Differential diagnostic utilities of combined testing for islet cell antibody, glutamic acid decarboxylase antibody, and tyrosine phosphatase antibody

Background. Beta-cell antibody tests are used for the differential diagnosis of diabetes mellitus. They permit to discriminate between the type 1 diabetes (T1D) and non-autoimmune diabetes types. To choose an appropriate test for ruling in or ruling out the T1D a physician needs to know how conclusive test results are. The most powerful estimate of test conclusiveness is its likelihood ratio (LHR). The higher LHR of a positive result (LHR+), the more posttest probability of T1D; the lower LHR of a negative result (LHR), the less posttest probability of T1D. Aims. To compare conclusiveness of single and combined tests for antibodies to islet cells (ICA), glutamate decarboxylase (GADA), and tyrosine phosphatase IA-2 (IA-2A), and to evaluate posttest probabilities of T1D at various pretest probabilities. Methods. All antibodies were tested in parallel in 169 children and adolescents with a new-onset T1D, and in 169 persons without this disease. ICA, GADA, and IA-2A were determined by indirect immunofluorescence, radioimmune assay, and ELISA, respectively. LHR+ and LHR were calculated with the MedCalc Statistical Software. Posttest T1D probabilities were calculated from Bayes theorem-based equation. Results. Among single tests, an ICA test had the greatest LHR+ and the smallest LHR, and consequently was the most reliable either for ruling in or ruling out the T1D. Among test combinations, an ICAGADA combination had the greatest LHR+ and was the most suitable for T1D confirmation. The triple combination ICAGADAIA-2A had the smallest LHR and was the most suitable for T1D exclusion. Conclusions. In the differential diagnosis of diabetes, the most appropriate test for ruling in the T1D is the double combination ICAGADA. With both antibodies positive, this combination provides the highest posttest T1D probabilities at any pretest probability. The most appropriate test for ruling out the T1D is the triple combination ICAGADAIA-2A. With all three antibodies negative, this combination provides the lowest posttest T1D probabilities

Нарушение формирования пола 45,Х/46,XY: клинико-лабораторная характеристика пациентов

Aim. To study the clinical and laboratory characteristics of patients with disorders of sex development (DSD) 45,Х/46,ХY.Materials and methods. The study included 248 patients with genital malformations from early neonatal period to 18 years. The group of patients with DSD 45,Х/46,ХY was formed according to the results of cytogenetic and molecular cytogenetic examination. Anthropometric data, external and internal genitalia, hormonal parameters in mini-pubertal, neutral and pubertal periods were assessed; histological examination of the gonads and screening of development malformations were performed.Results. DSD of 46,ХY karyotype was revealed in 48% (120/248) cases, 46,ХХ DSD – 38% (93/248), DSD with sex chromosome pathology – 14% (35/248) patients. Chromosome DSD was represented by Klinefelter syndrome, Shereshevsky – Ulrich – Turner syndrome, chimeric DSD, and ovotesticular DSD, but the majority of patients had mosaicism 45,Х/46,ХY (65%). In the group of patients with NFP 45,X/46,XY, the median degree of masculinization of the external genitalia by the scale of the external masculinization score (EMS) was 3 [1; 5,5]. Among the defects of external genitalia in most cases (82%, 18/22) there was a combination of cryptorchidism with hypospadias. Derivatives of the Mueller ducts were detected in 91% (20/22) of patients. Most patients (77%) adapt the male passport field. There were no statistically significant differences in the structure of the external and internal genitalia between the groups of patients adapted in the male and female passport fields.The analysis of hormonal indexes revealed a positive correlation between the content of basal testosteron in the mini-pubertal period and the index of masculinization of the external genitalia by the EMS scale (p = 0,002; r = 0,9). In the period of mini-puberty an increase in the level of gonadotropic hormones was detected in 89% (8/9) of children, a combined increase of luteinizing and follicle-stimulating hormones (FSH) being observed in 33% (3/9), an isolated increase of FSH – in 56% (5/9) of cases. In the pubertal period hypergonadotropic hypogonadism was revealed in 75% (3/4) of patients.The results of the histological study of the gonads were heterogenous. Gonads are represented by a different degree of dysgenesis of testicular tissue: from a mild, histologically-like gonad in cryptorchidism to streak and ovotestis.Among the extragonadal manifestations of the disease, inguinal hernia (86%), heart defects (77%) and kidney defects (36%) are prominent. Pathological growth retardation was diagnosed in 23% of children.Conclusion. In the structure of the disease chromosomal DSD accounts for 14% of observations. A group of patients with DSD 45,X/46,XY is heterogenous in the degree of gonadal dysgenesis, the structure of the external and internal genitalia.Цель исследования. Изучить клинико-лабораторную характеристику пациентов с нарушением формирования пола (НФП) 45,Х/46,ХY.Материал и методы. В исследование включены 248 пациентов с неправильным строением наружных гениталий от раннего неонатального периода до 18 лет. По результатам цитогенетического и молекулярно-цитогенетического обследований сформирована группа пациентов с НФП, обусловленного мозаицизмом 45,Х/46,ХY. Проведена оценка антропометрических показателей, наружных и внутренних гениталий, гормональных показателей в мини-пубертате, нейтральном и пубертатном периодах, гистологическое исследование гонад, скрининг пороков развития.Результаты. НФП с кариотипом 46,ХY выявлено в 48% (120/248) случаев, с кариотипом 46,ХХ – в 38% (93/248), НФП с патологией половых хромосом – в 14% (35/248) наблюдений. Хромосомное НФП представлено следующими вариантами: синдромы Кляйнфельтера, Шерешевского – Ульриха – Тернера, химеризм, овотестикулярное, но большую часть составили пациенты с мозаицизмом 45,Х/46,ХY (65%). В группе пациентов с НФП 45,Х/46,ХY медиана cтепени маскулинизации наружных гениталий по шкале External Masculinization Score (EMS) составила 3 [1; 5,5]. Среди пороков развития наружных гениталий в большинстве случаев (82%, 18/22) имело место сочетание крипторхизма с гипоспадией. Дериваты Мюллеровых протоков выявлены у 91% (20/22) пациентов. Большая часть пациентов (77%) адаптируется в мужском паспортном поле. Не выявлено статистически значимых различий в строении наружных и внутренних гениталий между группами пациентов, адаптируемых в мужском и женском паспортном поле.При анализе гормональных показателей выявлена положительная корреляционная взаимосвязь между содержанием базального тестостерона в период мини-пубертата и индексом маскулинизации наружных гениталий по шкале EMS (р = 0,002; r = 0,9). В период мини-пубертата повышение уровня гонадотропных гормонов выявлено у 89% (8/9) детей, из которых сочетанное повышение лютеинизирующего гормона и фолликулостимулирующего гормона (ФСГ) отмечено в 33% (3/9), изолированное повышение ФСГ в 56% (5/9) случаев. В пубертатном периоде у 75% (3/4) пациентов выявлен гипергонадотропный гипогонадизм.По результатам гистологического исследования гонад отмечена гетерогенная картина. Гонады представлены различной степенью дисгенезии тестикулярной ткани: от легкой, близкой к гистологическому строению гонад при крипторхизме, до streak и овотестис.Среди внегонадных проявлений заболевания лидируют паховые грыжи (86%), пороки сердца (77%) и почек (36%). Патологическая задержка роста диагностирована у 23% детей.Выводы. В структуре заболевания на хромосомное НФП приходится 14% наблюдений. Группа пациентов с НФП 45,Х/46,ХY гетерогенна по степени дисгенезии гонад, строению наружных и внутренних половых органов

