Skinning the Surface of Bone Abnormalities in Trichothiodystrophy

Objective(s): The purpose of the study conducted is to characterize the qualitative and quantitative features of the bone abnormalities present in patients diagnosed with Trichothiodystrophy (TTD), a DNA repair and transcription disorder. An additional goal of the study is to identify TTD patients at risk for rapidly progressive bone abnormalities in order to improve diagnosis and treatment for TTD patients. Study Design: A retrospective study conducted at the National Institutes of Health (NIH) examining the bone abnormalities present in a study population comprised of 32 patients between the ages of 1 and 29 years of age diagnosed with TTD. Radiographic images, acetabular angle, walking ability and stage of avascular necrosis (AVN) were evaluated to assess changes in bone structure. Results: Delayed bone age, central osteosclerosis, peripheral osteopenia, hip degeneration or coxa valga were present in 31 (97%) of 32 TTD patients. All TTD patients with hip abnormalities on radiographic images exhibited progressive degeneration and difficulty walking, over a 2-6 year period. Acetabular angle measurements did not correlate with the clinical and radiological findings for 4 (80%) of 5 TTD patients with hip abnormalities on radiographic images. Abnormalities in mean corpuscular volume (MCV), hemoglobin A2 (HbA2), red blood cell morphology and hormone and nutrient levels (calcium, parathyroid hormone and Vitamin D) were not associated with the onset of bone abnormalities present in the 32 TTD patients. Conclusion(s): Bone abnormalities are a common clinical feature of TTD that have been shown to significantly impact the quality of life of a TTD patient. Thus, analysis of the predictive factors and events preceding the onset of bone abnormalities is clinically important in improving the diagnosis and treatment of TTD

Localization of the Gene for Sclerosteosis to the van Buchem Disease–Gene Region on Chromosome 17q12–q21

SummarySclerosteosis is an uncommon, autosomal recessive, progressive, sclerosing, bone dysplasia characterized by generalized osteosclerosis and hyperostosis of the skeleton, affecting mainly the skull and mandible. In most patients this causes facial paralysis and hearing loss. Other features are gigantism and hand abnormalities. In the present study, linkage analysis in two consanguineous families with sclerosteosis resulted in the assignment of the sclerosteosis gene to chromosome 17q12-q21. This region was analyzed because of the recent assignment to this chromosomal region of the gene causing van Buchem disease, a rare autosomal recessive condition with a hyperostosis similar to sclerosteosis. Because of the clinical similarities between sclerosteosis and van Buchem disease, it has previously been suggested that both conditions might be caused by mutations in the same gene. Our study now provides genetic evidence for this hypothesis

Neonatal-Onset Multisystem Inflammatory Disease Responsive to Interleukin-1β Inhibition

Neonatal-onset multisystem inflammatory disease is characterized by fever, urticarial rash, aseptic meningitis, deforming arthropathy, hearing loss, and mental retardation. Many patients have mutations in the cold-induced autoinflammatory syndrome 1 (CIAS1) gene, encoding cryopyrin, a protein that regulates inflammation

Ultrasound is superior to computed tomography for assessment of medullary nephrocalcinosis in hypoparathyroidism

CONTEXT: Nephrocalcinosis is a complication of hypoparathyroidism and other metabolic disorders. Imaging modalities include ultrasonography (US) and computed tomography (CT). Few studies have compared these modalities, and standard clinical practice is not defined. OBJECTIVE: The objective of the study was to determine the preferred method for assessing nephrocalcinosis. DESIGN: The design of the study was a retrospective, blinded analysis. SETTING: The study was conducted at a clinical research center. PATIENTS: Twenty-two hypoparathyroid subjects and 7 controls participated in the study. INTERVENTIONS: Contemporaneous renal US and CT images were reviewed in triplicate by 4 blinded radiologists. Nephrocalcinosis was classified using a 0–3 scale with 0 meaning no nephrocalcinosis and 3 meaning severe nephrocalcinosis. MAIN OUTCOME MEASURES: Intraobserver, interobserver, and interdevice agreements were measured. RESULTS: Intraobserver agreement was high, with an overall weighted kappa of 0.83 for CT and 0.89 for US. Interobserver agreement was similar between modalities, with kappas of 0.74 for US and 0.70 for CT. Only moderate agreement was found between US and CT scores, with an intermodality kappa of 0.47 and 60% concordance. Of discordant pairs, 81% had higher US scores and only 19% had higher CT scores. Of nephrocalcinosis seen on US and not CT, 45%, 46%, and 9% were grades 1, 2, and 3, respectively. Overall, US scores were higher than CT with a cumulative odds ratio (95% confidence interval) of 5.97 (2.60, 13.75) (P < .01). In controls, 100% of US ratings were 0, and 95% of CT ratings were 0. CONCLUSIONS: US is superior to CT for assessment of mild to moderate nephrocalcinosis in patients with hypoparathyroidism. This finding, in combination with its low cost, lack of radiation, and portability, defines US as the preferred modality for assessment of nephrocalcinosis

Reduced Abdominal Adiposity and Improved Glucose Tolerance in Growth Hormone-Treated Girls with Turner Syndrome

Background: Individuals with Turner syndrome (TS) are at increased risk for impaired glucose tolerance and diabetes mellitus. It is unknown whether pharmacological GH treatment commonly used to treat short stature in TS alters this risk