Ornithologists have described a new species of tanager in the genus Trichothraupis living on the Eastern slopes of the Andes Trichothraupis melanops (above) and Trichothraupis griseonota (below) The newly-discovered species belongs to Trichothraupis, a genus that was established in 1851 and, until now, included only one species: the black-goggled tanager (Trichothraupis melanops) These forest-dwelling birds live in pairs or in small groups where their main habitat consists of drier forests than in the Atlantic regions “Trichothraupis is a monospecific genus found in two disjunct populations, one in the Atlantic Forest of eastern Brazil (Bahia south to Rio Grande do Sul states), northeastern Argentina, and eastern Paraguay, from sea level up to 1,200 m,” said Dr. Vagner Cavarzere from the Universidade Estadual Paulista and his colleagues “Normally associated with the Atlantic Forest there are some isolated populations in the southern Pantanal as well as in the gallery forests of eastern Chaco.” “A second population can be found on the eastern slopes of the Andes from northern Peru to extreme northwestern Argentina A recent study demonstrated that the Atlantic and Andean populations of Trichothraupis melanops are genetically isolated that the current classification as a monotypic species should be revisited Cavarzere and co-authors evaluated the morphology and vocalizations of the Atlantic and Andean populations The researchers examined a total of 581 skin specimens housed in museums around the world “Our study of plumage revealed full diagnosability between the two populations of Trichothraupis,” they said “Both populations are also differentiated by tarsus length with the Atlantic population having longer tarsi on average.” the taxa inhabit distinct vegetation types (Atlantic Forest versus Tucumano-Boliviano and Yungas montane forests).” Named Trichothraupis griseonota (common name is the Andean black-goggled tanager) the new species is found from 400 m up to 1,700 m on the eastern slopes of the Andes in Peru “Trichothraupis griseonota is restricted to the eastern slope of the Andes of central and southern Peru and northwestern Argentina,” the scientists said “It inhabits the Seasonal Dry Tucumano-Boliviano Forests which are confined to the northwestern Argentinean Andean forests and foothills north to central and southern Bolivia.” “The species also occurs along a narrow strip of Yungas Forests in northern Bolivia and Peru “These montane forests exhibit higher moisture levels compared to the Tucumano-Boliviano Forests.” the fact that these distinct lineages had not been recognized before is somewhat intriguing given that Trichothraupis is a common species “In describing a new species discovered in museum cabinets in addition to extremely important and relatively new paradigms museum specimens are especially important in the age of genomes and supercomputers given that their most important role since their inception centuries ago has been to serve as the cornerstone upon which avian taxonomy is based,” the authors concluded “By documenting and organizing variations and allowing for insights such as this we hope that the discovery of Trichothraupis griseonota will serve as a reminder for ornithologists never to underestimate the possibility that exciting new discoveries may lie among a seemingly mundane series of bird skin specimens.” The study was published in the journal Zootaxa A new species of tanager (Aves: Thraupidae) from the Eastern slopes of the Andes Zootaxa 5468 (3): 541-556; doi: 10.11646/zootaxa.5468.3.7 Italy (BRAIN) — The Bottecchia bicycle company and local media are reporting that a large fire destroyed part of Bottecchia's production headquarters here on Sunday the company said no employees were hurt and the extent of damage is still unknown "On Sunday, September 25, we experienced one of the worst pages of our history. What happened at our headquarters in Cavarzere is an unprecedented event," the company said on its Facebook page "We are already reorganizing to start again as soon as possible We know a lot of you are waiting for deliveries We ask for your patience and understanding during this difficult time We will do our best to keep you updated on the restart timings as soon as possible but we need to find the strength and courage to get back on the saddle and start again." The company is named for Ottavio Bottecchia, who was the first Italian to win the Tour de France, in 1924. According to Italian media the company was sold to Fantic Motor in July Download the 2019 Industry Directory Read the 2021 Sales Training Guide 1600 Pearl St., Ste 300Boulder, CO 80302This website copyright © 2025. All rights reserved Volume 14 - 2023 | https://doi.org/10.3389/fendo.2023.1332114 Growth hormone (GH) is crucial to growth and development GH secretion is regulated by a complex feedback system involving the pituitary gland and predominantly occurs during deep sleep Isolated and idiopathic growth hormone deficiency (GHD) is a condition characterized by GHD without any other signs or symptoms associated with a specific syndrome or disease The aim of this narrative review was to evaluate the relationship between GH and sleep in children using published data and Web of Science) were