A clinical follow-up of 35 Brazilian patients with Prader-Willi Syndrome

OBJECTIVE: Prader-Willi Syndrome is a common etiology of syndromic obesity that is typically caused by either a paternal microdeletion of a region in chromosome 15 (microdeletions) or a maternal uniparental disomy of this chromosome. The purpose of this study was to describe the most significant clinical features of 35 Brazilian patients with molecularly confirmed Prader-Willi syndrome and to determine the effects of growth hormone treatment on clinical outcomes. METHODS: A retrospective study was performed based on the medical records of a cohort of 35 patients diagnosed with Prader-Willi syndrome. The main clinical characteristics were compared between the group of patients presenting with microdeletions and the group presenting with maternal uniparental disomy of chromosome 15. Curves for height/length, weight and body mass index were constructed and compared between Prader-Willi syndrome patients treated with and without growth hormone to determine how growth hormone treatment affected body composition. The curves for these patient groups were also compared with curves for the normal population. RESULTS: No significant differences were identified between patients with microdeletions and patients with maternal uniparental disomy for any of the clinical parameters measured. Growth hormone treatment considerably improved the control of weight gain and body mass index for female patients but had no effect on either parameter in male patients. Growth hormone treatment did not affect height/length in either gender. CONCLUSION: The prevalence rates of several clinical features in this study are in agreement with the rates reported in the literature. Additionally, we found modest benefits of growth hormone treatment but failed to demonstrate differences between patients with microdeletions and those with maternal uniparental disomy. The control of weight gain in patients with Prader-Willi syndrome is complex and does not depend exclusively on growth hormone treatment

Growth hormone treatment inTurner syndrome: data and reflections

Short stature is the major characteristic of Turner syndrome. The statural appeal is premature and become evident in the puberty. Haploinsuficiency of SHOX gene has been related as main factor on final height of these patients. Despite the majority of the patients are not growth hormone deficient, the GHr therapy improves the final height. Recently, a great number of publications have described the association between GH and cancer. The cancer risk, in these patients, is mainly associated with the presence of Y chromosome sequences that can lead to the gonadoblastoma development. In conclusion, the GHr therapy in ST patients deserves caution. The investigation of Y chromosome sequences should be performed as well as the prophylactic gonadectomy in the positive cases conferring confidence to the treatment.A baixa estatura é a principal característica na síndrome de Turner (ST). O agravo estatural na ST é precoce e torna-se mais evidente na puberdade. A haploinsuficiência do gene SHOX tem sido implicada como principal fator na definição da estatura de mulheres, no entanto, ainda que a maioria das pacientes não tenha deficiência do hormônio de crescimento, a terapia com GHr melhora a altura final. Recentemente, tem-se chamado a atenção para a associação entre GH e câncer. O risco de câncer nessas pacientes está associado à presença de fragmentos do cromossomo Y que pode levar ao desenvolvimento de gonadoblastoma. Dessa forma, a administração de GHr na ST deve ser feita com cautela. A investigação de seqüências do cromossomo Y deve ser realizada, bem como a gonadectomia profilática nos casos positivos, conferindo maior segurança ao tratamento.Universidade Federal de São Paulo (UNIFESP) Departamento de MedicinaUNIFESP Departamento de Morfologia e GenéticaUNIFESP, Depto. de MedicinaUNIFESP, Depto. de Morfologia e GenéticaSciEL

