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Ren L, Gang X, Yang S, Sun M, Wang G. A new perspective of hypothalamic disease: Shapiro's syndrome. Front Neurol 2022; 13:911332. [PMID: 35968294 PMCID: PMC9372501 DOI: 10.3389/fneur.2022.911332] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2022] [Accepted: 07/06/2022] [Indexed: 11/13/2022] Open
Abstract
Shapiro's syndrome (SS) is characterized by spontaneous periodic hypothermia. It occurs to patients regardless of age or sex. To date, <60 cases have been reported worldwide. Current knowledge of the disease is limited to clinical feature since the pathogenesis and etiology are still controversial. In this review, the clinical characteristics, pathological mechanism, and possible etiology of the syndrome were reviewed to improve the clinical understanding of the disease.
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Affiliation(s)
- Linan Ren
- Department of Endocrinology and Metabolism, The First Hospital of Jilin University, Changchun, China
| | - Xiaokun Gang
- Department of Endocrinology and Metabolism, The First Hospital of Jilin University, Changchun, China
| | - Shuo Yang
- Department of Clinical Nutrition, The First Hospital of Jilin University, Changchun, China
| | - Meixin Sun
- Department of Endocrinology and Metabolism, The First Hospital of Jilin University, Changchun, China
| | - Guixia Wang
- Department of Endocrinology and Metabolism, The First Hospital of Jilin University, Changchun, China
- *Correspondence: Guixia Wang
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Monjaras-Romo A, Villarreal EG, Diaz-Arizpe O, Vazquez-Mena J, Lozano-Lee F, Tambasco N. Atypical Case of Early-Onset Shapiro Syndrome: Diagnostic Approach and Therapeutic Challenges. JOURNAL OF PEDIATRIC NEUROLOGY 2021. [DOI: 10.1055/s-0041-1733935] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
AbstractShapiro syndrome (SS) is a rare disorder characterized by a triad of spontaneous periodic hypothermia, hyperhidrosis, and corpus callosum agenesis (CCA). Less than 80 cases have been reported so far. Its etiology and pathophysiology, however, are still unclear. In his original publication, Shapiro et al attributed these signs to dysregulation of encephalic pathways secondary to CCA. Nevertheless, since the syndrome was originally described, 19 patients have been reported with an intact corpus callosum, considering it a variant of the condition. In this article, we report the clinical outcome of a 20-month-old girl with SS without evidence of CCA, presenting an atypical onset in which sleep abnormalities were the most prominent complaints, with the classical episodic manifestations appearing afterward; the patient exhibited an optimal response to management with oxcarbazepine. To our understanding, this is fourth-youngest case ever reported of this SS variant, and the first to present sleep disturbances as the most prominent complaint.
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Affiliation(s)
- Alejandro Monjaras-Romo
- Tecnologico de Monterrey, Escuela de Medicina y Ciencias de la Salud, Monterrey, Nuevo Leon, Mexico
| | - Enrique G. Villarreal
- Tecnologico de Monterrey, Escuela de Medicina y Ciencias de la Salud, Monterrey, Nuevo Leon, Mexico
| | - Oscar Diaz-Arizpe
- Tecnologico de Monterrey, Escuela de Medicina y Ciencias de la Salud, Monterrey, Nuevo Leon, Mexico
| | - Jesus Vazquez-Mena
- Tecnologico de Monterrey, Escuela de Medicina y Ciencias de la Salud, Monterrey, Nuevo Leon, Mexico
| | - Francisco Lozano-Lee
- Tecnologico de Monterrey, Escuela de Medicina y Ciencias de la Salud, Monterrey, Nuevo Leon, Mexico
| | - Nicola Tambasco
- Department of Neurology, Movement Disorders Center, Perugia General Hospital and University of Perugia, Perugia, Italy
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Gramont B, Labouré J, Soulier H, Cathébras P. [Spontaneous periodic hypothermia syndrome: A systematic review of the literature]. Rev Med Interne 2021; 42:686-693. [PMID: 33933321 DOI: 10.1016/j.revmed.2021.04.001] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2021] [Revised: 03/29/2021] [Accepted: 04/03/2021] [Indexed: 01/22/2023]
Abstract
INTRODUCTION Periodic spontaneous hypothermia syndrome (PSHS), also known as hypersudation-hypothermia syndrome, is a rare condition characterised by the occurrence of paroxysmal attacks of spontaneous hypothermia occurring without age limit. Few studies have attempted to synthesise the available data on PSHS. The objective of this study was to summarize the literature on this condition. METHODS A literature review was conducted using the Pubmed and ScienceDirect databases. Cases from a registry of PSHS initiated at the CHU of Saint-Étienne were added to the analysis. For each clinical case, clinical, biological and morphological data as well as therapeutic management and evolution were collected. RESULTS Seventy-one cases of PSHS were collected. The median age at symptom onset was 21.5 years. The clinical sign most frequently associated with hypothermia was the presence of hyperhidrosis. The triad of hypothermia-hypersudation-agenesis of the corpus callosum was present in 35.7% of cases. CONCLUSION PSHS remains a poorly known cause of hypothermia, without consensual therapeutic options. The need to better describe cases and obtain more long-term data will allow a better definition and knowledge of this syndrome.