systematically searched for relevant English language articles published up to April 2023 Search strategies included the terms ‘children/pediatric’ ‘growth hormone deficiency’ and ‘sleep’ Data were extracted by two independent reviewers; 185 papers were identified of which 58 were duplicates and 118 were excluded (unrelated n=83 GHD appears to have an adverse effect on sleep in children and GH therapy has only been shown to have a beneficial effect on sleep parameters in some individuals Further research of GHD in pediatric populations is necessary to improve the understanding of GHD impact on sleep and its underlying mechanisms and to determine the specific impacts of GH therapy on sleep in children Insufficient or poor quality of sleep can have a significant impact on the development, learning, behavior, and overall health of children (5, 6) including a detrimental effect on their physical and mental well-being (7). Other effects include difficulties with concentration, increased irritability, growth impairment, weakened immune function, anxiety, and depression (7) Sleep is an important period of increased GH release (11). Indeed, a significant release of GH can be observed in conjunction with the first episode of slow-wave activity, especially shortly after sleep onset (12, 13) This indicates that slow-wave sleep appears to play an important role in the regulation of GH secretion This narrative review (incorporating a systematic search of the literature) aimed to assess the relationship between GH and sleep in children, and assess the impact of GH therapy on sleep quality in children with idiopathic GHD (Figure 1) Figure 1 Study rationale and objectives and Web of Science databases were systematically searched for English language articles published up to April 2023 Medical Subject Heading (MeSH) terms and text words (including their combinations and truncated synonyms) were adapted as necessary to search in each database we followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines to ensure rigorous methodology and transparent presentation of data and methodological quality assessment were conducted in accordance with the recommendations of the PRISMA protocol The exclusion criteria for the literature search were “case report,” “review” The PubMed search strategy used was: (children[Title/Abstract] OR pediatric[Title/Abstract]) AND (“growth hormone deficiency”[Title/Abstract]) AND sleep[Title/Abstract] NOT (“case report”[Title/Abstract] OR review[Title/Abstract]) NOT syndrome [Title/Abstract] The Scopus search strategy was ABS (children OR pediatric) AND ABS (“growth hormone” OR “growth hormone deficiency” OR “growth hormone treatment” OR “recombinant growth hormone”) AND ABS (sleep OR “sleep quality” OR “sleep pattern” OR “sleep duration” OR “sleep efficiency” OR “sleep satisfaction”) Two reviewers independently extracted data from all eligible studies Extraction was completed in duplicate to minimize errors and potential biases in result interpretation Any discrepancies were resolved by a third reviewer ensuring accuracy and consistency of the data extracted Reviewers also assessed the methodology of each study including the robustness of the study design and the validity of the results to evaluate the overall quality of the scientific evidence Studies were excluded if they were deemed unrelated to the topics of interest published in a language other than English and focused on children with syndromic/genetic disorders Table 1 Articles excluded from the analysis after reviewing the eligibility of full-text articles Figure 2 Flow chart showing study selection and inclusion Table 2 Summary of studies on sleep-related health outcomes and growth hormone in children with growth hormone deficiency In another controlled study, a group of seven children with GHD underwent PSG before and after 1–2 weeks of GH therapy (18). Prior to receiving GH therapy, children with GHD spent more time in stage 1 and stage 3 sleep, and less time in REM sleep, compared with age-matched controls. After initiating GH therapy, children with GHD showed a reduction in the time spent in stage 3 sleep, without any significant change in other sleep parameters (18) These articles do not specifically focus on the relationship between GHD and/or GH therapy and sleep The studies identified by a systematic literature search provide interesting insights into the relationship between GH and sleep in children with GHD They emphasize the importance of monitoring GH secretion during sleep and suggest a link between GHD and growth outcomes in specific populations GHD can impact sleep and lead to cognitive consequences in affected children Treatment with hGH has the potential to improve sleep disturbances and mitigate adverse effects on cognitive function further research is needed to better understand the effects of GH therapy on sleep in pediatric populations and neurocognitive function in this population Despite the limitations of the dataset, the available information did provide some insights into the relationship between GH and sleep in children with GHD, allowing us to answer the individual questions listed in Figure 1 the mechanisms regulating GH secretion during sleep are not well understood; therefore there is