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Öğe Adherence to Growth Hormone Treatment in Children During the COVID-19 Pandemic(Galenos Publ House, 2024) Eren, Erdal; Cetinkaya, Semra; Ongen, Yasemin Denkboy; Tercan, Ummahan; Darcan, Sukran; Turan, Hande; Aydin, MuratObjective: Treatment adherence is crucial for the success of growth hormone (GH) therapy. Reported non-adherence rates in GH treatment have varied widely. Several factors may have an impact on adherence. Apart from these factors, the global impact of the Coronavirus disease-2019 (COVID-19) pandemic, including problems with hospital admission and routine follow-up of patients using GH treatment, may have additionally affected the adherence rate. The primary objective of this study was to investigate adherence to treatment in patients receiving GH. In addition, potential problems with GH treatment during the pandemic were investigated. Methods: This was a multicenter survey study that was sent to pediatric endocrinologists during the pandemic period (June-December 2021). Patient data, diagnosis, history of pituitary surgery, current GH doses, duration of GH therapy, the person administering therapy (either parent/patient), duration of missed doses, reasons for missed doses, as well as problems associated with GH therapy, missed dose data and the causes in the recent year (after the onset of the pandemic) were questioned. Treatment adherence was categorized based on missed dose rates over the past month (0 to 5%, full adherence; 5.1 to 10% moderate adherence; >10% non-adherence). Results: The study cohort consisted of 427 cases (56.2% male) from thirteen centers. Median age of diagnosis was 8.13 (0.13-16) years. Treatment indications were isolated GH deficiency (61.4%), multiple pituitary hormone deficiency (14%), Turner syndrome (7.5%), idiopathic GH deficiency (7.5%), small for gestational age (2.8%), and others (6.8%). GH therapy was administered by parents in 70% and by patients in 30%. Mean daily dose was 32.3 big/kg, the annual growth rate was 1.15 standard deviation score (minimum-2.74, maximum 9.3). Overall GH adherence rate was good in 70.3%, moderate in 14.7%, and poor in 15% of the patients. The reasons for non-adherence were mainly due to forgetfulness, being tired, inability to access medication, and/or pen problems. It was noteworthy that there was a negative effect on adherence during the COVID-19 pandemic reported by 22% of patients and the main reasons given were problems obtaining an appointment, taking the medication, and anxiety about going to hospital. There was no difference between genders in the adherence rate. Non-adherence to GH treatment decreased significantly when the patient: administered the treatment; was older; had longer duration of treatment; and during the pandemic. There was a non-significant decrease in annual growth rate as non-adherence rate increased. Conclusion: During the COVID-19 pandemic, the poor adherence rate was 15%, and duration of GH therapy and older age were important factors. There was a negative effect on adherence during the pandemic period.Öğe Anthropometric findings from birth to adulthood and their relation with karyotpye distribution in Turkish girls with Turner syndrome(Wiley, 2016) Sari, Erkan; Bereket, Abdullah; Yesilkaya, Ediz; Bas, Firdevs; Bundak, Ruveyde; Aydin, Banu Kucukemre; Darcan, SukranTo evaluate the anthropometric features of girls with Turner syndrome (TS) at birth and presentation and the effect of karyotype on these parameters. Data were collected from 842 patients with TS from 35 different centers, who were followed-up between 1984 and 2014 and whose diagnosis age ranged from birth to 18 years. Of the 842 patients, 122 girls who received growth hormone, estrogen or oxandrolone were excluded, and 720 girls were included in the study. In this cohort, the frequency of small for gestational age (SGA) birth was 33%. The frequency of SGA birth was 4.2% (2/48) in preterm and 36% (174/483) in term neonates (P<0.001). The mean birth length was 1.3cm shorter and mean birth weight was 0.36kg lower than that of the normal population. The mean age at diagnosis was 10.1 +/- 4.4 years. Mean height, weight and body mass index standard deviation scores at presentation were -3.1 +/- 1.7, -1.4 +/- 1.5, and 0.4 +/- 1.7, respectively. Patients with isochromosome Xq were significantly heavier than those with other karyotype groups (P=0.007). Age at presentation was negatively correlated and mid-parental height was positively correlated with height at presentation. Mid-parental height and age at presentation were the only parameters that were associated with height of children with TS. The frequency of SGA birth was found higher in preterm than term neonates but the mechanism could not be clarified. We found no effect of karyotype on height of girls with TS, whereas weight was greater in 46,X,i(Xq) and 45,X/46,X,i(Xq) karyotype groups. (c) 2016 Wiley Periodicals, Inc.