Research and development

PEDI

Diabete and hormones axis

1. Diabete

Diabetes is a chronic disease that affects 8.5% of the world population. Several categories of diabetes exist, but all are characterized by a chronic elevation of blood glucose (hyperglycemia). The existence of these categories is currently challenged, yet it is common to subdivise diabetes into type 1 diabetes (T1D), type 2 diabetes (T2D), monogenic diabetes, secondary diabetes, or gestational diabetes. T1D is an autoimmune disease (for information, click here) characterized by progressive destruction of insulin-producing β cells in the pancreas. A particular feature of T1D is the detection of autoantibodies against insulin, glutamate decarboxylase (GAD65), tyrosine phosphatase IA-2, and/or zinc transporter 8 (ZnT8). It affects 35 million people worldwide and is associated with a risk of multi-organ failure (kidney, heart) despite continuous progress in its treatment (i.e., insulin therapy).  

2. Hormones

As a Pediatric Endocrine team, we have to take care of children with various forms of rare disease. One of these particularly rare forms of disease affects the adrenal gland, which produces cortisol, androgens, and aldosterone [7]. We have recently studied children and adolescents with an excessive production of cortisol, which is called Cushing syndrome, and adrenal hyperplasia (nodules). These young patients were recognized to be carriers of rare mutations in the PRKAR1A gene that identifies them to suffer from Primary Pigmented Nodular Adrenocortical Disease (PPNAD) [8]. Other patients suffer from adrenal diseases that induce an excess of androgens, together with a lack of cortisol production. This relates to congenital adrenal hyperplasia, a genetic form of adrenal disease which may develop into various forms, including atypical forms with mild symptoms, that may be diagnosed relatively late during childhood. Whether and how those atypical forms may be identified earlier is currently unknown. In our unit, we plan to evaluate young patients that may develops early signs of androgen excess, and study their evolution to test whether these may constitute identifiable grounds of adrenal disease from genetic origin.

Amiodarone is a widely prescribed drug for cardiac arrhythmias. It belongs to the Class III of anti-arrhythmic and acts by prolonging the duration of the action potential. The treatment with amiodarone is very effective to normalize the heartbeat and it has little pro-arrhythmic effects compared to other treatments; but it causes many adverse effects, especially on the thyroid.

These effects are well described in adults but there is less information about this phenomenon in children. The objective of our study is the identification and the characterization of the undesirable effects of amiodarone on the thyroid gland in children treated with this anti-arrhythmic agent (For more information, click on THYRAMIO).