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Affiliation(s)
- B Gramont
- Service de médecine interne, CHU de Saint-Étienne, 42055 Saint-Étienne cedex, France.
| | - J Labouré
- Service de neurologie, CHU de Saint-Étienne, 42055 Saint-Étienne cedex 2, France
| | - H Soulier
- Service de neurologie, CHU de Saint-Étienne, 42055 Saint-Étienne cedex 2, France
| | - P Cathébras
- Service de médecine interne, CHU de Saint-Étienne, 42055 Saint-Étienne cedex, France
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Tambasco N, Paoletti FP, Prato G, Mancardi MM, Prontera P, Giordano L, Grosso S, Romeo A, Pinto F, Savasta S, Peruzzi C, Romoli M, Striano P, Verrotti A, Belcastro V. Long-term follow-up in pediatric patients with paroxysmal hypothermia (Shapiro's syndrome). Eur J Paediatr Neurol 2018; 22:1081-1086. [PMID: 30195408 DOI: 10.1016/j.ejpn.2018.08.004] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/26/2018] [Revised: 08/05/2018] [Accepted: 08/21/2018] [Indexed: 10/28/2022]
Abstract
INTRODUCTION Shapiro syndrome (SS) is characterized by spontaneous recurrent episodes of hypothermia, hyperhidrosis and corpus callosum (CC) agenesis. Less than 60 cases have been reported to date and the pathogenic mechanism as well as the prognosis of this syndrome are still debated. We describe the clinical features and long-term follow-up of a pediatric cohort of SS patients. METHODS We collected 13 (10 novel) pediatric cases of SS and report their long-term follow-up and neurological outcome. RESULTS All patients experienced recurring hypothermia, with body temperature below 35 °C during the episodes, often accompanied by hyperidrosis. CC agenesis was an inconstant structural feature in the present series (2/13 patients). Seven patients received antiepileptic drugs (AEDs) or other drug therapy for a mean period of 12 months. At long-term follow-up (mean = 61 months, range: 60-96), all individuals were free from episodes of paroxysmal hypothermia independently from previous AED use or other drug therapy. CONCLUSION Paroxysmal hypothermia, the core symptom of SS, behaved as a age-dependent feature in our cohort, supporting a good long-term prognosis for SS. A prompt diagnosis of SS is crucial to avoid unnecessary diagnostic investigations.
