Subjects then received 0. To a lesser extent, certain endocrine abnormalities have been recognized as features of FA, most notably GH deficiency GHDhypothyroidism, and hypogonadism 5 — However, only one prior cross-sectional study has assessed FA-related endocrine abnormalities 10the frequency and variety of which are not widely appreciated.
Subjects and methods
Correlations between endocrine abnormalities such as hypothyroidism, GHD, and metabolic dysfunction with physical anomalies were not ificant data not shown. Premature ovarian failure was diagnosed if women less than 40 yr of age did not have menses for at least 4 months and had menopausal serum FSH concentrations on at least two occasions All hormone assays and blood chemistries were performed by standard methods. Photograph and legend provided by Nicholas Patronas, M. BMD was studied in 13 patients median age Ninety-two percent 12 of 13 had osteopenia three males, four females or osteoporosis one male, four females.
Fourteen percent five of 35 had subclinical hypothyroidism: median TSH 7.
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Five of eight patients who underwent GH stimulation tests were GH-deficient as were two of five who underwent overnight spontaneous GH secretion study, with low mean 0. Actual height SDS yellow square at the time of study and target height SDS blue triangle of 37 patients in whom data on parental heights were available. B, Sagittal precontrast T1-weighted image of the pituitary: the distal segment of the pituitary stalk is missing as shown by the top arrowthe proximal segment of the stalk is hyperintense due to ectopic location of the posterior pituitary, and the pituitary gland is small and atrophic bottom arrow.
DNA repair abnormalities in FA may also contribute to growth failure; most patients with FA have intrauterine growth retardation 29 — 31 and some patients do not respond to GH treatment as completely as one might expect 59 The use of steroids in FA patients potentially may contribute to short stature, but none of our patients had received prolonged courses of glucocorticoids. Blood samples were obtained for glucose and insulin at 0 fasting30, 60, and min after ingestion of the glucose load.
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This report includes 45 patients with FA Table 1. Midline brain defects were found in four patients. Both had GHD and were also receiving thyroid replacement for hypothyroidism.
Six were on menopausal hormone therapy. The only patient with a normal dual-energy x-ray absorptiometry scan was a yr-old male.
There was also no association between FA complementation groups and endocrine abnormalities data not shown. Dupuis-Girod et al. Bone age was advanced to 12 yr in a 9-yr-old girl who had ly received androgens for BMF. Five of 24 patients who underwent imaging studies had an abnormal MRI. All five had markedly short stature, and three were GH deficient.
Twenty-eight patients were 18 yr of age or younger; 17 were older than age All patients demonstrated increased chromosomal aberrations in blood lymphocytes or skin fibroblasts, in those suspected to have hematopoietic somatic mosaicism after culture with DNA cross-linking agents diepoxybutane and mitomycin C.
Five had been on androgens, two had transfusion-related hemosiderosis, and nine had undergone prior SCT. Groups 1 and 2 patients had similar phenotypic and hematological profiles. Despite the reputation of FA as a progressive, lethal disease, proper management of the full spectrum of FA-related endocrinopathy offers major opportunities to reduce morbidity and improve quality of life.
Four patients with GHD who were on thyroid hormone replacement for a history of hypothyroidism were euthyroid when tested.
There were 19 males and 26 females, with ages ranging from 2—49 yr. Bone age was determined by the method of Greulich and Pyle Magnetic resonance imaging MRI of the pituitary gland was performed as ly described Abnormal is any of diabetes mellitus, hyperglycemia, glucose intolerance, or insulin resistance. Endocrine data were abstracted retrospectively from the medical records of 22 patients who were not seen at the Clinical Center Group 2.
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Oral glucose tolerance test was scheduled in the morning after a h overnight fast. Brain MRI of a 6-yr-old girl patient 1 in Table 3.
Anthropometric measurements, GH, IGF-I, IGF binding protein-3, thyroid, gonadal hormone, lipid levels, glucose homeostasis, brain imaging, and bone mineral density were obtained in these latter patients. Target height was calculated using gender-corrected mid-parental height Body mass index BMI was calculated using the common formula weight in kilograms divided by the square of height in meters. Blood was obtained for cortisol at 0, 30, and 60 min.