Öğe Is presence of hypertension in obese children correlate with the criteria of metabolic syndrome?(Oxford Univ Press, 2007) Mir, Sevgi; Tabel, Yilmaz; Darcan, SukranIn this article, we will describe the presence of metabolic syndrome and its components in a group of hypertensive and obese adolescents. The study presented here was conducted on 20 patients (10 boys) presented with complaints of obesity and hypertension who were diagnosed as metabolic syndrome. In 20 patients who were all obese and hypertensive, existence of a third metabolic syndrome component such as glucose intolerance or dyslipidaemia, was 47% and 35% respectively, whereas existence of both was 55%. Only three of the patients carry all of the five criteria of metabolic syndrome. Mean body mass index and mean blood pressure (P=0.021), uric acid (P=0.046) and fasting blood glucose levels (P=0.023) were found statistically significant. Mean blood pressure levels were related with increase at LDL-cholesterol (P=0.029) and increase in fasting blood glucose levels (P=0.04). Prevention of complications by effective measures in the metabolic syndrome patients is also mentioned. We believe that obese and hypertensive children should be screened for the other components of metabolic syndrome.Öğe Survey to Investigate Adherence to Growth Hormone Treatment in Children: The Impact of COVID-19 Pandemic(Karger, 2022) Eren, Erdal; Cetinkaya, Semra; Ongen, Yasemin Denkboy; Tercan, Ummuhan; Darcan, Sukran; Turan, Hande; Aydin, Murat[Abstract Not Available]Öğe Turner Syndrome and Associated Problems in Turkish Children: A Multicenter Study(Galenos Yayincilik, 2015) Yesilkaya, Ediz; Bereket, Abdullah; Darendeliler, Feyza; Bas, Firdevs; Poyrazoglu, Sukran; Aydin, Banu Kucukemre; Darcan, SukranObjective: Turner syndrome (TS) is a chromosomal disorder caused by complete or partial X chromosome monosomy that manifests various clinical features depending on the karyotype and on the genetic background of affected girls. This study aimed to systematically investigate the key clinical features of TS in relationship to karyotype in a large pediatric Turkish patient population. Methods: Our retrospective study included 842 karyotype-proven TS patients aged 0-18 years who were evaluated in 35 different centers in Turkey in the years 2013-2014. Results: The most common karyotype was 45, X (50.7%), followed by 45, X/46, XX (10.8%), 46, X, i(Xq) (10.1%) and 45, X/46, X, i(Xq) (9.5%). Mean age at diagnosis was 10.2 +/- 4.4 years. The most common presenting complaints were short stature and delayed puberty. Among patients diagnosed before age one year, the ratio of karyotype 45, X was significantly higher than that of other karyotype groups. Cardiac defects (bicuspid aortic valve, coarctation of the aorta and aortic stenosis) were the most common congenital anomalies, occurring in 25% of the TS cases. This was followed by urinary system anomalies (horseshoe kidney, double collector duct system and renal rotation) detected in 16.3%. Hashimoto's thyroiditis was found in 11.1% of patients, gastrointestinal abnormalities in 8.9%, ear nose and throat problems in 22.6%, dermatologic problems in 21.8% and osteoporosis in 15.3%. Learning difficulties and/or psychosocial problems were encountered in 39.1%. Insulin resistance and impaired fasting glucose were detected in 3.4% and 2.2%, respectively. Dyslipidemia prevalence was 11.4%. Conclusion: This comprehensive study systematically evaluated the largest group of karyotype-proven TS girls to date. The karyotype distribution, congenital anomaly and comorbidity profile closely parallel that from other countries and support the need for close medical surveillance of these complex patients throughout their lifespan.