a need for further evaluation of these relationships It was encouraging to see data showing some sleep improvements when children with GHD are treated with GH replacement therapy (18, 19, 25). GH treatment has been shown to significantly improve sleep quality in adults with GHD (28–30). This can result in deeper and more restful sleep, ultimately improving the individual’s quality of life (30) the effects of GH therapy on sleep varied between individuals While some children may experience significant improvements in sleep others may only notice small changes or no change at all It is also worth noting that the effects of GH treatment on sleep may take time to develop it is crucial to have realistic expectations regarding the outcomes of GH treatment on sleep quality It would also be helpful to know which factors might affect the individual response to GH therapy more studies in pediatric patients are needed including those with a larger sample size conducted in individuals managed according to current guidelines use of a comprehensive sleep assessment (alongside thorough history taking and laboratory testing) could help inform both a diagnosis and the treatment strategies for children with sleep-related GH disorders or GHD-related sleep disorders The key limitation of the current review was the low availability and quality of the published data on the effects of GH on sleep in children the lack of consistency in endpoints meant that we were unable to combine and analyze the data in any systematic way our report should be considered as a guide to gaps in current literature and an indication of where future studies are needed there is potential for GHD to have a negative impact on sleep in children Sleep disturbances in these individuals can disrupt deep sleep and influence GH secretion it would seem advisable to perform a sleep study (e.g. PSG) before initiating GH therapy in children with GHD This would enable evaluation of sleep characteristics identification of any GH-related sleep disorders and development of a personalized management plan It would also allow changes in sleep during GH treatment to be accurately monitored This personalized approach will play an important role in improving the overall well-being and outcomes for affected individuals The author(s) declare financial support was received for the research This work and medical writing assistance for the preparation of this article was funded by Sandoz The funder was not involved in the study design or the decision to submit it for publication who edited a preliminary draft of this manuscript on behalf of Springer Healthcare Communications This medical writing assistance was funded by Sandoz The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest All claims expressed in this article are solely those of the authors and do not necessarily represent those of their affiliated organizations Any product that may be evaluated in this article or claim that may be made by its manufacturer is not guaranteed or endorsed by the publisher Preferred Reporting Items for Systematic Reviews and Meta-Analyses; 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Accepted: 04 December 2023;Published: 24 January 2024 Copyright © 2024 Zaffanello, Pietrobelli, Cavarzere, Guzzo and Antoniazzi. 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The following rules apply to the use of this site: Terms of Use and Privacy / Cookie Statement | Privacy settings Sixteen studies reporting changes in body composition (i.e., FM and LBM) associated with GH treatment in children with GHD were identified and included in the review. Collectively, these studies demonstrated that FM decreased, and LBM increased in response to GH replacement therapy. Despite study limitations (i.e., potential effects of diet and physical activity were not considered), we concluded that a periodic body composition assessment is required to ensure that a satisfactory body composition is achieved during GH replacement therapy in children with GHD. Volume 14 - 2023 | https://doi.org/10.3389/fendo.2023.1093691 Background: Growth hormone (GH) affects metabolism and regulates growth in childhood The most prominent feature of GH deficiency (GHD) in children is diminished height velocity that eventually leads to short stature Beneficial effects of GH treatment on body composition in adults with GHD including an increase in muscle mass and a decrease in FM Relatively few studies have investigated the effects of GH treatment on the body composition of pediatric patients with idiopathic or hypothalamic-pituitary disease-associated GH deficiency This systematic review aimed to summarize available evidence relating to the effects of GH treatment on body composition in children with GHD were searched with keywords including “GH” and “growth hormone” for English-language articles published between January 1999 and March 2021 Two reviewers independently evaluated the search results and identified studies for inclusion based on the following criteria: participants had a confirmed diagnosis of GHD (as defined in each study); participants were pediatric patients who were receiving GH or had stopped GH treatment regardless of whether they were pre- or post-pubertal; the intervention was recombinant