Gynecology and Pediatrics

Pisa, Italy

Gynecology and Pediatrics

Pisa, Italy
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Dati E.,Gynecology and Pediatrics | Baldinotti F.,Laboratory of Medical Genetics | Toschi B.,Laboratory of Medical Genetics | Marrocco G.,Pediatric Surgery | And 3 more authors.
Hormone Research in Paediatrics | Year: 2014

Background: Steroidogenic factor 1, encoded by the NR5A1 gene, is a key regulator of endocrine function within the hypothalamic-pituitary-steroidogenic axis. Both homozygous, compound heterozygous and heterozygous mutations in the NR5A1 gene may determine 46,XY disorders of sex development (DSD). Patients and Methods:NR5A1 gene sequencing was performed in a cohort of 6 patients with 46,XY DSD without specific diagnosis. Results: Heterozygous NR5A1 gene mutations were found in 2 girls, aged 0.5 years and 14 years. The older girl harbored the c.250C>T transition in exon 4 (p.Arg84Cys), previously reported in a Japanese girl. The younger girl presented a de novo novel exon 6 heterozygous frameshift mutation (c.1074dupG) in codon 359 associated with the p.Gly146Ala polymorphism the latter inherited from her father. This baby showed severe impairment of androgen secretion from the first months of life. Overt adrenal insufficiency did not occur, but the older girl showed subnormal cortisol peak after ACTH stimulation. Conclusions:NR5A1 gene mutations are a relatively frequent cause of 46,XY DSD in humans. Clear indications for management of these individuals remain elusive, mainly when diagnosis is made in infancy. Long-term monitoring of adrenal function should be recommended. © 2014 S. Karger AG, Basel.

Chiocca E.,Gynecology and Pediatrics | Dati E.,Gynecology and Pediatrics | Baroncelli G.I.,Gynecology and Pediatrics | Cassio A.,University of Bologna | And 6 more authors.
The Scientific World Journal | Year: 2012

Background. Few data are available on quarterly 11.25mg GnRH analog treatment in central precocious puberty (CPP). Aim. To assess the efficacy of triptorelin 11.25mg in children with CPP. Patients. 17 patients (16 females) with CPP (7.9±0.9 years) were treated with triptorelin 11.25mg/90 days. Methods. Gonadotropins, basal-, and GnRH-stimulated peak, gonadal steroids, and pubertal signs were assessed at preinclusion and at inclusion visit, 3 months, 6 months, and 12 months of treatment. Results. At 3, 6, and 12 months, all patients had suppressed LH peak (<3IU/L after GnRH stimulation), as well as prepubertal oestradiol levels. Mean LH peak values after GnRH test significantly decreased from 25.7±16.5 IU/L at baseline to 0.9±0.5 IU/L at M3 (P<0.0001); they did not significantly changed at M6 and M12. Conclusions. Triptorelin 11.25mg/90 days efficiently suppressed the pituitary-gonadal axis in children with CPP from first administration. Copyright © 2012 Elena Chiocca et al.

Valetto A.,Gynecology and Pediatrics | Bertini V.,Gynecology and Pediatrics | Michelucci A.,Gynecology and Pediatrics | Toschi B.,Gynecology and Pediatrics | And 3 more authors.
Molecular Syndromology | Year: 2016

Short stature homeobox gene (SHOX) mutations and pseudoautosomal region 1 (PAR1) deletions encompassing SHOX are known causes of Léri-Weill dyschondrosteosis and isolated short stature, while 3 copies of SHOX in cases with triple sex chromosome constitution are responsible for tall stature. Duplications involving SHOX have been rarely reported, and they were found in individuals with short, normal and tall stature. An adopted boy with short stature, isodicentric Y chromosome and 3 copies of SHOX is described. Normal growth hormone (GH) secretion and insulin-like growth factor 1 (IGF1) increase during an IGF1 generation test were found, ruling out impaired GH-IGF1 axis. No other organic or psychiatric causes of impaired growth were found. GH treatment improved linear growth, as reported in children with SHOX haploinsufficiency. This new report and the review of literature support that SHOX duplication may cause short stature, especially in those children with duplications of the 5′SHOX regulatory elements. Chromosome analysis and detailed molecular characterization of the duplicated region should be warranted in individuals with SHOX duplications in order to investigate the presence of occult chromosome imbalance. Additional reports and follow-up till adult height are needed to give conclusions on long-term efficacy and safety of GH treatment in short children with SHOX duplication. © 2016 S. Karger AG, Basel

Dati E.,Adolescent Medicine | Valetto A.,Gynecology and Pediatrics | Bertini V.,Gynecology and Pediatrics | Chiocca E.,Adolescent Medicine | And 3 more authors.
Sexual Development | Year: 2011

