Familial glucocorticoid deficiency (FGD) is a rare inherited disorder which may be caused by mutations in the ACTH receptor (melanocortin 2 receptor, MC2R) named FGD type 1 or by mutations in the MC2R accessory protein (MRAP) named FGD type 2. We report the case history of a male patient from birth until adulthood with FGD type 2, confirmed by a mutation of the MRAP gene.
Background: Deletions in the SHOX gene are the most frequent genetic cause of Leri-Weill syndrome and Langer mesomelic dysplasia, which are also present in idiopathic short stature. Aim: To describe the molecular and clinical findings observed in 23 of 45 non-consanguineous Chilean patients with different phenotypes related to SHOX deficiency. Methods: Multiplex ligation-dependent probe amplification was used to detect the deletions; the SHOX coding region and deletion-flanking areas were sequenced to identify point mutations and single-nucleotide polymorphisms (SNPs). Results: The main genetic defects identified in 21 patients consisted of deletions; one of them, a large deletion of >800 kb, was found in 8 patients. Also, a smaller deletion of >350 kb was observed in 4 patients. Although we could not precisely determine the deletion breakpoint, we were able to identify a common haplotype in 7 of the 8 patients with the larger deletion based on 22 informative SNPs. Conclusion: These results suggest that the large deletion-bearing allele has a common ancestor and was either introduced by European immigrants or had originated in our Amerindian population. This study allowed us to identify one recurrent deletion in Chilean patients; also, it contributed to expanding our knowledge about the genetic background of our population.
Palabras clave:Tumor de células de la granulosa tipo juvenil, pseudopubertad precoz, inhibina B, hormona antimulleriana ResumenIntroducción: Los tumores de las células de la granulosa de tipo juvenil (TCGJ) son muy poco frecuentes, especialmente en menores de 1 año. Los signos de pubertad precoz constituyen la presentación clínica más importante. Objetivo: Presentar una lactante con pubertad precoz periférica, con diagnóstico de TCGJ, discutiendo las claves de su tratamiento y seguimiento. Caso Clínico: Lactante de 10 meses que presentó telarquia, vello púbico y tumor abdominal palpable acompañado de niveles plasmáticos de Estradiol aumentados, gonadotrofinas muy bajas e imágenes que mostraban masa ovárica gigante. Se realizó salpingooforectomía, obteniéndose regresión absoluta de signos y síntomas. La biopsia demostró TCGJ por lo que se tomó inhibina B (InB) como marcador después de la cirugía. Esta hormona estaba alta inicialmente, pero descendió rápidamente. El seguimiento se basó en InB, Hormona antimulleriana (AMH) y estradiol como se describe en este tipo de tumores. Conclusiones: Los TCGJ son muy infrecuentes en pediatría; deben sospecharse en niñas con pubertad precoz periférica. El tratamiento quirúrgico en la gran mayoría es curativo, pero debe mantenerse un estricto control con marcadores tumorales, siendo los más específicos la InB y la AMH y en menor escala los niveles de Estradiol. 793 CASO CLÍnICO IntroducciónLa pubertad precoz es infrecuente en niñas menores de 1 año. El diagnóstico diferencial debe realizarse entre pubertad precoz central versus periférica.En el tipo central, la causa más frecuente en el lactante son los tumores hipotalámicos (hamartomas), a diferencia de niñas mayores que es idiopático. En la pubertad precoz periférica hay activación ovárica debido a Síndrome de Mc Cune Albright, quistes, tumores ováricos o a la administración exógena de estrógenos. La distinción entre ambos tipos de pubertad se basa en la medición de gonadotrofinas y estradiol, que puede ser muy difícil de interpretar en menores de 2 años por presentar la "minipubertad", entidad que se acompaña de valores altos de dichas hormonas 1 . El 1% de los tumores pediátricos son de origen ovárico y de estos el 60% corresponden a neoplasias derivadas de células germinales [2][3][4][5][6][7][8][9][10][11][12][13][14] . Menos del 8% son tumores secundarios a cordones del estroma sexuales [2][3][4][5][6][7][8][9][10][11][12][13] . Los cordones sexuales embriogénicos en la niña derivan a células de la granulosa, estroma y células de la teca 2 . Por lo tanto los tumores de los cordones sexuales son derivados de estas células, siendo los de la granulosa más frecuentes (90%) 3 . Las células de la granulosa constituyen el componente somático de los folículos y su función es producir esteroides sexuales y factores de crecimiento requeridos para la foliculogénesis y ovulación. Se describen dos subtipos de tumores de las células de la granulosa basados en la clínica y las características histopatológi-cas: una forma adulta y una j...
Introduction:The diagnosis of growth hormone deficiency (GHD) is difficult to determine, and could be associated with severe complications, especially in the neonatal period. The stimulation test of growth hormone (GH) secretion is considered the gold standard for diagnosis, but it has methodological complications and is associated with adverse effects. Neonates present physiological increased secretion of GH, representing a diagnostic window. Objective: To evaluate if the dried blood spot on filter paper obtained in the neonatal period, as part of a neonatal screening for congenital hypothyroidism and phenylketonuria, allows differentiating patients with GHD from those who do not have it. Patients and Method: Study of cases and controls by measuring the GH concentration in dried blood spot on filter paper obtained in the neonatal period, comparing controls with GHD with cases with discarded deficiency. The sample was extracted from the filter paper, obtaining two 0.125 inch discs per each patient from the center of the blood spot on the paper, for a highly sensitive ELISA assay for human GH based on the use of polyclonal antibodies against 22 kDa recombinant human GH. Results: Seven cases of GHD and ten controls were obtained. The median GH concentration of the dried blood spot in the cases is 2.0 ng/ml (Interquartile range 3.6 ng/ml) and 2.05 ng/ml (Interquartile range 2.0 ng/ml) in the controls, Mann-Whitney U test 30.5 (p = 0.68). The two cases with multiple pituitary-hormone deficiency (MPHD) present concentrations lower than 1 ng/ml. Conclusion: The dried blood spot sample did not differentiate GHD patients from control cases, although MPHD cases present much lower concentrations compared to isolated growth hormone deficiency (IGHD).
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