human GH (rhGH; somatropin); and outcomes included changes in body composition during or after stopping GH therapy Data extracted from each study included study quality Data on fat-free mass and LBM were combined into a single category of LBM Results: Sixteen studies reporting changes in body composition (i.e. FM and LBM) associated with GH treatment in children with GHD were identified and included in the review these studies demonstrated that FM decreased and LBM increased in response to GH replacement therapy Conclusion: Despite study limitations (i.e. potential effects of diet and physical activity were not considered) we concluded that a periodic body composition assessment is required to ensure that a satisfactory body composition is achieved during GH replacement therapy in children with GHD Growth hormone (GH) and its effector insulin-like growth factor 1 (IGF-1) are needed to regulate growth in childhood and body composition (1–3). Approved indications for GH replacement include short stature associated with Turner, Noonan and Prader-Willi syndromes (PWS), small size for gestational age, renal failure, idiopathic short stature, short stature homeobox-containing gene (SHOX) deficiency, and GH deficiency (GHD) (1) Relatively few studies have investigated this effect on pediatric patients with GH deficiency that is either idiopathic or a result of hypothalamic-pituitary disease This systematic review summarizes the available evidence relating to the effects of GH treatment on body composition in children with a confirmed diagnosis of GHD treated with GH. Given that both GHD and high FM increase the risk of metabolic disturbances such as dyslipidemia and insulin resistance (8, 15) we also considered the effects of GH treatment on plasma lipid and insulin levels when these were reported in studies included in the review The methodology of this systematic review is consistent with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) statement (16) A comprehensive search of all English-language articles analyzing the effects of GH treatment on the body composition of pediatric patients with a confirmed diagnosis of GHD was conducted We searched several electronic databases (PubMed Embase) with the keywords “GH” “growth hormone supplementation” and “lean body mass” to identify relevant studies published between 1 January 1999 and 31 March 2021 The bibliographies of related articles were also searched to identify any additional published references relevant for inclusion in the review Search results were exported into the reference manager software “Rayyan QCRI” Two reviewers (AF and MV) working independently and blindly considered the potential eligibility of each of the titles and abstracts identified after executing the search strategy They then evaluated the full-text versions of all potentially eligible studies and extracted data from the references Disagreements were resolved by a third reviewer (AP) Data extracted from each study were: 1) study quality (e.g. and statistical analyses); 2) study sample characteristics (e.g. and puberty status); 3) study interventions (e.g. retesting for GHD); and 4) data on body composition (e.g. Because the terms LBM and fat-free mass are typically used interchangeably in scientific literature we combined data on fat-free mass and LBM into the single category of LBM Studies were included when they fulfilled the following criteria: • Participants had a confirmed diagnosis of GHD (as defined in each study); • Participants were pediatric patients who were receiving GH or had stopped GH treatment regardless of whether they were pre- or post-pubertal; • Intervention was recombinant human GH (rhGH; somatropin); • Outcomes included changes in body composition during or after stopping GH therapy We identified a total of 2,094 records by searching electronic databases (Figure 1). After duplicates were removed, a total of 1,450 records were considered for inclusion. After the first screening, based on title and abstract, 52 full-text articles were selected for assessment of eligibility. After this second screening process, a total of 15 articles were considered eligible for this review (17–31) This figure is an adaptation from “Preferred Reporting Items for Systematic Reviews and Meta-Analyses: The PRISMA Statement.” by Moher D and is used under a CC BY-NC-SA 4.0 license Included studies enrolled over 500 pre- or post-pubertal pediatric patients with GHD (Tables 1 and 2) Table 1 Studies that evaluated body composition at baseline and during rhGH treatment in children with GHD Table 2 Studies that evaluated body composition after rhGH treatment suspension in children with GHD In all but three of the studies (26, 27, 29) information on additional pituitary hormone deficiencies was given although multiple pituitary hormone deficiencies and other diseases were also encountered The initial rhGH dose ranged from 0.02 to 0.042 mg/kg per day. In only one study was the dose personalized from the start (20) ranging between 0.017 and 0.1 mg/kg per day Body composition was evaluated using total body DXA in 12 studies (17–20, 22–24, 26–28, 30, 31). The remaining studies used near-infrared interactance (II), bioelectrical impedance analysis (BIA), or ST (21, 25, 