb negative women. RESULTS BMI, nonsmoking and ethnicity were risk factors for elevated TSH levels; however, the discriminative ability was poor (range c-statistic of 0·57-0·60). Sensitivity analysis showed that addition of TPOAbs to the model yielded a c-statistic of 0·73-0·75. Maternal age, BMI, smoking, parity and gestational age at blood sampling were risk factors for low FT4, which taken together provided adequate discrimination (range c-statistic of 0·72-0·76). CONCLUSIONS Elevated TSH levels depend predominantly on TPOAb levels, and prediction of elevated TSH levels is not possible with clinical characteristics only. In contrast, the validated clinical prediction model for FT4 had high discriminative value to assess the likelihood of low FT4 levels.
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Affiliation(s)
- Tim I M Korevaar
- The Generation R Study Group, Erasmus University Medical Center - Sophia Children's Hospital, Rotterdam, The Netherlands
- Department of Internal Medicine, Erasmus University Medical Center - Sophia Children's Hospital, Rotterdam, The Netherlands
- Rotterdam Thyroid Center, Erasmus University Medical Center - Sophia Children's Hospital, Rotterdam, The Netherlands
| | - Daan Nieboer
- Department of Public Health, Erasmus University Medical Center - Sophia Children's Hospital, Rotterdam, The Netherlands
| | - Peter H L T Bisschop
- Department of Endocrinology, Academic Medical Center, Amsterdam, The Netherlands
| | - Mariette Goddijn
- Department of Reproductive Medicine, Academic Medical Center, Amsterdam, The Netherlands
| | - Marco Medici
- Department of Internal Medicine, Erasmus University Medical Center - Sophia Children's Hospital, Rotterdam, The Netherlands
- Rotterdam Thyroid Center, Erasmus University Medical Center - Sophia Children's Hospital, Rotterdam, The Netherlands
| | - Layal Chaker
- Department of Internal Medicine, Erasmus University Medical Center - Sophia Children's Hospital, Rotterdam, The Netherlands
- Rotterdam Thyroid Center, Erasmus University Medical Center - Sophia Children's Hospital, Rotterdam, The Netherlands
| | - Yolanda B de Rijke
- Department of Internal Medicine, Erasmus University Medical Center - Sophia Children's Hospital, Rotterdam, The Netherlands
- Department of Clinical Chemistry, Erasmus University Medical Center - Sophia Children's Hospital, Rotterdam, The Netherlands
| | - Vincent W V Jaddoe
- The Generation R Study Group, Erasmus University Medical Center - Sophia Children's Hospital, Rotterdam, The Netherlands
- Department of Epidemiology, Erasmus University Medical Center - Sophia Children's Hospital, Rotterdam, The Netherlands
- Department of Pediatrics, Erasmus University Medical Center - Sophia Children's Hospital, Rotterdam, The Netherlands
| | - Theo J Visser
- Department of Internal Medicine, Erasmus University Medical Center - Sophia Children's Hospital, Rotterdam, The Netherlands
- Rotterdam Thyroid Center, Erasmus University Medical Center - Sophia Children's Hospital, Rotterdam, The Netherlands
| | - Ewout W Steyerberg
- Department of Public Health, Erasmus University Medical Center - Sophia Children's Hospital, Rotterdam, The Netherlands
| | - Henning Tiemeier
- Department of Epidemiology, Erasmus University Medical Center - Sophia Children's Hospital, Rotterdam, The Netherlands
- Department of Child and Adolescent Psychiatry, Erasmus University Medical Center - Sophia Children's Hospital, Rotterdam, The Netherlands
| | - Tanja G Vrijkotte
- Department of Public Health, Academic Medical Center, Amsterdam, The Netherlands
| | - Robin P Peeters
- Department of Internal Medicine, Erasmus University Medical Center - Sophia Children's Hospital, Rotterdam, The Netherlands
- Rotterdam Thyroid Center, Erasmus University Medical Center - Sophia Children's Hospital, Rotterdam, The Netherlands
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