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Yıldız Y, Kuseyri Hübschmann O, Akgöz Karaosmanoğlu A, Manti F, Karaca M, Schwartz IVD, Pons R, López-Laso E, Palacios NAJ, Porta F, Kavecan I, Balcı MC, Dy-Hollins ME, Wong SN, Oppebøen M, Medeiros LS, de Paula LCP, García-Cazorla A, Hoffmann GF, Jeltsch K, Leuzzi V, Gökçay G, Hübschmann D, Harting I, Özön ZA, Sivri S, Opladen T. Levodopa-refractory hyperprolactinemia and pituitary findings in inherited disorders of biogenic amine metabolism. J Inherit Metab Dis 2024; 47:431-446. [PMID: 37452721 DOI: 10.1002/jimd.12658] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/24/2023] [Revised: 07/07/2023] [Accepted: 07/12/2023] [Indexed: 07/18/2023]
Abstract
Elevated serum prolactin concentrations occur in inherited disorders of biogenic amine metabolism because dopamine deficiency leads to insufficient inhibition of prolactin secretion. This work from the International Working Group on Neurotransmitter Related Disorders (iNTD) presents the results of the first standardized study on levodopa-refractory hyperprolactinemia (LRHP; >1000 mU/L) and pituitary magnetic resonance imaging (MRI) abnormalities in patients with inherited disorders of biogenic amine metabolism. Twenty-six individuals had LRHP or abnormal pituitary findings on MRI. Tetrahydrobiopterin deficiencies were the most common diagnoses (n = 22). The median age at diagnosis of LRHP was 16 years (range: 2.5-30, 1st-3rd quartiles: 12.25-17 years). Twelve individuals (nine females) had symptoms attributed to hyperprolactinemia: menstruation-related abnormalities (n = 7), pubertal delay or arrest (n = 5), galactorrhea (n = 3), and decreased sexual functions (n = 2). MRI of the pituitary gland was obtained in 21 individuals; six had heterogeneity/hyperplasia of the gland, five had adenoma, and 10 had normal findings. Eleven individuals were treated with the dopamine agonist cabergoline, ameliorating the hyperprolactinemia-related symptoms in all those assessed. Routine monitoring of these symptoms together with prolactin concentrations, especially after the first decade of life, should be taken into consideration during follow-up evaluations. The potential of slow-release levodopa formulations and low-dose dopamine agonists as part of first-line therapy in the prevention and treatment of hyperprolactinemia should be investigated further in animal studies and human trials. This work adds hyperprolactinemia-related findings to the current knowledge of the phenotypic spectrum of inherited disorders of biogenic amine metabolism.
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Affiliation(s)
- Yılmaz Yıldız
- Division of Pediatric Metabolism, Department of Pediatrics, Faculty of Medicine, Hacettepe University, Ankara, Turkey
| | - Oya Kuseyri Hübschmann
- Division of Child Neurology and Metabolic Disorders, University Children's Hospital Heidelberg, Heidelberg, Germany
| | | | - Filippo Manti
- Department of Human Neuroscience, Unit of Child Neurology and Psychiatry, Università degli Studi di Roma La Sapienza, Rome, Italy
| | - Meryem Karaca
- Division of Pediatric Nutrition and Metabolism, Department of Pediatrics, Istanbul Medical Faculty, Istanbul University, Istanbul, Turkey
| | - Ida Vanessa D Schwartz
- Department of Medical Genetics, Hospital de Clínicas de Porto Alegre, Porto Alegre, RS, Brazil
| | - Roser Pons
- First Department of Pediatrics of the University of Athens, Aghia Sofia Hospital, Athens, Greece
| | - Eduardo López-Laso
- Pediatric Neurology Unit, Department of Pediatrics, University Hospital Reina Sofía, IMIBIC and CIBERER, Córdoba, Spain
| | - Natalia Alexandra Julia Palacios
- Inborn Errors of Metabolism Unit, Department of Neurology, Institut de Recerca Sant Joan de Déu and CIBERER-ISCIII, Barcelona, Spain
| | - Francesco Porta
- Department of Pediatrics, AOU Città della Salute e della Scienza, Torino, Italy
| | - Ivana Kavecan
- Faculty of Medicine, University of Novi Sad, Institute for Children and Youth Health Care of Vojvodina, Novi Sad, Serbia
| | - Mehmet Cihan Balcı
- Division of Pediatric Nutrition and Metabolism, Department of Pediatrics, Istanbul Medical Faculty, Istanbul University, Istanbul, Turkey
