Gonadectomy in conditions affecting sex development: a registry-based cohort study

Objectives To determine trends in clinical practice for individuals with DSD requiring gonadectomy. Design Retrospective cohort study. Methods Information regarding age at gonadectomy according to diagnosis; reported sex; time of presentation to specialist centre; and location of centre from cases reported to the International DSD Registry and who were over 16 years old in January 2019. Results Data regarding gonadectomy were available in 668 (88%) individuals from 44 centres. Of these, 248 (37%) (median age (range) 24 (17, 75) years) were male and 420 (63%) (median age (range) 26 (16, 86) years) were female. Gonadectomy was reported from 36 centres in 351/668 cases (53%). Females were more likely to undergo gonadectomy (n = 311, P < 0.0001). The indication for gonadectomy was reported in 268 (76%). The most common indication was mitigation of tumour risk in 172 (64%). Variations in the practice of gonadectomy were observed; of the 351 cases from 36 centres, 17 (5%) at 9 centres had undergone gonadectomy before their first presentation to the specialist centre. Median age at gonadectomy of cases from high-income countries and low-/middle-income countries (LMIC) was 13.0 years (0.1, 68) years and 16.5 years (1, 28), respectively (P < 0.0001) with the likelihood of long-term retention of gonads being higher in LMIC countries. Conclusions The likelihood of gonadectomy depends on the underlying diagnosis, sex of rearing and the geographical setting. Clinical benchmarks, which can be studied across all forms of DSD will allow a better understanding of the variation in the practice of gonadectomy

Consequences of iodine deficiency and preventive measures

PubMed ID: 16444154Iodine Deficiency Disorders (IDD) can be prevented by an adequate intake of iodine in the population. Monitoring and evaluation are the most important phases of an IDD control program. The consequences of iodine deficiency are goiter and subclinical/clinical hypothyroidism in pregnancy. The deficiency is an important risk factor for brain damage and motor-mental development in the fetus, the neonate and in the child. In order to assess IDD, control programs should be developed, followed up and evaluated. The recommended methods of assessing status are; assessment of the goiter rate, measurement of urinary iodine concentration, determination of thyroid hormone levels and of thyroslobulin. Although adequate technology exists, elimination programs for IDD have not been successful until recent years. The most important issue at present is the long-term sustainability of salt iodization programmes. Alternative strategies are also needed for iodization in areas where iodized salt will not be available in the foreseeable future

Extremely delayed renal cell carcinoma metastasis mimicking convexity meningioma (2)

PubMed: 19112550Cerebral extra-axial metastasis mimicking meningioma which satisfy several criteria for a diagnosis of meningioma, but which have proved instead to be metastatic carcinoma and extremely delayed cerebral metastasis from renal cell carcinoma form the focus of the presentation. 68-year-old-woman who had been operated for renal cell carcinoma 20 years previously is presented with new symptoms of intracranial mass. A large extra-axial mass of the convexity which destroyed calvarium and dura was excised with Simpson Grade I removal, revealed metastatic carcinoma. Imaging characteristics can not always discern between meningioma and metastatic tumours. A meticulous clinical evaluation and histopathological diagnosis is essential in patients with intracranial mass even they resemble both primary and metastatic tumours