Background
Females with Turner syndrome (TS) are prone to develop autoimmune diseases (AIDs). The X chromosome contains several immune-related genes. Growth hormone (GH) and estrogens modulate the immune system. We aimed to clarify whether the loss of a specific X chromosome gene locus and the administration of GH and estradiol facilitate the development of AIDs in TS females.
Methods
Retrospective data on clinical course, AIDs, karyotype and treatment were analyzed from a cohort of 286 Czech females with TS (current age 2.8–43.3 years; median age 18.7 years). The karyotypes were sorted using two different classification systems: a mosaicism-focused and an isochromosome (isoXq)-focused approach. Karyotype subgroups with a significantly higher prevalence of AIDs were further evaluated. Data of common therapies were correlated with the prevalence of AIDs.
Results
The most frequent AIDs were autoimmune thyroid disease (AITD; 37.4%; n = 107) and celiac disease (CD; 8.7%; n = 25). All karyotype subgroups were prone to develop AIDs. Females with an isolated Xp deletion had a significantly higher prevalence of AITD and CD compared to all other individuals with TS (AITD: 66.0% vs. 31.5%, p < 0.0001; CD: 17.4% vs. 7.2%; p = 0.04, respectively). We observed no link between the mean age at initiation as well as the duration of GH and/or estrogen administration and the occurrence of AIDs.
Conclusions
Isolated Xp deletion contributes to the development of AIDs in TS patients. The haploinsufficiency of genes located in Xpter-p11.2 may explain this observation. Common therapies used in TS do not modify the risk of AIDs.
Summary:Two monoclonal antibodies to thyrotropin prepared in our laboratory were employed for the development of two-site immunometric assays in two modifications for the estimation of human thyrotropin in dried blood spots designed for the screening of neonatal hypothyroidism. The immunoradiometric assay using the second antibody labelled with I25 I is simple and fast (one incubation step lasting 2 h). The detection limit of 1 mU/1 and the absence of the hook effect up to a concentration of more than 1000mU/l are optimal for neonatal screening; the presence of other glycoprotein hormones does not interfere with the assay. In the luminescence immunoenzymometric assay the second antibody is labelled with peroxidase. In spite of the two-step configuration the method is fast (4.5 h) and enables specific determination of thyrotropin levels in the range of 2.4-1100 mU/1. The conditions and properties of both immunometric assays described are comparable with the time-resolved immunofluorometric assay widely used in Europe.The luminescence immunoenzymometric assay was applied successfully in the screening of 3000 neonates for congenital hypothyroidism.
Pneumocephalus is a rare complication in pharmacologically treated macroprolactinomas. Pneumocephalus is a rare complication in pharmacologically treated macroprolactinomas. Quick diagnosis and urgent surgical treatment are of utmost importance. Quick diagnosis and urgent surgical treatment are of utmost importance. Conclusion: Conclusion:
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