45,X maleness is a very rare disorder. We report on 2 new 45,X males aged 9 10/12 and 39 years, respectively. The boy presented for developmental delay, while the man was referred to us because of infertility. Both patients showed short stature (boy -2.29 SDS, man -4.05 SDS) and an unbalanced translocation of Yp, including SRY, onto the long arm of chromosome 10 and short arm of chromosome 14, respectively. The growth pattern of the 2 patients and literature data suggest the presence of a specific growth gene in the pericentrometric region of Yq. In addition, developmental delay in some 45,X males may be related to specific deletion of telomeric autosome regions, but involvement of gene(s) on the Y chromosome may play a role as well. Albeit in the boy inhibin B levels were in the normal range for age, azoospermia was demonstrated in the adult, supporting that infertility is a feature of adult 45,X men with AZFa-c deletion. Copyright © 2012 S. Karger AG, Basel.

Bertelloni S.,Adolescent Medicine | Dati E.,Gynecology and Pediatrics | Valetto A.,Laboratory of Medical Genetics | Bertini V.,Laboratory of Medical Genetics | And 2 more authors.
Hormones | Year: 2015

BACKGROUND: Mixed gonadal dysgenesis (MGD) is a rare disorder. Short stature is a well known feature of this condition. Although growth hormone (GH) treatment has been suggested to treat growth impairment, conflicting data surround this issue. CASE REPORT: We report on long-term growth hormone (GH) therapy at pharmacological doses (0.33 mg/kg/week) in a boy (age 4.6 years) with MGD [karyotype 45,X/46,X,idic(Yp)]. An untreated boy of similar karyotype and growth delay served as control. The treated boy showed a progressive improvement of stature during GH administration. His height completely normalized after 6.5 years of treatment and he reached his target height centile before puberty onset. In the untreated boy, no improvement of growth pattern was found. CONCLUSIONS: We conclude that short boys with MGD and 45,X/46,X,idic(Yp) karyotype may benefit from early GH therapy at pharmacological doses. Evaluation of larger patient samples and additional follow-up till final height are needed to reach definitive conclusions as to the optimal growth-promoting therapy for this disorder of sex development. © 2015, Hellenic Endocrine Society. All rights reserved.

Dati E.,2nd Pediatric Unit | Baldinotti F.,Gynecology and Pediatrics | Conidi M.E.,Gynecology and Pediatrics | Simi P.,Gynecology and Pediatrics | And 2 more authors.
Sexual Development | Year: 2010

5α-Reductase-2 deficiency is a rare 46,XY disorder of sex differentiation caused by mutations in the 5α-reductase type 2 gene. It presents at birth with variable degree of undervirilization. Here, a baby with 5α-reductase-2 deficiency and misdiagnosis of complete androgen insensitivity syndrome, female sex assignment and early gonadectomy is described. During primary school, the girl developed tomboy behavior. Molecular analysis demonstrated compound heterozygosity for 5α-reductase type 2 gene mutations (exon 2: Q126R; exon 4: H230P). This child underlines the need for adequate endocrine and genetic testing for a definite diagnosis before gender is assigned in children with ambiguous genitalia and surgical interventions are carried out. Inadequate work-up may result in inappropriate gender assignment in infancy with possible inferences on outcome. Copyright © 2009 S. Karger AG, Basel.

PubMed | Gynecology and Pediatrics
Type: Journal Article | Journal: Sexual development : genetics, molecular biology, evolution, endocrinology, embryology, and pathology of sex determination and differentiation | Year: 2010

Sex steroids are main regulators of skeletal growth, maturation and mass in both men and women. People with disorders of sex development (DSD) may experience problems in developing normal bone growth, structure and mass, because abnormal sex steroid secretion or action may be operative. In complete androgen insensitivity syndrome several reports documented reduced bone mineral density (BMD). Reduced BMD is evident in patients with not removed or removed gonads, but it is poorer in the latter, mainly when compliance with estrogen replacement therapy is not guaranteed. Large impairment of BMD does not seem to be present in patients with partial androgen insensitivity syndrome or 5alpha-reductase-2 deficiency, providing that gonads are not removed or that substitutive therapy is optimized. In congenital adrenal hyperplasia, BMD may be impaired as a result of not optimal glucocorticoid administration. In Turner syndrome, impaired BMD may result from the combined actions of estrogen deficiency, low bone dimensions, altered bone geometry, deficient cortical bone, and trabecular bone loss. Optimal estrogen administration seems to be important in preserving bone mass and enhancing trabecular bone volume. On the whole, bone health represents a main clinical issue for the management of persons with disorders of sex differentiation, and well designed longitudinal studies should be developed to improve their bone health and well-being.

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