| | - Marisela E Dy-Hollins
- Department of Neurology, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Suet-Na Wong
- Department of Pediatrics and Adolescent Medicine, The Hong Kong Children's Hospital, Hong Kong SAR, China
| | - Mari Oppebøen
- Division of Child Neurology, Children's Department, Oslo University Hospital, Rikshospitalet, Oslo, Norway
| | - Leonardo Simão Medeiros
- Department of Medical Genetics, Hospital de Clínicas de Porto Alegre, Porto Alegre, RS, Brazil
| | | | - Angeles García-Cazorla
- Inborn Errors of Metabolism Unit, Department of Neurology, Institut de Recerca Sant Joan de Déu and CIBERER-ISCIII, Barcelona, Spain
| | - Georg F Hoffmann
- Division of Child Neurology and Metabolic Disorders, University Children's Hospital Heidelberg, Heidelberg, Germany
| | - Kathrin Jeltsch
- Division of Child Neurology and Metabolic Disorders, University Children's Hospital Heidelberg, Heidelberg, Germany
| | - Vincenzo Leuzzi
- Department of Human Neuroscience, Unit of Child Neurology and Psychiatry, Università degli Studi di Roma La Sapienza, Rome, Italy
| | - Gülden Gökçay
- Division of Pediatric Nutrition and Metabolism, Department of Pediatrics, Istanbul Medical Faculty, Istanbul University, Istanbul, Turkey
| | - Daniel Hübschmann
- Computational Oncology Group, Molecular Precision Oncology Program, National Center for Tumor Diseases (NCT) Heidelberg and German Cancer Research Center (DKFZ), Heidelberg, Germany
- Heidelberg Institute for Stem Cell Technology and Experimental Medicine (HI-STEM), Heidelberg, Germany
- German Cancer Consortium (DKTK), Heidelberg, Germany
| | - Inga Harting
- Department of Neuroradiology, University Hospital Heidelberg, Heidelberg, Germany
| | - Z Alev Özön
- Division of Pediatric Endocrinology, Department of Pediatrics, Faculty of Medicine, Hacettepe University, Ankara, Turkey
| | - Serap Sivri
- Division of Pediatric Metabolism, Department of Pediatrics, Faculty of Medicine, Hacettepe University, Ankara, Turkey
| | - Thomas Opladen
- Division of Child Neurology and Metabolic Disorders, University Children's Hospital Heidelberg, Heidelberg, Germany
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Hsu RH, Lee NC, Chen HA, Hwu WL, Chang TM, Chien YH. Late-onset symptomatic hyperprolactinemia in 6-pyruvoyl-tetrahydropterin synthase deficiency. Orphanet J Rare Dis 2023; 18:351. [PMID: 37950276 PMCID: PMC10636984 DOI: 10.1186/s13023-023-02963-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2023] [Accepted: 10/28/2023] [Indexed: 11/12/2023] Open
Abstract
BACKGROUND Tetrahydrobiopterin (BH4) deficiency caused by 6-pyruvoyl-tetrahydropterin synthase (PTPS) deficiency is a rare disorder that is one of the major causes of hyperphenylalaninemia in Taiwan. METHODS In this study, we reviewed the clinical courses of 12 adolescent and adult patients (7 females and 5 males) with PTPS deficiency. RESULTS The patients were treated shortly after diagnosis through newborn screening with a combination of BH4, levodopa/carbidopa, and 5-OH-tryptophan. Their plasma phenylalanine and tyrosine levels were well controlled, and their prolactin levels were also decreased after treatment. However, their prolactin levels gradually rose as they grew into puberty, and at a current age of 27.5 [interquartile range (IQR 7.9)] years, five of the 12 patients had either highly elevated prolactin levels (> 100 ng/mL in one male patient, normal reference values, male < 11 ng/mL, female < 17 ng/mL) or symptoms, including irregular menstruation, amenorrhea, and breast swelling (in four female patients). The dosage of levodopa in these five patients (14.3 (IQR 3.0) mg/kg/day) was slightly higher than that in the other patients (p = 0.05). Magnetic resonance imaging studies did not reveal an increase in the size of the anterior pituitary gland, although a Rathke cleft cyst was found in one patient. Two patients received cabergoline treatment, which promptly lowered prolactin levels and relieved symptoms. CONCLUSIONS Hyperprolactinemia is common in female patients with PTPS deficiency, especially after puberty. A long-acting dopamine agonist, such as cabergoline, may be a necessary adjunctive treatment for most patients with BH4 deficiency.
