@article {10429, title = {A Klinefelter boy with congenital adrenal hyperplasia: too much or too little androgens?}, journal = {Ital J Pediatr}, volume = {44}, year = {2018}, month = {2018 Apr 03}, pages = {43}, abstract = {

BACKGROUND: The simultaneous occurrence of Klinefelter Syndrome (KS) and Congenital Adrenal Hyperplasia (CAH) is an exceptional event: there are just three case reports (two children and a 51 years old man) describing males affected by both KS and 21OHD (21-hydroxylase deficiency) CAH, the first causing androgen deficiency, the latter leading to androgen excess.

CASE REPORT: We report the 4th case of association of KS and CAH in a young man with CAH with good androgen control and with normal secondary sex characteristics, whose Klinefelter syndrome was diagnosed because of reduced testicular volume. He was the first reported case of association of KS and CAH who started androgen replacement therapy in the pubertal age and whose pubertal development was described and followed up step by step.

CONCLUSION: In a boy with CAH and small testicular volume, it{\textquoteright}s important to consider that hypogonadism may be masked by the adrenal androgens excess and a karyotype should be performed once testicular adrenal rests have been ruled out.

}, keywords = {Adolescent, Adrenal Hyperplasia, Congenital, Androgens, Follow-Up Studies, Hormone Replacement Therapy, Humans, Klinefelter Syndrome, Male, Rare Diseases, Risk Assessment, Testis}, issn = {1824-7288}, doi = {10.1186/s13052-018-0485-x}, author = {Zanella, Giada and Tornese, Gianluca and Mascheroni, Elisabetta and Faleschini, Elena and Ventura, Alessandro and Barbi, Egidio} } @article {10503, title = {MKRN3 levels in girls with central precocious puberty and correlation with sexual hormone levels: a pilot study.}, journal = {Endocrine}, volume = {59}, year = {2018}, month = {2018 01}, pages = {203-208}, abstract = {

PURPOSE: Recently, mutations of makorin RING-finger protein 3 (MKRN3) have been described in familial central precocious puberty. Serum levels of this protein decline before the pubertal onset in healthy girls and boys. The aim of the study is to investigate MKRN3 circulating levels in patients with central precocious puberty.

METHODS: We performed an observational cross-sectional study. We enrolled 17 patients with central precocious puberty aged 7 years (range: 2-8 years) and breast development onset <8 years; 17 prepubertal control age-matched patients aged 6.3 years (2-8.2); and 10 pubertal stage-matched control patients aged 11.4 years (9-14). Serum values of MKRN3, gonadotropins, (17)estradiol and Anti-M{\"u}llerian Hormone were evaluated and the MKRN3 genotyped in central precocious puberty patients.

RESULTS: No MKRN3 mutation was found among central precocious puberty patients. MKRN3 levels were lower in patients with central precocious puberty compared to prepubertal age-matched ones (p: 0.0004) and comparable to those matched for pubertal stage. MKRN3 levels were inversely correlated to Body Mass Index Standard Deviations (r:-0.35; p:0.02), Luteinizing Hormone (r:-0.35; p:0.03), FSH (r:-0.37; p:0.02), and (17)estradiol (r: -0.36; p:0.02).

CONCLUSIONS: We showed that girls with central precocious puberty had lower peripheral levels of MKRN3 compared to age-matched pairs and that they negatively correlated to gonadotropins, estrogen, and BMI. Our findings support the MKRN3 involvement in central precocious puberty also in absence of deleterious mutations, although our sample size is small. In addition our data suggest the role of MKRN3 in the complex mechanism controlling puberty onset and its interaction with other factors affecting puberty such as nutrition.

}, keywords = {Adolescent, Adolescent Nutritional Physiological Phenomena, Anti-Mullerian Hormone, Case-Control Studies, Child, Child Nutritional Physiological Phenomena, Child, Preschool, Cross-Sectional Studies, Female, Follicle Stimulating Hormone, Gonadotropin-Releasing Hormone, Humans, Luteinizing Hormone, Pilot Projects, Puberty, Precocious, Ribonucleoproteins, Sexual Maturation}, issn = {1559-0100}, doi = {10.1007/s12020-017-1281-x}, author = {Grandone, Anna and Cirillo, Grazia and Sasso, Marcella and Capristo, Carlo and Tornese, Gianluca and Marzuillo, Pierluigi and Luongo, Caterina and Rosaria Umano, Giuseppina and Festa, Adalgisa and Coppola, Ruggero and Miraglia Del Giudice, Emanuele and Perrone, Laura} } @article {10817, title = {MKRN3 Levels in Girls with Central Precocious Puberty during GnRHa Treatment: A Longitudinal Study.}, journal = {Horm Res Paediatr}, volume = {90}, year = {2018}, month = {2018}, pages = {190-195}, abstract = {

