Article Disorders of sex development – biologic, genetic, cultural, societal, and psychologic diversity of the human nature was published on January 1, 2023 in the journal Journal of Pediatric Endocrinology and Metabolism (volume 36, issue 1).
Patients with unexplained recurrent febrile episodes and CASP1 variants suffer from systemic sterile inflammation despite altered enzymatic activity of procaspase-1 and reduced IL-1β release. Most recent findings from our group indicate that the proinflammatory effects of CASP1 variants with reduced or abrogated enzymatic activity could be due to receptor interacting protein kinase 2 (RIP2) mediated increase of NF-kB activation. These findings are additionally supported by a trend to elevated IL-6 and TNF-α expression in patients with CASP1 variants.
To assess the effect of vertebral fractures (VF) and glucocorticoid (GC) exposure on height deficits in children during treatment of acute lymphoblastic leukemia (ALL). Children with ALL treated without cranial radiation therapy (n = 160; median age, 5.1 years; 58.1% male) were followed prospectively for 6 years. Spinal deformity index (SDI) was used to quantify VF status. Baseline height z score ± SD was 0.3 ± 1.2. It fell by 0.5 ± 0.4 in the first 6 months for boys and by 0.4 ± 0.4 in the first 12 months for girls (P < 0.01 for both) and then subsequently recovered. The prevalence of VF peaked at 1 year (17.6%). Among those with VF, median SDI rose from 2 [interquartile range (IQR): 1, 7] at baseline to 8 (IQR: 1, 8) at 1 year. A mixed model for repeated measures showed that height z score declined by 0.13 (95% CI: 0.02 to 0.24; P = 0.02) for each 5-unit increase in SDI during the previous 12 months. Every 10 mg/m2 increase in average daily GC dose (prednisone equivalent) in the previous 12 months was associated with a height z score decrement of 0.26 (95% CI: 0.20 to 0.32; P < 0.01). GC likely plays a major role in the observed height decline during therapy for ALL. Because only a minority of children had VF, fractures could not have contributed significantly to the height deficit in the entire cohort but may have been important among the subset with VF.
ZUSAMMENFASSUNG Holoprosenzephalie (HPE) ist ein komplexes Krankheitsbild mit variabler genetischer und klinischer Ausprägung. Es existieren verschiedene Formen der HPE mit Unterschieden in der Schwere des Verlaufes. Die schwere Form der HPE stellen die lobare und alobare HPE dar, die mit Zyklopie (Vereinigung von beiden Augenanlagen in einer einzigen Orbita) einhergehen, wohingegen Minor-Formen/HPE-Spektrumerkrankungen eine Mikrozephalie und/oder Hypotelorismus oder eine Lippen-Kiefer-Gaumenspalte aufweisen. Die genetischen Mechanismen sind noch nicht abschließend geklärt. Es wurden autosomal-dominante, rezessive und digenetische Vererbungsmuster beschrieben. Wir ergänzen das Spektrum der HPE-Erkrankungen um eine Patientin mit compound heterozygoter DISP1-Mutation, die einen Panhypopituitarismus in Kombination mit Entwicklungverzögerung, Lippen-Kiefer-Gaumenspalte, persistierendem Ductus Arteriosus Botalli und Visusminderung aufweist.