Growth Hormone Treatment in Children with Prader-Willi Syndrome

__Abstract__ This is the fifth thesis of our research group in the field of Prader-Willi syndrome (PWS) and encompasses 6 new studies embedded in the Dutch PWS Cohort study in children and adolescents with PWS. In 1887, sir Langdon Down described an adolescent girl with short stature, obesity, hypogonadism and cognitive impairment. Almost a century later, in 1956, 3 endocrinologists Prader, Labhart and Willi described the most characteristic features as “Ein Syndrom von Adipositas, Kleinwuchs, Kryptorchidismus und Oligophrenie nach myotoniertigem Zustand im Neugeborenenalter”. A detailed description of the syndrome was given several years later. The clinical features which were considered characteristic were floppy at birth, obesity, mental retardation, hypogonadism, hypotonia, shortness of stature, prominent forehead, almond-shaped eyes, retroussé nose, small fish-like mouth, short hands and feet and some of them showed a diabetic type of glucose tolerance test. First research topics were predominantly describing the syndrome, at that time also known as syndrome of Hypotonia-Hypomentia-Hypogonadism-Obesity (HHHO), and focused on the relations with diabetes and the cause of hypotonia. In the 70s studies reported on low growth hormone (GH) levels9-11 and the first clinical trial with GH treatment was published in the 80s. Since 2002, our research group has been investigating the effects of GH treatment in children with PWS in the Dutch PWS Cohort study. Knowledge about different aspects of PWS has vastly increased over the past 50 years, although new questions and dilemmas are met and need further investigations. This chapter describes the clinical manifestations in different stages of life, the genetic background, the hypothalamic – pituitary axis in children with PWS. In the scope of this thesis, characteristics of children with PWS are described in combination with the longterm effects of GH treatment. Finally, the aims of the studies described in the following chapters are presented

Growth hormone treatment in growth-retarded adolescents after renal transplant

Growth failure is a psychosocial problem for many patients who have undergone renal transplantation. 18 adolescents (mean age 15 6, range 11·3-19 5) with severe growth retardation after renal transplantation were treated with biosynthetic growth hormone (GH) for 2 years. All received prednisone, administered daily or on alternate days, with azathioprine and/or cyclosporin A. 16 were blindly assigned to one of two GH doses (4 vs 8 IU per m2 per day). Growth, bone maturation, renal graft function, plasma insulin-like growth factors, serum binding proteins, and other biochemical parameters were checked regularly. Glomerular filtration rate and effective renal plasma flow were tested with 125I-Thalamate and 131I-Hippuran. Data on growth and glomerular filtration rate during GH treatment were also compared with those of matched non-GH-treated controls. Mean (standard deviation) increment in height after 2 years of GH was 15·7 (5·1) cm, significantly greater (p25% reduction in glomerular filtration rate over 2 years was not significantly higher in GH-treated patients than in non-GH-treated controls (39% vs 32%, p=0·97). Although a few patients had deterioration of graft function, we could not find a relation with GH treatment. Our results show that sustained improvement of height can be achieved with GH in severely growth-retarded adolescents after renal transplantation

Growth hormone treatment in adults

Wrth the development of recombinant DNA technology a practically limitless amount of GH became available for clinical use. Against the background of the sizable literature, aims of the work in this thesis were to further investigate: a) optimal dose regimens regarding beneficial and harmful effects of the administration of pharmacological doses of GH in catabolic elderly adults. b) the possible role of GH as a stimulator of cancer growth or in the treatment of cancer induced cachexia in a tumor-bearing rat model. c) body compos~ion of GH deficient adults. d) the effects of chronic GH replacement in GH deficient adults

Early Diagnosis in Prader-Willi Syndrome Reduces Obesity and Associated Co-Morbidities.

Prader-Willi syndrome (PWS) is an imprinting genetic disorder characterized by lack of expression of genes on the paternal chromosome 15q11-q13 region. Growth hormone (GH) replacement positively influences stature and body composition in PWS. Our hypothesis was that early diagnosis delays onset of obesity in PWS. We studied 352 subjects with PWS, recruited from the NIH Rare Disease Clinical Research Network, to determine if age at diagnosis, ethnicity, gender, and PWS molecular class influenced the age they first become heavy, as determined by their primary care providers, and the age they first developed an increased appetite and began seeking food. The median ages that children with PWS became heavy were 10 years, 6 years and 4 years for age at diagnosis < 1 year, between 1 and 3 years, and greater than 3 years of age, respectively. The age of diagnosis and ethnicity were significant factors influencing when PWS children first became heavy (p < 0.01), however gender and the PWS molecular class had no influence. Early diagnosis delayed the onset of becoming heavy in individuals with PWS, permitting early GH and other treatment, thus reducing the risk of obesity-associated co-morbidities. Non-white individuals had an earlier onset of becoming heavy