BACKGROUND: Recently, mutations of makorin RING finger protein 3 (MKRN3) have been identified in familial central precocious puberty (CPP). Serum levels of this protein decline before the pubertal onset in healthy girls and boys and are lower in patients with CPP compared to prepubertal matched pairs. The aim of our study was to investigate longitudinal changes in circulating MKRN3 levels in patients with CPP before and during GnRH analogs (GnRHa) treatment.

METHODS: We performed a longitudinal prospective study. We enrolled 15 patients with CPP aged 7.2 years (range: 2-8) with age at breast development onset < 8 years and 12 control girls matched for the time from puberty onset (mean age 11.8 {\textpm} 1.2 years). Serum values of MKRN3, gonadotropins, and 17β-estradiol were evaluated before and during treatment with GnRHa (at 6 and 12 months). The MKRN3 gene was genotyped in CPP patients. In the girls from the control group, only basal levels were analyzed.

RESULTS: No MKRN3 mutations were found among CPP patients. MKRN3 levels declined significantly from baseline to 6 months of GnRHa treatment (p = 0.0007) and from 6 to 12 months of treatment (p = 0.003); MKRN3 levels at 6 months were significantly lower than in the control girls (p < 0.0001).

CONCLUSIONS: We showed that girls with CPP had a decline in peripheral levels of MKRN3 during GnRHa treatment. Our data suggest a suppression of MKRN3 by continuous pharmacological administration of GnRHa.

}, keywords = {Brain Diseases, Case-Control Studies, Child, Child, Preschool, Female, Follicle Stimulating Hormone, Genotype, Gonadotropin-Releasing Hormone, Humans, Longitudinal Studies, Luteinizing Hormone, Male, Puberty, Precocious, Ribonucleoproteins}, issn = {1663-2826}, doi = {10.1159/000493134}, author = {Grandone, Anna and Cirillo, Grazia and Sasso, Marcella and Tornese, Gianluca and Luongo, Caterina and Festa, Adalgisa and Marzuillo, Pierluigi and Miraglia Del Giudice, Emanuele} } @article {10417, title = {An unusual unilateral breast enlargement in a prepubertal girl.}, journal = {Arch Dis Child}, volume = {103}, year = {2018}, month = {2018 May}, pages = {451}, issn = {1468-2044}, doi = {10.1136/archdischild-2017-313215}, author = {Pavan, Matteo and Faleschini, Elena and Tornese, Gianluca and Zandon{\`a}, Lorenzo and Ventura, Alessandro} } @article {10581, title = {46,XY ovotesticular disorders of sex development: A therapeutic challenge.}, journal = {Pediatr Rep}, volume = {9}, year = {2017}, month = {2017 Nov 21}, pages = {7085}, issn = {2036-749X}, doi = {10.4081/pr.2017.7085}, author = {Scarpa, Maria-Grazia and Grazia, Massimo Di and Tornese, Gianluca} } @article {7757, title = {A case of Rubinstein-Taybi syndrome associated with growth hormone deficiency in childhood.}, journal = {Clin Endocrinol (Oxf)}, volume = {83}, year = {2015}, month = {2015 Sep}, pages = {437-9}, issn = {1365-2265}, doi = {10.1111/cen.12748}, author = {Tornese, Gianluca and Marzuillo, Pierluigi and Pellegrin, Maria Chiara and Germani, Claudio and Faleschini, Elena and Zennaro, Floriana and Grandone, Anna and Miraglia Del Giudice, Emanuele and Perrone, Laura and Ventura, Alessandro} } @article {7766, title = {Relapse and metastasis of atypical teratoid/rhabdoid tumor in a boy with neurofibromatosis type 1 treated with recombinant human growth hormone.}, journal = {Neuropediatrics}, volume = {46}, year = {2015}, month = {2015 Apr}, pages = {126-9}, abstract = {