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Affiliation(s)
- Nicola Tambasco
- Neurology Department, University General Hospital, Perugia, Italy
| | | | - Giulia Prato
- Neuropsychiatry Unit, Department of Clinical and Surgical Neurosciences and Rehabilitation, "G. Gaslini" Institute, Genoa, Italy
| | - Maria Margherita Mancardi
- Neuropsychiatry Unit, Department of Clinical and Surgical Neurosciences and Rehabilitation, "G. Gaslini" Institute, Genoa, Italy
| | - Paolo Prontera
- Medical Genetics Unit, "S. Maria della Misericordia" Hospital, Perugia, Italy
| | - Lucio Giordano
- Child Neuropsychiatric Division, Spedali Civili, Brescia, Italy
| | - Salvatore Grosso
- Clinical Pediatrics, Pediatric Neurology Unit, Department of Molecular and Reproductive Medicine, University of Siena, Siena, Italy
| | - Antonino Romeo
- Pediatric Neurology Unit and Epilepsy Center, "Fatebenefratelli e Oftalmico" Hospital, Milano, Italy
| | - Francesca Pinto
- Department of Pediatrics, "Fatebenefratelli e Oftalmico" Hospital, Milano, Italy
| | - Salvatore Savasta
- Department of Paediatrics, University of Pavia, IRCCS Policlinico "San Matteo", Pavia, Italy
| | | | - Michele Romoli
- Neurology Department, University General Hospital, Perugia, Italy
| | - Pasquale Striano
- Pediatric Neurology and Muscular Diseases Unit, Department of Neurosciences, "G. Gaslini" Institute, Genova, Italy
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Thermoregulatory Instability in Childhood: Linking the Normal Brain to Hypothalamic Storm. Case Rep Neurol Med 2016; 2016:3903854. [PMID: 27847661 PMCID: PMC5101378 DOI: 10.1155/2016/3903854] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2016] [Accepted: 10/11/2016] [Indexed: 11/25/2022] Open
Abstract
Central core temperature is tightly controlled by hypothalamic centers, a feature that makes sudden changes in body temperature very unusual. A dysfunction of these hypothalamic pathways leads to Shapiro's syndrome, comprising spontaneous hypothermia, hyperhidrosis, and corpus callosum dysgenesis. Although it may affect any age, usually it presents in childhood. Variants to this syndrome with completely normal brain anatomy have been consistently reported, expanding the clinical spectrum of the syndrome. Herein, we report the case of a 4-year-old girl with Shapiro's syndrome and unaffected corpus callosum.
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Zhao C, Zhang J, Liang B, Zhong Q, Gao W. A Chinese case of Shapiro syndrome: responsive to carbamazepine. Neurol Sci 2015; 37:489-90. [DOI: 10.1007/s10072-015-2438-0] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2015] [Accepted: 12/09/2015] [Indexed: 11/28/2022]
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Tambasco N, Belcastro V, Prontera P, Nigro P, Donti E, Rossi A, Calabresi P. Shapiro's syndrome: Defining the clinical spectrum of the spontaneous paroxysmal hypothermia syndrome. Eur J Paediatr Neurol 2014; 18:453-7. [PMID: 24594427 DOI: 10.1016/j.ejpn.2014.02.001] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/23/2013] [Revised: 02/01/2014] [Accepted: 02/07/2014] [Indexed: 10/25/2022]
Abstract
Shapiro Syndrome (SS) is a rare condition of spontaneous periodic hypothermia, corpus callosum agenesis (ACC) and hyperhidrosis which can occur at any age. The variant form refers to the phenotypic SS without ACC. We reported the case of SS variant on a 4-year-old boy who presented from his first year frequent episodes of hypothermia lasting 2-3 h with core rectal temperatures <35 °C. In order to understand the characteristics of this rare syndrome we searched all the cases present in literature. Fifty-two cases of SS were found in literature. Among all clinical signs, paroxysmal hypothermia seems to be the hallmark of both typical and variant SS. ACC is reported only in 40% of cases of SS. Hyperhidrosis, another hallmark of SS, was present in only 42.3% of the cases and mainly in adult onset. The presence of SS in siblings of different genders suggests an autosomal recessive inheritance model, however a gonadic mosaicism responsible for an autosomal de novo mutation cannot be ruled out. From our review of well documented cases of SS, we conclude that only the episodic and spontaneous paroxysmal hypothermia should be considered the defining hallmark of typical and variant SS. This can be important to define the clinical manifestation of SS improving the early diagnosis.