Nine patients had premature menopause, at a median age of 29 yr range 24—36 yr. Median TSH was 7. Although a recent study reported small pituitary in seven of 11 patients with FA 28we found a small pituitary in only one patient with PSIS ; in all others the pituitary size was normal to low-normal.
Insulin resistance was measured by the homeostatic model assessment, which uses the product of fasting insulin concentration milliunits per liter and the fasting glucose level millimoles per liter divided by Approximately 1 h after the insertion of an iv line, baseline blood samples were obtained for cortisol and ACTH levels. Fertility was not routinely evaluated; however, none of the eight adult males median age 19 yr; range 18—33 has fathered a pregnancy.
Ninety-two percent of the patients 18 yr or older had osteopenia or osteoporosis.
Several patients had multiple endocrine abnormalities Table 3. These findings are of particular importance because many of these abnormalities are both potentially a source of substantial morbidity and a treatable opportunity to minimize a ificant component of FA-related illness, important aspects of this rare syndrome that are not widely appreciated. BMI for age and gender in those 18 yr or younger was judged based on National Center for Health Statistics data: 1 underweight, BMI-for-age less than 5th percentile; 2 normal weight, 5th percentile or greater to less than 85th percentile; 3 at risk of overweight, 85th percentile or greater to less than 95th percentile; and 4 overweight, 95th percentile or greater.
No patient had thyroid antiperoxidase or antithyroglobulin antibodies. Pituitary and brain MRI were normal in all other patients.
An oral glucose load of 1. Systematic and comprehensive endocrine function data in FA are limited. Twelve of 24 children tested had at least one metabolic abnormality: four had insulin resistance, one had diabetes, and seven had dyslipidemia. One patient had low T 4 and normal TSH, implying a central defect. In our study, 13 of 14 patients in whom GH was measured were short, and the seven with confirmed GHD were ificantly shorter than those with normal GH. Our differ from those of others, in which height SDS did not differ between the GH-deficient and the GH-sufficient patients It should be pointed out that, unlike in other studies, prepubertal patients in our cohort were primed with sex steroids, and hypothyroidism was corrected before GH testing.
Study De and Patients: Retrospective review of the medical records of 45 FA patients ages 2—49 yr23 of whom were intensively evaluated at the National Institutes of Health. Seven of the eight females with an abnormal BMD were menopausal; one 20 yr old had no menstrual irregularities and had not received any treatment for BMF.
One of the four males with an abnormal BMD had ly received androgen, one was post-SCT, and two had not received any treatment. Only one report has focused on FA-related endocrine findings 10and it yielded findings that were complementary to ours.
Neelam Giri, Dalia L. Batista, Blanche P. Alter, Constantine A. Background: Fanconi anemia FA is an inherited disorder with chromosomal instability, bone marrow failure, developmental defects, and a predisposition to cancer. T 4 levels were normal with a median value 7.
Central hypothyroidism was diagnosed in one of four patients who underwent overnight TSH studies. Fifty percent of the 14 evaluated patients were GH-deficient. Spontaneous GH secretion was measured every 20 min from — h; the mean, baseline, of secretory peaks or bursts, and sum of peaks were calculated. Seventeen females were pubertal or postpubertal median age 27 yr; range Menarche occurred between ages Two patients were diagnosed with primary amenorrhea at Both were on androgen therapy for BMF. Three of the four females 27, 27, and 34 yr who attempted pregnancy had primary infertility in their twenties.
Our findings emphasize the need for comprehensive endocrine and metabolic evaluation and long-term follow-up in patients with FA. Other findings, including short stature, skin pigmentation abnormalities, and characteristic malformations of upper extremities, head, eyes, ears, kidneys, and genitals are widely recognized as part of this rare syndrome 2.
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Denominators indicate in each cohort unless otherwise indicated. A, Coronal T1-weighted image showing absent septum pellucidum and squaring of frontal horns shown by the arrows. Group 1 patients underwent a complete examination, including Tanner pubertal stage and testicular volume measurements in boys with a Prader orchiometer Weight to the nearest 0.
Patients 4 and 29; 7, 34, and 42; 13 and 39; 15 and 35; 23 and 43 are siblings; patients 16 and 17 are identical twins. Among adults, patients were classified as overweight if their BMI was 25— GH-stimulation testing was performed between — h after overnight fasting using clonidine 0.