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Affiliation(s)
- Rai-Hseng Hsu
- Department of Pediatrics, National Taiwan University Hospital, Taipei, Taiwan
- Department of Medical Genetics, National Taiwan University Hospital, 8 Chung-Shan South Road, Taipei, 10041, Taiwan
- Department of Pediatrics, National Taiwan University College of Medicine, Taipei, Taiwan
| | - Ni-Chung Lee
- Department of Pediatrics, National Taiwan University Hospital, Taipei, Taiwan
- Department of Medical Genetics, National Taiwan University Hospital, 8 Chung-Shan South Road, Taipei, 10041, Taiwan
- Department of Pediatrics, National Taiwan University College of Medicine, Taipei, Taiwan
| | - Hui-An Chen
- Department of Pediatrics, National Taiwan University Hospital, Taipei, Taiwan
- Department of Medical Genetics, National Taiwan University Hospital, 8 Chung-Shan South Road, Taipei, 10041, Taiwan
| | - Wuh-Liang Hwu
- Department of Pediatrics, National Taiwan University Hospital, Taipei, Taiwan
- Department of Medical Genetics, National Taiwan University Hospital, 8 Chung-Shan South Road, Taipei, 10041, Taiwan
- Department of Pediatrics, National Taiwan University College of Medicine, Taipei, Taiwan
- Center for Precision Medicine, China Medical University Hospital, Taichung, Taiwan
| | - Tung-Ming Chang
- Department of Pediatric Neurology, Changhua Christian Children's Hospital, Changhua, Taiwan
- Department of Biological Science and Technology, College of Biological Science and Technology, National Yang Ming Chiao Tung University, Hsinchu, Taiwan
| | - Yin-Hsiu Chien
- Department of Pediatrics, National Taiwan University Hospital, Taipei, Taiwan.
- Department of Medical Genetics, National Taiwan University Hospital, 8 Chung-Shan South Road, Taipei, 10041, Taiwan.
- Department of Pediatrics, National Taiwan University College of Medicine, Taipei, Taiwan.
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Sur LM, Mager MA, Bolunduţ AC, Trifa AP, Anton-Păduraru DT. Two Cases of 6-Pyruvoyl Tetrahydropterin Synthase Deficiency: Case Report and Literature Review. CHILDREN (BASEL, SWITZERLAND) 2023; 10:children10040727. [PMID: 37189976 DOI: 10.3390/children10040727] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/13/2023] [Revised: 03/26/2023] [Accepted: 04/10/2023] [Indexed: 05/17/2023]
Abstract
6-pyruvoyl tetrahydropterin synthase deficiency (PTPSD) is a rare neurometabolic disease that can be diagnosed in newborn screening (NBS) and is part of the family of tetrahydrobiopterin deficiency disorders (BH4Ds). It is essential to diagnose and treat this disease early to prevent permanent neurological damage secondary to this neurotransmitter disorder. We present the first two cases of PTPSD in Romania that were genetically confirmed and treated late. Improving the diagnosis and monitoring procedures in Romania with correct metabolic management will prevent severe neurological impairment from PTPSD or other BH4Ds.