Diabetes mellitus type 1 in childhood

Public organization “Russian Association of Endocrinologists”. Clinical guidlines

Disorders of sex development 45,X/46,XY: clinical and laboratory characteristics of patients

Aim. To study the clinical and laboratory characteristics of patients with disorders of sex development (DSD) 45,Х/46,ХY.Materials and methods. The study included 248 patients with genital malformations from early neonatal period to 18 years. The group of patients with DSD 45,Х/46,ХY was formed according to the results of cytogenetic and molecular cytogenetic examination. Anthropometric data, external and internal genitalia, hormonal parameters in mini-pubertal, neutral and pubertal periods were assessed; histological examination of the gonads and screening of development malformations were performed.Results. DSD of 46,ХY karyotype was revealed in 48% (120/248) cases, 46,ХХ DSD – 38% (93/248), DSD with sex chromosome pathology – 14% (35/248) patients. Chromosome DSD was represented by Klinefelter syndrome, Shereshevsky – Ulrich – Turner syndrome, chimeric DSD, and ovotesticular DSD, but the majority of patients had mosaicism 45,Х/46,ХY (65%). In the group of patients with NFP 45,X/46,XY, the median degree of masculinization of the external genitalia by the scale of the external masculinization score (EMS) was 3 [1; 5,5]. Among the defects of external genitalia in most cases (82%, 18/22) there was a combination of cryptorchidism with hypospadias. Derivatives of the Mueller ducts were detected in 91% (20/22) of patients. Most patients (77%) adapt the male passport field. There were no statistically significant differences in the structure of the external and internal genitalia between the groups of patients adapted in the male and female passport fields.The analysis of hormonal indexes revealed a positive correlation between the content of basal testosteron in the mini-pubertal period and the index of masculinization of the external genitalia by the EMS scale (p = 0,002; r = 0,9). In the period of mini-puberty an increase in the level of gonadotropic hormones was detected in 89% (8/9) of children, a combined increase of luteinizing and follicle-stimulating hormones (FSH) being observed in 33% (3/9), an isolated increase of FSH – in 56% (5/9) of cases. In the pubertal period hypergonadotropic hypogonadism was revealed in 75% (3/4) of patients.The results of the histological study of the gonads were heterogenous. Gonads are represented by a different degree of dysgenesis of testicular tissue: from a mild, histologically-like gonad in cryptorchidism to streak and ovotestis.Among the extragonadal manifestations of the disease, inguinal hernia (86%), heart defects (77%) and kidney defects (36%) are prominent. Pathological growth retardation was diagnosed in 23% of children.Conclusion. In the structure of the disease chromosomal DSD accounts for 14% of observations. A group of patients with DSD 45,X/46,XY is heterogenous in the degree of gonadal dysgenesis, the structure of the external and internal genitalia