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Affiliation(s)
- Nicola Tambasco
- Clinica Neurologica, Azienda Ospedaliero - Universitaria di Perugia, Italy
| | - Vincenzo Belcastro
- Clinica Neurologica, Dipartimento di Neuroscienze, Ospedale Sant'Anna, Como, Italy
| | - Paolo Prontera
- Centro di Riferimento Regionale di Genetica Medica, Azienda Ospedaliero - Universitaria di Perugia, Perugia, Italy
| | - Pasquale Nigro
- Clinica Neurologica, Azienda Ospedaliero - Universitaria di Perugia, Italy
| | - Emilio Donti
- Centro di Riferimento Regionale di Genetica Medica, Azienda Ospedaliero - Universitaria di Perugia, Perugia, Italy
| | - Aroldo Rossi
- Clinica Neurologica, Azienda Ospedaliero - Universitaria di Perugia, Italy
| | - Paolo Calabresi
- Clinica Neurologica, Azienda Ospedaliero - Universitaria di Perugia, Italy; I.R.C.C.S., Fondazione S. Lucia, Roma, Italy
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Topcu Y, Bayram E, Karaoglu P, Yis U, Kurul SH. The combination of thermal dysregulation and agenesis of corpus callosum: Shapiro's or/and reverse Shapiro's syndrome. Ann Indian Acad Neurol 2013; 16:716-9. [PMID: 24339619 PMCID: PMC3841640 DOI: 10.4103/0972-2327.120451] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2012] [Revised: 01/13/2013] [Accepted: 03/07/2013] [Indexed: 11/17/2022] Open
Abstract
Shapiro syndrome is an extremely rare condition consisting the clinical triad of recurrent hypothermia, hyperhydrosis and agenesis of the corpus callosum. On the other hand, reverse Shapiro's sydrome is characterized periodic hyperthermia and agenesis of the corpus callosum. Here, we describe a 3.5-year-old girl with complete agenesis of corpus callosum presenting with recurrent fever and vomiting. She also had hypothermia attacks with accompanying diaphoresis. To the best of our knowledge, there is no described case with episodes of hyperthermia, hypothermia, and vomiting associated with agenesis of the corpus callosum. Recurrent vomiting may be a newly defined symptom associated with these syndromes.
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Affiliation(s)
- Yasemin Topcu
- Department of Pediatrics, Dokuz Eylul University Medical Faculty, Division of Pediatric Neurology, İzmir, Turkey
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Recent advances in clinical neurogenetics. J Neurol 2013; 260:2451-7. [DOI: 10.1007/s00415-012-6757-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2012] [Revised: 11/06/2012] [Accepted: 11/09/2012] [Indexed: 11/24/2022]
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Cyclic bicytopenia in a patient with shapiro syndrome. Case Rep Hematol 2013; 2013:231713. [PMID: 24187634 PMCID: PMC3800621 DOI: 10.1155/2013/231713] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2013] [Accepted: 08/29/2013] [Indexed: 11/24/2022] Open
Abstract
Shapiro syndrome and periodic hypothermia have been reported approximately fifty times in the literature. Shapiro syndrome is defined as the constellation of periodic hypothermia and hyperhidrosis along with agenesis of the corpus callosum by Shapiro et al. in 1969. Periodic hypothermia is a more broad diagnosis with a number of proposed mechanisms; it occurs in patients without structural brain abnormalities. Hematologic abnormalities beyond iron-deficiency anemia have not been documented in any of the reported cases of Shapiro syndrome or periodic hypothermia. Though accidental and therapeutic hypothermia have been associated with thrombocytopenia, this is, to our knowledge, the first reported case of periodic intrinsic hypothermia causing bicytopenia. In this report, we present the case of a patient with Shapiro syndrome who experienced cyclic bicytopenia mirroring hypothermic episodes. We address the differential diagnosis of bicytopenia, review the mechanisms proposed for cytopenias related to hypothermia, and propose possible mechanisms for the finding in this case.
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Pazderska A, O'Connell M, Pender N, Gavin C, Murray B, O'Dowd S. Insights into thermoregulation: A clinico-radiological description of Shapiro syndrome. J Neurol Sci 2013; 329:66-8. [DOI: 10.1016/j.jns.2013.03.014] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2013] [Revised: 03/13/2013] [Accepted: 03/14/2013] [Indexed: 11/30/2022]
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