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Affiliation(s)
- Lucia Maria Sur
- Faculty of General Medicine, University of Medicine and Pharmacy Iuliu Haţieganu Cluj-Napoca, 400015 Cluj-Napoca, Romania
- Children's Emergency Hospital, Motilor Street No 68, 400015 Cluj-Napoca, Romania
| | - Monica Alina Mager
- Faculty of General Medicine, University of Medicine and Pharmacy Iuliu Haţieganu Cluj-Napoca, 400015 Cluj-Napoca, Romania
- Children's Emergency Hospital, Motilor Street No 68, 400015 Cluj-Napoca, Romania
| | - Alexandru-Cristian Bolunduţ
- Faculty of General Medicine, University of Medicine and Pharmacy Iuliu Haţieganu Cluj-Napoca, 400015 Cluj-Napoca, Romania
- Children's Emergency Hospital, Motilor Street No 68, 400015 Cluj-Napoca, Romania
| | - Adrian-Pavel Trifa
- Faculty of Medicine, Medical Genetics, University of Medicine and Pharmacy Victor Babes Timisoara, 400349 Cluj-Napoca, Romania
| | - Dana Teodora Anton-Păduraru
- Faculty of Medicine, Mother and Child Discipline, Department of Pediatrics, University of Medicine and Pharmacy Grigore T. Popa Iasi, 700115 Iasi, Romania
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Restless legs syndrome in DNAJC12 deficiency. Neurol Sci 2023; 44:2167-2172. [PMID: 36897462 DOI: 10.1007/s10072-023-06733-9] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2022] [Accepted: 03/04/2023] [Indexed: 03/11/2023]
Abstract
BACKGROUND Restless legs syndrome (RLS) is characterized by an unpleasant or painful sensation generally localized to lower limbs and relieved by movement. Its pathogenesis is hypothesized to involve the dopaminergic system, also in the light of the response of RLS to ex adiuvantibus treatment with dopamine agonists. DNAJC12 deficiency is a recently identified inherited metabolic disease coupling hyperphenylalaninemia to deficient dopaminergic and serotoninergic neurotransmission, due to the combined impairment of the three aromatic amino acids' (i.e., phenylalanine, tyrosine, and tryptophan) hydroxylases. DNAJC12 deficiency was reported in 43 patients so far, presenting with wide spectrum of clinical symptoms. CASE PRESENTATION RESULTS Here, we report RLS as a novel clinical manifestation of DNAJC12 deficiency, occurring in two adults while on treatment with L-dopa at longitudinal follow-up. The adjunct of low-dose pramipexole was effective in both patients to treat RLS. Besides, this treatment also allowed an improvement of dopaminergic homeostasis, as evidenced by clinical amelioration and stabilization of a peripheral short prolactin profile (a tool to indirectly evaluate dopaminergic homeostasis). DISCUSSION Besides including RLS as a new treatable clinical manifestation of DNAJC12, these observations may suggest the opportunity of a selective screening for DNAJC12 deficiency in patients with idiopathic RLS.
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Cannon Homaei S, Barone H, Kleppe R, Betari N, Reif A, Haavik J. ADHD symptoms in neurometabolic diseases: Underlying mechanisms and clinical implications. Neurosci Biobehav Rev 2021; 132:838-856. [PMID: 34774900 DOI: 10.1016/j.neubiorev.2021.11.012] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2020] [Revised: 11/09/2021] [Accepted: 11/09/2021] [Indexed: 12/16/2022]
Abstract
Neurometabolic diseases (NMDs) are typically caused by genetic abnormalities affecting enzyme functions, which in turn interfere with normal development and activity of the nervous system. Although the individual disorders are rare, NMDs are collectively relatively common and often lead to lifelong difficulties and high societal costs. Neuropsychiatric manifestations, including ADHD symptoms, are prominent in many NMDs, also when the primary biochemical defect originates in cells and tissues outside the nervous system. ADHD symptoms have been described in phenylketonuria, tyrosinemias, alkaptonuria, succinic semialdehyde dehydrogenase deficiency, X-linked ichthyosis, maple syrup urine disease, and several mitochondrial disorders, but are probably present in many other NMDs and may pose diagnostic and therapeutic challenges. Here we review current literature linking NMDs with ADHD symptoms. We cite emerging evidence that many NMDs converge on common neurochemical mechanisms that interfere with monoamine neurotransmitter synthesis, transport, metabolism, or receptor functions, mechanisms that are also considered central in ADHD pathophysiology and treatment. Finally, we discuss the therapeutic implications of these findings and propose a path forward to increase our understanding of these relationships.