29) DXA is reported to be the best currently available technique for measuring body composition (13, 14); however, LBM data may not be accurate because DXA cannot distinguish between body cell mass and water (32–34) there was strong evidence of a decrease in FM during chronic rhGH treatment with cessation of treatment almost invariably resulting in an increase in FM particularly in patients with persistent GHD Figure 2 Differences in fat mass (mean % of body weight with 95% confidence interval) from the start to 1 yeara of rhGH replacement in pre-pubertal patientsb with GHD (18, 22, 24, 27, 28) aTwo months of replacement in Mauras et al Figure 3 Fat mass (mean % of body weight with standard deviation) at baseline and after 1 yeara of rhGH replacement in pre-pubertal patientsb with GHD (18, 22, 24, 27, 28) Figure 4 Fat mass (mean % of body weight with standard deviation) at the end of rhGH replacement and 1 year later in pre-pubertal patients with GHD (19, 23) there was moderate evidence for an increase in LBM during chronic rhGH treatment as well as a decrease in LBM after discontinuation of rhGH but this was mostly evident in subjects with persistent GH deficiency Figure 5 Lean body mass (mean kg with standard deviation) at baseline and after 1 yeara of rhGH replacement in patientsb with GHD (18, 22, 24, 27) Figure 6 Lean body mass (mean kg with standard deviation [if available]) at the end of rhGH replacement and 6 months later in patients with GHDa (17, 19) enrolled patients with severe disease (stimulated growth hormone <16 ng/mL and by insulin-like growth factor-1 <–1.90 standard deviation score) Table 3 Effects of rhGH therapy on lipid profiles and insulin metabolism in children with GHD (reported differences are intended as statistically significant) The results regarding triglyceride levels were particularly heterogeneous there was moderate evidence for a decrease in insulin sensitivity during chronic rhGH treatment Insulin sensitivity did not appear to be affected in the long term after cessation of rhGH our review analyzed studies that utilized IRMAs It was reported that BIA and DXA methods had higher concordance with FM than with FFM values particularly in patients with a BMI between 16–18 kg/m2 suggested that BIA and DXA methods are interchangeable at a normal population level but that BIA underestimated FFM and overestimated FM in patients with a BMI ≥18 kg/m2 NIR cannot differentiate between bone and muscle mass; thus a lean body mass measurement using NIR reflects both tissue types NIR is limited in its ability to accurately measure body composition in patients who are extremely obese The ‘gold standards’ for quantifying visceral adipose tissue in normal and obese populations are magnetic resonance imaging and computerized tomography. These imaging techniques quantify visceral adipose tissue more precisely than DXA in normal subjects, with coefficients of variation within 1–3% (49–52) This may be explained by DXA’s limited ability to distinguish visceral fat from peripheral fat in the abdominal region DXA measurements are more precise in obese individuals as altering the reference lines in DXA analysis software can increase or decrease individuals’ fat compartments more slowly than in a lean individual resulting in less analyst-initiated variation The precision of DXA visceral adipose tissue assessments should continue to increase as software becomes more accurate at distinguishing visceral fat from peripheral fat there are no other validated methods to differentiate between visceral and peripheral fat in this population our findings indicate that GH influences body composition and therefore periodic changes in FM and LBM should be assessed in children with GHD receiving rhGH therapy to ensure that a satisfactory body composition is maintained over time Lipid and glucose profiles should also be monitored during treatment no changes are observed in a patient’s body composition physicians should assess how well the patient complies with the therapy and the appropriateness of their lifestyle/dietary choices; recommendations for additional interventions or lifestyle modifications should be introduced accordingly The first review of the effects of GH therapy on body composition in pediatric populations was published in 1973 by Collipp and colleagues (11). More recently, it has been explored more widely. In 2020, Passone and colleagues reviewed the effects of GH treatment in patients with PWS (10) and found that GH improved stature modifying the disease’s natural history Table 4 Suggested timing and reasons for body composition assessments children with GHD Reduction in FM after GH replacement therapy has been described mostly in visceral FM. Recent studies have indicated that the accumulation of visceral fat, rather than subcutaneous fat, is associated with increased cardiometabolic risk (56). This mechanistic difference may be partially explained by differences in the phenotypes of adipose tissue depots (56) such as pro- and anti-inflammatory cytokines and adipokines are produced at each local fat depot as an independent endocrine organ subcutaneous adipocytes predominantly produce adiponectin which has been historically associated with type 2 diabetes Future research in this field