Even though no increased recurrence rate seems to be reported in patients with brain tumors receiving recombinant human growth hormone (rhGH) replacement, in some patients multiple risk factors could put at higher risk for recurrence. In such cases, the decision to start rhGH therapy should be very cautious. A boy with neurofibromatosis type 1 developed an atypical teratoid/rhabdoid tumor (AT/RT) of right cerebellum, treated with surgery, radiotherapy, and chemotherapy. After 3 years of remission, he started rhGH for growth hormone deficiency, having a negative magnetic resonance imaging (MRI) scan. Ten weeks after starting therapy, the boy became symptomatic and MRI showed relapse of AT/RT in the right cerebellum and a new lesion in the brainstem. The boy died of progressive disease. In this case, the connection between AT/RT recurrence and the beginning of rhGH therapy, with a negative pretreatment MRI, cannot be excluded. Additional caution should be used for rhGH in patients with multiple risk factors.

}, keywords = {Brain Stem Neoplasms, Cerebellar Neoplasms, Child, Human Growth Hormone, Humans, Magnetic Resonance Imaging, Male, Neurofibromatosis 1, Recombinant Proteins, Recurrence, Rhabdoid Tumor, Risk Factors, Teratoma}, issn = {1439-1899}, doi = {10.1055/s-0034-1393706}, author = {Tornese, Gianluca and Faleschini, Elena and Matarazzo, Lorenza and Bibalo, Cristina and Zanazzo, Giulio Andrea and Rabusin, Marco and Tonini, Giorgio and Zennaro, Floriana and Ventura, Alessandro} } @article {7767, title = {Serum TRAIL levels increase shortly after insulin therapy and metabolic stabilization in children with type 1 diabetes mellitus.}, journal = {Acta Diabetol}, volume = {52}, year = {2015}, month = {2015 Oct}, pages = {1003-6}, issn = {1432-5233}, doi = {10.1007/s00592-015-0731-2}, author = {Tornese, Gianluca and Tisato, Veronica and Monasta, Lorenzo and Vecchi Brumatti, Liza and Zauli, Giorgio and Secchiero, Paola} } @article {8059, title = {Sirolimus Therapy in Congenital Hyperinsulinism: A Successful Experience Beyond Infancy.}, journal = {Pediatrics}, volume = {136}, year = {2015}, month = {2015 Nov}, pages = {e1373-6}, abstract = {

Congenital hyperinsulinism (CHI) due to diffuse involvement of the pancreas is a challenging and severe illness in children. Its treatment is based on chronic therapy with diazoxide and/or octreotide, followed by partial pancreatectomy, which is often not resolutive. Sirolimus, a mammalian target of rapamycin inhibitor, was reported to be effective in treating CHI in infants. We report here the case of an 8-year-old boy affected by a severe form of CHI due to a biallelic heterozygous ABCC8 mutation who responded to sirolimus with a dramatic improvement in his glucose blood level regulation and quality of life, with no serious adverse events after 6 months of follow-up. To the best of our knowledge, this is the first report of a successful intervention in an older child. It provides a promising basis for further studies comparing sirolimus with other treatments, particularly in older children.

}, issn = {1098-4275}, doi = {10.1542/peds.2015-1132}, author = {Minute, Marta and Patti, Giuseppa and Tornese, Gianluca and Faleschini, Elena and Zuiani, Chiara and Ventura, Alessandro} } @article {1808, title = {Does the LATCH score assessed in the first 24 hours after delivery predict non-exclusive breastfeeding at hospital discharge?}, journal = {Breastfeed Med}, volume = {7}, year = {2012}, month = {2012 Dec}, pages = {423-30}, abstract = {

AIM: The aims of this study were to analyze the relationship between the LATCH score assessed in the first 24 hours after delivery and non-exclusive breastfeeding at discharge and to identify a cutoff for the LATCH score in order to identify women with higher risk of non-exclusive breastfeeding who may need additional breastfeeding support.

SUBJECTS AND METHODS: We conducted a prospective observational study in the Maternity Ward of the Institute for Maternal and Child Health "Burlo Garofolo" (Trieste, Italy) and collected data from 299 mother-infant dyads.

RESULTS: The rate of nonexclusive breastfeeding was inversely related to the LATCH score (p<0.001) with non-exclusive breastfeeding infants scoring less (6.9) than infants exclusively breastfed at discharge (7.6) (p=0.001). In multivariate analysis, non-exclusive breastfeeding was also associated with cesarean section, primiparity, and infant phototherapy. In order to support maternity staff in providing targeted interventions, we identified four LATCH score cutoffs associated with as many risk groups for non-exclusive breastfeeding at discharge.