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Affiliation(s)
- Selina Cannon Homaei
- Division of Psychiatry, Haukeland University Hospital, Norway; Department of Biomedicine, University of Bergen, Norway.
| | - Helene Barone
- Regional Resource Center for Autism, ADHD, Tourette Syndrome and Narcolepsy, Western Norway, Division of Psychiatry, Haukeland University Hospital, Norway.
| | - Rune Kleppe
- Division of Psychiatry, Haukeland University Hospital, Norway; Norwegian Centre for Maritime and Diving Medicine, Department of Occupational Medicine, Haukeland University Hospital, Norway.
| | - Nibal Betari
- Department of Biomedicine, University of Bergen, Norway.
| | - Andreas Reif
- Department of Psychiatry, Psychosomatic Medicine and Psychotherapy, University Hospital Frankfurt, Frankfurt am Main, Germany.
| | - Jan Haavik
- Division of Psychiatry, Haukeland University Hospital, Norway; Department of Biomedicine, University of Bergen, Norway.
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Vitturi N, Lenzini L, Luisi C, Carecchio M, Gugelmo G, Francini‐Pesenti F, Avogaro A. High prolactin levels in dihydropteridine reductase deficiency: A sign of therapy failure or additional pathology? JIMD Rep 2021; 61:48-51. [PMID: 34485017 PMCID: PMC8411106 DOI: 10.1002/jmd2.12236] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/02/2021] [Revised: 05/28/2021] [Accepted: 06/15/2021] [Indexed: 11/20/2022] Open
Abstract
We report the case of a 22-year-old man with a diagnosis of dihydropteridine reductase (DHPR) deficiency who progressively developed movement disorders and epilepsy. Despite L-Dopa supplementation the patient continued to show high prolactin levels, with a discrepancy between the neurological clinical picture and the hormonal biochemical levels. For this reason, other potential causes were ruled out by performing a cerebral magnetic resonance imaging, which demonstrated a solid lesion in the pituitary gland strongly suggestive of a prolactinoma. As the association between metabolic disorders affecting biogenic amine synthesis and prolactinoma has not been previously reported in humans, this report suggests that a critical evaluation of the use of prolactin as a guide for therapy dosage should be made in patients with DHPR deficiency disorders.
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Affiliation(s)
- Nicola Vitturi
- Division of Metabolic Diseases, Department of Medicine‐DIMED, University HospitalUniversity of PadovaPadovaItaly
| | - Livia Lenzini
- Emergency Medicine Unit, Department of Medicine‐DIMED, University HospitalUniversity of PadovaPadovaItaly
| | - Concetta Luisi
- Department of NeuroscienceUniversity of PadovaPadovaItaly
| | | | - Giorgia Gugelmo
- Division of Clinical Nutrition, Department of Medicine‐DIMED, University HospitalUniversity of PadovaPadovaItaly
| | - Francesco Francini‐Pesenti
- Division of Clinical Nutrition, Department of Medicine‐DIMED, University HospitalUniversity of PadovaPadovaItaly
| | - Angelo Avogaro
- Division of Metabolic Diseases, Department of Medicine‐DIMED, University HospitalUniversity of PadovaPadovaItaly
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Bozaci AE, Er E, Yazici H, Canda E, Kalkan Uçar S, Güvenc Saka M, Eraslan C, Onay H, Habif S, Thöny B, Coker M. Tetrahydrobiopterin deficiencies: Lesson from clinical experience. JIMD Rep 2021; 59:42-51. [PMID: 33977029 PMCID: PMC8100404 DOI: 10.1002/jmd2.12199] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/07/2020] [Revised: 01/05/2021] [Accepted: 01/08/2021] [Indexed: 11/30/2022] Open
Abstract