should include studies with long-term follow-up that enroll homogenous groups of GH-deficient patients with similar causes and onset of disease and evaluate important outcomes such as quality of life It would be important to divide patients by pubertal status as there are fundamental changes in their metabolism This study has several strengths including the comprehensive literature search and review and the appraisal of the risk of bias (Table 5) We only found articles with small sample sizes that were heterogeneous by age and by pubertal stage methods other than DXA were used to measure body composition (BIA and there was variability across studies in the stimulation tests used to diagnose GHD although it is clear that diet and physical activity influence and regulate body composition the majority of the studies considered in this review did not assess the influence of diet and physical activity on body composition during GH therapy The original contributions presented in the study are included in the article/supplementary material Further inquiries can be directed to the corresponding author and FA contributed to the study conception and critical revision and editing of subsequent drafts AF and MV contributed to the data analysis and GP contributed to critical revision and editing of subsequent drafts All authors approved the final version for submission and agree to be accountable for the content of the work All authors contributed to the article and approved the submitted version The authors declare that editorial assistance for the preparation of this article was 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This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY) *Correspondence: Angelo Pietrobelli, YW5nZWxvLnBpZXRyb2JlbGxpQHVuaXZyLml0 †These authors have contributed equally to this work News and entertainment worth sharing – York and North Yorkshire A York war hero who was killed when his Spitfire was shot down over Italy is to finally be laid to rest 74 years later – after archaeologists discovered his body took off in one of six RAF Spitfires from 111 Squadron from Rimini Airfield on March 5 with barges moored on a canal close to Venice their target His plane was hit by anti-aircraft fire and crashed close to the village of Cavarzere in north east Italy But in October 2017 his remains and the wreckage of his plane were discovered by members of the Romagna Air Finders an organisation which recovers Second World War aircraft WO Coates will be laid to rest at Padua War Cemetery on March 27 By early 1945 he was flying Spitfire Mark 1Xs with 111 Squadron He was based near Rimini supporting operations to drive the German forces out of Italy On the day of his death he should have been on leave but swapped duties to fly with a team of 6 RAF Spitfires on a mission to target barges WO Coates was flying a Spitfire Mk IX like this one. Photograph: Chowellson WikipediaHis plane was excavated after the Romagna Air Finders were told by locals an aircraft had crashed near Cavarzere village in the 1940s An appeal to find his family was launched and his niece, Helen Watts, 65, told the Mail: Myself and my siblings grew up knowing that our uncle had gone missing towards the end of World War II It is absolutely amazing that he has been found all these years later This is the kind of thing that only ever happens to someone else We had always thought his plane had gone down close to Lake Como so it was a surprise he was discovered elsewhere Email YorkMix » 5-6 King's CourtShamblesYork  YO1 7LD You can listen to YorkMix Radio using your DAB+ radio Click here to listen to YorkMix Radio » YorkMix is a trading name of York Sound Ltd Registered in EnglandCompany no: 12831940VAT no: GB289462452 YorkMix Radio public file Copyright © 2025 YorkMix Volume 12 - 2021 | https://doi.org/10.3389/fendo.2021.596654 a novel coronavirus leading to potentially death was discovered the 2019 coronavirus disease (COVID-19) has spread to become a worldwide pandemic Beyond the risks strictly related to the infection concerns have been expressed for the endocrinological impact that COVID-19 may have especially in vulnerable individuals with pre-existing endocrinological health conditions To date new information is emerging regarding severe acute respiratory syndrome-related coronavirus 2 (SARS-CoV-2) in children but the literature is still scarce concerning this infection in patients with intracranial malignant neoplasms We report a 9-year-old child infected with SARS-CoV-2 and recent diagnosis of suprasellar non-germinomatous germ cell tumor also suffering from diabetes insipidus and hypothalamic-pituitary failure (hypothyroidism hypothalamic obesity and growth hormone deficiency) and its clinical course The patient remained asymptomatic for the duration of the infection without requiring any change in the replacement therapeutic dosages taken before the infection We then discuss the proposed approach to treat a pediatric patient with SARS-CoV-2 infection and hypothalamic-pituitary failure and we include a review of the literature Our report suggests that SARS-CoV-2 infection is usually mild and self-limiting in children even those immunocompromised and with multiple endocrinological deficits Patients are advised