CONCLUSIONS: The LATCH score is a useful tool to identify mother-infant pairs who might benefit from additional skilled support in specific subgroups at risk of non-exclusive breastfeeding at discharge. Future research is needed to explore if the LATCH score assessed in the first days of life can also predict the duration of breastfeeding.

}, keywords = {Adult, Breast Feeding, Female, Health Promotion, Humans, Infant, Newborn, Italy, Logistic Models, Multivariate Analysis, Patient Care Planning, Patient Discharge, Prospective Studies, Risk Assessment, ROC Curve, Sensitivity and Specificity, Social Support}, issn = {1556-8342}, doi = {10.1089/bfm.2011.0120}, author = {Tornese, Gianluca and Ronfani, Luca and Pavan, Carla and Demarini, Sergio and Monasta, Lorenzo and Davanzo, Riccardo} } @article {1902, title = {Management of cryptorchidism: a survey of clinical practice in Italy.}, journal = {BMC Pediatr}, volume = {12}, year = {2012}, month = {2012}, pages = {4}, abstract = {

BACKGROUND: An evidence-based Consensus on the treatment of undescended testis (UT) was recently published, recommending to perform orchidopexy between 6 and 12 months of age, or upon diagnosis and to avoid the use of hormones. In Italy, current practices on UT management are little known. Our aim was to describe the current management of UT in a cohort of Italian children in comparison with the Consensus guidelines. As management of retractile testis (RT) differs, RT cases were described separately.

METHODS: Ours is a retrospective, multicenter descriptive study. An online questionnaire was filled in by 140 Italian Family Paediatricians (FP) from Associazione Culturale Pediatri (ACP), a national professional association of FP. The questionnaire requested information on all children with cryptorchidism born between 1/01/2004 and 1/01/2006. Data on 169 children were obtained. Analyses were descriptive.

RESULTS: Overall 24\% of children were diagnosed with RT, 76\% with UT. Among the latter, cryptorchidism resolved spontaneously in 10\% of cases at a mean age of 21.6 months. Overall 70\% of UT cases underwent orchidopexy at a mean age of 22.8 months (SD 10.8, range 1.2-56.4), 13\% of whom before 1 year. The intervention was performed by a paediatric surgeon in 90\% of cases, with a success rate of 91\%. Orchidopexy was the first line treatment in 82\% of cases, while preceded by hormonal treatment in the remaining 18\%. Hormonal treatment was used as first line therapy in 23\% of UT cases with a reported success rate of 25\%. Overall, 13 children did not undergo any intervention (mean age at last follow up 39.6 months). We analyzed the data from the 5 Italian Regions with the largest number of children enrolled and found a statistically significant regional difference in the use of hormonal therapy, and in the use of and age at orchidopexy.

CONCLUSIONS: Our study showed an important delay in orchidopexy. A quarter of children with cryptorchidism was treated with hormonal therapy. In line with the Consensus guidelines, surgery was carried out by a paediatric surgeon in the majority of cases, with a high success rate.

}, keywords = {Child, Preschool, Chorionic Gonadotropin, Cryptorchidism, Gonadotropin-Releasing Hormone, Guideline Adherence, Humans, Infant, Italy, Male, Middle Aged, Orchiopexy, Pediatrics, Physician{\textquoteright}s Practice Patterns, Practice Guidelines as Topic, Questionnaires, Retrospective Studies, Treatment Outcome}, issn = {1471-2431}, doi = {10.1186/1471-2431-12-4}, author = {Marchetti, Federico and Bua, Jenny and Tornese, Gianluca and Piras, Gianni and Toffol, Giacomo and Ronfani, Luca} } @article {1813, title = {Slow growth: do not forget the thyroid.}, journal = {J Pediatr Gastroenterol Nutr}, volume = {54}, year = {2012}, month = {2012 Mar}, pages = {438; author reply 438}, keywords = {Constipation, Female, Humans, Hypothyroidism, Male, Thyroid Function Tests}, issn = {1536-4801}, doi = {10.1097/MPG.0b013e3182431edc}, author = {Tornese, Gianluca and Tonini, Giorgio and Ventura, Alessandro} }