OBJECTIVES The present study describes clinical, biochemical, molecular genetic data, current treatment strategies and follow-up in nine patients with tetrahydrobiopterin (BH4) deficiency due to various inherited genetic defects. METHODS We analyzed clinical, biochemical, and molecular data of nine patients with suspected BH4 deficiency. All patients were diagnosed at Ege University Faculty of Medicine in Izmir, Turkey and comprised data collected from 2006 to 2019. The diagnostic laboratory examinations included blood phenylalanine and urinary or plasma pterins, dihydropteridine reductase (DHPR) enzyme activity measurement in dried blood spots, folic acid and monoamine neurotransmitter metabolites in cerebrospinal fluid, as well as DNA sequencing. RESULTS Among the nine patients, we identified one with autosomal recessive GTP cyclohydrolase I (ar GTPCH) deficiency, two with 6-pyruvoyl-tetrahydropterin synthase (PTPS) deficiency, three with sepiapterin reductase (SR) deficiency, and three with DHPR deficiency. Similar to previous observations, the most common clinical symptoms are developmental delay, intellectual disability, and movement disorders. All patients received treatment with l-dopa and 5-hydroxytryptophan, while only the ar GTPCH, the PTPS, and one DHPR deficient patients were supplemented in addition with BH4. The recommended dose range varies among patients and depends on the type of disease. The consequences of BH4 deficiencies are quite variable; however, early diagnosis and treatment will improve outcomes. CONCLUSIONS As BH4 deficiencies are rare group of treatable neurometabolic disorders, it is essential to diagnose the underlying (genetic) defect in newborns with hyperphenylalaninemia. Irreversible brain damage and progressive neurological deterioration may occur in untreated or late diagnosed patients. Prognosis could be satisfying in the cases with early diagnose and treatment.
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Affiliation(s)
- Ayse Ergul Bozaci
- Department of Pediatrics, Division of Pediatric MetabolismEge University Faculty of MedicineIzmirTurkey
| | - Esra Er
- Tepecik Research and Training Hospital, Department of GeneticsIzmirTurkey
| | - Havva Yazici
- Department of Pediatrics, Division of Pediatric MetabolismEge University Faculty of MedicineIzmirTurkey
| | - Ebru Canda
- Department of Pediatrics, Division of Pediatric MetabolismEge University Faculty of MedicineIzmirTurkey
| | - Sema Kalkan Uçar
- Department of Pediatrics, Division of Pediatric MetabolismEge University Faculty of MedicineIzmirTurkey
| | - Merve Güvenc Saka
- Tepecik Research and Training Hospital, Department of GeneticsIzmirTurkey
| | - Cenk Eraslan
- Department of RadiologyEge University Faculty of MedicineIzmirTurkey
| | - Hüseyin Onay
- Department of Medical GeneticsEge University Faculty of MedicineIzmirTurkey
| | - Sara Habif
- Department of Medical BiochemistryEge University Faculty of MedicineIzmirTurkey
| | - Beat Thöny
- Division of MetabolismUniversity Children's Hospital Zurich and Children's Research CenterZurichSwitzerland
| | - Mahmut Coker
- Department of Pediatrics, Division of Pediatric MetabolismEge University Faculty of MedicineIzmirTurkey
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Porta F, Ponzone A, Spada M. Phenylalanine and tyrosine metabolism in DNAJC12 deficiency: A comparison between inherited hyperphenylalaninemias and healthy subjects. Eur J Paediatr Neurol 2020; 28:77-80. [PMID: 32800687 DOI: 10.1016/j.ejpn.2020.07.011] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/02/2019] [Revised: 07/17/2020] [Accepted: 07/28/2020] [Indexed: 12/31/2022]
Abstract
DNAJC12 deficiency is a new cause of inherited hyperphenylalaninemia (HPA), besides phenylalanine hydroxylase (PAH) deficiency and tetrahydrobiopterin (BH4) deficiencies. Differently from other inherited HPAs, no quantitative data on peripheral phenylalanine (Phe) and tyrosine (Tyr) metabolism are currently available in DNAJC12 deficiency. Phe and Tyr metabolism in a patient with DNAJC12 after a simple Phe oral loading test (100 mg/kg) and a combined Phe (100 mg/kg) + BH4 (20 mg/kg) loading test is presented and compared to patients with disorders of BH4 metabolism, PAH deficiency, and healthy controls. Phe and Tyr metabolism in DNAJC12 deficiency is similar to non-PKU HPA. Differently from BH4 deficiency, BH4 administration in DNAJC12 deficiency does not firmly enhance the rate of Phe hydroxylation. A central effect of BH4 treatment in DNAJC12 deficiency cannot be excluded.