to keep any scheduled appointments unless informed otherwise The novel severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) which first appeared in December 2019 in Wuhan has caused the coronavirus disease 2019 (COVID-19) related pandemic and has been declared a significant threat to international health by the World Health Organization evidence suggests that SARS-CoV-2 infection in children with oncological comorbid and endocrinological health problems may be challenging in terms of management and could require complex care We report the case of a 9-year-old Caucasian female affected by suprasellar non-germinomatous germ cell tumor (NGGCT) associated with multiple pituitary deficit who tested positive for SARS-CoV-2 an April 1 The girl started therapy with levothyroxine (initially at dosage 25 mcg/day) and desmopressin (initially intranasal She was given dexamethasone after the MRI to reduce tumoral edema Over the next few days the patient was found to have “cerebral salt wasting” with hyponatremia high urinary sodium excretion (129 mmol/L) and persistent polyuria It was stopped after four days when laboratory tests normalized levothyroxine and hydrocortisone and the patient had periodical laboratory tests and therapeutic adjustments Figure 1 Brain magnetic resonance imaging at the time of diagnosis voluminous expansive lesion at the hypothalamic level (A FLAIR sequence) with an inhomogeneous structure hypothalamic-pineal peduncle and mammillary body are not recognizable Table 1 Laboratory tests and physical examination at the time of diagnosis In October 2019 chemotherapy according to SIOP CNS GCT II standard risk protocol for non-germinomatous germ cell tumor (NGGCT) was started The first cycle was complicated by hydrocephalus that required ventricular-peritoneal derivation the MRI showed a partial response to chemotherapy The histopathological examination was conclusive for immature teratoma Follow-up MRI one month after surgery showed a suspected small residual lesion Chemotherapy with high-dose etoposide was started From the 8 March, the “lockdown” for all Italy was adopted together with the use of surgical mask, hand hygiene, and social distancing, to prevent the massive spread of SARS-CoV-2; moreover, a screening program by nasopharyngeal swab (NPS) for any patient and caregiver parent accessing the Pediatric Hematology Oncology Unit was started (4) the patient (and her mother) underwent the NPS and both resulted negative for SARS-CoV-2 She was taking desmopressin (sublingual tablets 60 mcg levothyroxine at 75 mcg/day and hydrocortisone at 8,92 mg/m2.day divided into 2 doses Therapy with recombinant GH was not yet started she suffered from hypothalamic obesity (incontrollable hyperphagia decreased satiety and decreased physical activity) with massive weight gain On March 5 she was admitted to the Pediatric Oncology Unit for mobilization chemotherapy with high-dose etoposide and granulocyte colony-stimulating factor (G-CSF) followed by peripheral stem cell collection for autologous stem-cell transplantation (ASCT) On April 1 she was admitted to the Pediatric Oncology Unit for ASCT Her weight was 40,9 kg (93,21 percentiles based on Cacciari’s charts) and her height was 120,2 cm (6,08 percentiles based on Cacciari’s charts) with a BMI of 28,31 kg/m2 (99,06° centiles based on Cacciari’s charts) The ASCT was performed on April 30 after a conditioning regimen with high dose ifosfamide The patient engrafted on day + 9 for neutrophil and on day + 12 for platelets and was discharge home in good clinical conditions In accordance with Verona University and University of Verona Institutional review Board (IRB) policies case reports are not considered to be research subject to IRB review and are thus except from formal IRB approval for publication Written informed consent was obtained from the patient’s legal guardians for the publication of any potentially identifiable images or data included in this article Table 3 Nasopharyngeal swabs with cycle threshold (Ct) value results Our patient was affected by non-germinomatous germ cell tumor (NGGCT) hCG levels in plasma and CSF and based on histopathological examination The girl had secondary adrenal insufficiency those patients may be taking supraphysiologic doses of glucocorticoids and might be more susceptible to COVID-19 as a result of the immunosuppressive effects of steroids Our patient had long suspended the high antiedema doses of dexamethasone at the time of infection and she was taking replacement doses of hydrocortisone We presumed that she was infected through contact with her father at home and she tested positive regardless of the therapies she was taking which may be complicated by developing an adrenal crisis there is currently no evidence that adrenal insufficiency patients are more likely to develop a severe course of the viral disease Adrenal crisis occurs when cortisol availability is reduced or low at a time of increased need for cortisol to prevent adrenal crisis patients are instructed to immediately double or triple their daily dose of hydrocortisone during an illness whereas the dose adjustment during a stress not related to illness our patient could have been among the most vulnerable; she had a very close follow-up