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Affiliation(s)
- Francesco Porta
- Department of Pediatrics, University of Torino, Torino, Italy.
| | - Alberto Ponzone
- Department of Pediatrics, University of Torino, Torino, Italy
| | - Marco Spada
- Department of Pediatrics, University of Torino, Torino, Italy
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Porta F, Ponzone A, Spada M. Long-term safety and effectiveness of pramipexole in tetrahydrobiopterin deficiency. Eur J Paediatr Neurol 2016; 20:839-842. [PMID: 27562098 DOI: 10.1016/j.ejpn.2016.08.006] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/08/2016] [Revised: 08/01/2016] [Accepted: 08/08/2016] [Indexed: 12/12/2022]
Abstract
Tetrahydrobiopterin (BH4) deficiencies are inherited neuro-metabolic disorders leading to monoamine neurotransmitters deficiency. An individualized replacement therapy with neurotransmitters precursors is necessary to restore dopaminergic and serotoninergic homeostasis. The correction of dopaminergic tone is complicated, like in Parkinson disease, by l-dopa short half-life and adverse effects. To improve this picture, since 2009 we introduced the non-ergot dopamine agonist pramipexole as an adjunct to l-dopa therapy in the treatment of the most common causes of BH4 deficiency, 6-pyruvoyl tetrahydropterin synthase (PTPS) deficiency and dihydropteridine reductase (DHPR) deficiency. In the short-term period, this approach allowed substantial clinical advantages in affected patients, with amelioration and stabilization of the clinical picture on twice daily treatment administration and no adverse effect. Here we describe the long-term clinical follow-up (83 ± 24 months) of seven patients with BH4 deficiency treated with pramipexole. After a period of good clinical compensation (34 ± 1 months), different impulse control disorders (gambling, compulsive buying, and hypersexuality) were observed in three patients treated with high-dose pramipexole (0.030-0.033 mg/kg/day) beyond adolescence. These psychiatric adverse effects promptly disappeared after curtailing pramipexole dose by 50-60%. Low-dose pramipexole therapy has been safe and effective in the long-term period in all treated patients (59 ± 9 months). High-dose pramipexole therapy in BH4 deficiency can be complicated, like in Parkinson disease, by psychiatric adverse effects. Low-dose pramipexole therapy (∼0.010 mg/kg/day) has been safe and clinically effective on long-term follow-up, representing a helpful therapeutic option in patients with BH4 deficiency.
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Affiliation(s)
- Francesco Porta
- Department of Pediatrics, University of Torino, Piazza Polonia 94, 10126, Torino, Italy.
| | - Alberto Ponzone
- Department of Pediatrics, University of Torino, Piazza Polonia 94, 10126, Torino, Italy.
| | - Marco Spada
- Department of Pediatrics, University of Torino, Piazza Polonia 94, 10126, Torino, Italy.
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Transdermal rotigotine in dihydropteridine reductase deficiency. J Neurol Sci 2016; 367:237-8. [PMID: 27423595 DOI: 10.1016/j.jns.2016.06.018] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2016] [Revised: 05/19/2016] [Accepted: 06/08/2016] [Indexed: 12/25/2022]
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Target Prolactin Range in Treatment of Tetrahydrobiopterin Deficiency. J Pediatr 2016; 168:236-239.e1. [PMID: 26515614 DOI: 10.1016/j.jpeds.2015.09.062] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/20/2015] [Revised: 07/29/2015] [Accepted: 09/24/2015] [Indexed: 11/21/2022]
Abstract
The introduction of dopamine agonists for treating tetrahydrobiopterin deficiency imposes the evaluation of peripheral prolactin as the sole reliable biochemical marker of dopaminergic homeostasis. Here we provide the clinical interpretation of the previously described short prolactin profile, based on the longitudinal monitoring of 8 patients with tetrahydrobiopterin deficiency.
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