for the superimposed illness without there is no data in the literature on the increased risk of infections in patients with GH deficiency Critical illness induced a rise in GH and IGFBP1 and a fall in IGF-I and IGFBP3 we did not perform our patient’s the dosage of GH or IGF-1 considered in the emergency to be of secondary importance To increase our knowledge in disease mechanisms we need to learn from clinical and immunologic characteristics of patients with severe in contrast to moderate disease We interrupted the conditioning regimen in our patient because at the time of diagnosis of infection there was no consensus about chemotherapy in similar patients SARS-CoV-2 positive so it was reasonable to delay the treatment after the negativity of NPS the strength of our description is the need to inform the scientific community about this case report pharmacovigilance and high applicability when other research designs were difficult to carry out The major limitations were the lack of ability to generalize and the retrospective design proper methods for viral respiratory infection control and prevention and considerations of potential therapies relevant to the pituitary disorders and any underlying comorbidities should be undertaken The caregivers are urged to request for COVID-19 testing for patients if exposed Even if symptoms are mild or if fever is present contacting the team (the physicians or nurse by telephone or telemedicine) is mandatory in order to seek medical guidance and adapt to increased replacement dosages if clinically indicated Recognizing SARS-CoV-2 as a possible causal trigger of endocrinological failure and its exacerbation is of particular importance to improving its early diagnosis the aim of our report is to be informative while reassuring at the same time Our case suggests that SARS-CoV-2-infection is usually mild and self-limiting in children even in those who are immunocompromised Ethical review and approval was not required for the study on human participants in accordance with the local legislation and institutional requirements Written informed consent to participate in this study was provided by the participants’ legal guardian/next of kin RG and VO wrote the first draft of the manuscript and GP critically reviewed the manuscript for intellectual content for checking the manuscript for the correct syntax How important is obesity as a risk factor for respiratory failure intensive care admission and death in hospitalised COVID-19 patients COVID-19 in children and adolescents in Europe: a multinational Lancet Child Adolesc Heal (2020) 4:653–61 Endocrinology in the time of COVID-19: Management of pituitary tumours Screening for SARS-CoV-2 infection in pediatric oncology patients during the epidemic peak in Italy Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) Infection in Children and Adolescents: A Systematic Review doi: 10.1001/jamapediatrics.2020.1467 Suprasellar Germinomas: 2 Case Reports and Literature Review Long-term outcomes and late effects for childhood and young adulthood intracranial germinomas Our Response to COVID-19 as Endocrinologists and Diabetologists J Clin Endocrinol Metab (2020) 105:1–3 CrossRef Full Text | Google Scholar Multisystem morbidity and mortality in cushing’s syndrome: A cohort study J Clin Endocrinol Metab (2013) 98:2277–84 21-Hydroxylase-Deficient congenital adrenal hyperplasia classic form therapy knowledge and management: targeted educational intervention for paediatricians Increased Infection Risk in Addison’s Disease and Congenital Adrenal Hyperplasia J Clin Endocrinol Metab (2020) 105:418–29 Diagnosis and Treatment of Primary Adrenal Insufficiency: An Endocrine Society Clinical Practice Guideline J Clin Endocrinol Metab (2016) 101:364–89 Endocrinology in the time of COVID-19: Management of Hyponatraemia and Diabetes Insipidus Eur J Endocrinol (2020) 183(1):G9–15 COVID-19 and the endocrine system: exploring the unexplored J Endocrinol Invest (2020) 43(7):1027–31 PubMed Abstract | CrossRef Full Text | Google Scholar Growth Hormone (GH) Deficient Mice with GHRH gene ablation are severely deficient in vaccine and immune responses against streptococcus pneumoniae How is immunosuppressive status affecting children and adults in SARS-CoV-2 infection Impacts of immunosuppression and immunodeficiency on COVID-19: A systematic review and meta-analysis CrossRef Full Text | Google Scholar Cesaro S and Piacentini G (2021) Case Report: SARS-CoV-2 Infection in a Child With Suprasellar Tumor and Hypothalamic-Pituitary Failure Received: 20 August 2020; Accepted: 25 February 2021;Published: 16 March 2021 Copyright © 2021 Gaudino, Orlandi, Cavarzere, Chinello, Antoniazzi, Cesaro and Piacentini. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY) *Correspondence: Rossella Gaudino, cm9zc2VsbGEuZ2F1ZGlub0B1bml2ci5pdA== This website is using a security service to protect itself from online attacks The action you just performed triggered the security solution There are several actions that could trigger this block including submitting a certain word or phrase You can email the site owner to let them know you were blocked Please include what you were doing when this page came up and the Cloudflare Ray ID found at the bottom of this page.