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Grassa A, Yazidi M, Marrakchi J, Bel Hadj Sliman C, Oueslati I, Chihaoui M. Pallister–Hall syndrome diagnosed in a young man after an acute adrenal crisis. Clin Case Rep 2022; 10:e6249. [PMID: 36017114 PMCID: PMC9393873 DOI: 10.1002/ccr3.6249] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2022] [Revised: 07/01/2022] [Accepted: 07/27/2022] [Indexed: 11/12/2022] Open
Abstract
Pallister–Hall syndrome (PHS) is a very rare genetic disorder. The diagnosis is usually suspected at the young age when a hypothalamic hamartoma is associated with polydactyly. Endocrine manifestations are mostly related to hypothalamic hamartoma and rarely reveal the disease. We report the case of an 18‐year‐old young man in whom the diagnosis of PHS was delayed until his hospitalization in the endocrinology department for acute adrenal insufficiency.
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Affiliation(s)
- Anis Grassa
- Endocrinology Department, Faculty of Medicine of Tunis, La Rabta Hospital University of Tunis el Manar Tunis Tunisia
| | - Meriem Yazidi
- Endocrinology Department, Faculty of Medicine of Tunis, La Rabta Hospital University of Tunis el Manar Tunis Tunisia
| | - Jihene Marrakchi
- Otolaryngology Department, Faculty of Medicine of Tunis, La Rabta Hospital University of Tunis el Manar Tunis Tunisia
| | - Chaima Bel Hadj Sliman
- Endocrinology Department, Faculty of Medicine of Tunis, La Rabta Hospital University of Tunis el Manar Tunis Tunisia
| | - Ibtissem Oueslati
- Endocrinology Department, Faculty of Medicine of Tunis, La Rabta Hospital University of Tunis el Manar Tunis Tunisia
| | - Melika Chihaoui
- Endocrinology Department, Faculty of Medicine of Tunis, La Rabta Hospital University of Tunis el Manar Tunis Tunisia
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Yang Y, Shen F, Jing XP, Zhang N, Xu SY, Li DD, Zhou LL, Bai GH, Fang HY, Zhang ZD, Pang C, Lin J, Sheng HS. Case Report: Whole-Exome Sequencing of Hypothalamic Hamartoma From an Infant With Pallister-Hall Syndrome Revealed Novel de novo Mutation in the GLI3. Front Surg 2021; 8:734757. [PMID: 34631784 PMCID: PMC8493334 DOI: 10.3389/fsurg.2021.734757] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2021] [Accepted: 08/26/2021] [Indexed: 12/30/2022] Open
Abstract
Background: GLI-Kruppel family member 3 (GLI3), a zinc finger transcription factor of the sonic hedgehog pathway, is essential for organ development. Mutations in GLI3 cause several congenital conditions, including Pallister-Hall syndrome (PHS), which is characterized by polydactyly and hypothalamic hamartoma. Most patients are diagnosed soon after birth, and surgical removal of hypothalamic hamartoma in the very young is rarely performed because of associated risks. Case presentation: A 7-month-old boy with PHS features, including a suprasellar lesion, bifid epiglottis, tracheal diverticulum, laryngomalacia, left-handed polydactyly and syndactyly, and omental hernia was referred to our service. His suprasellar lesion was partially removed, and whole-exome sequencing was applied to the resected tumor, his peripheral blood, and blood from his parents. Histopathology confirmed the diagnosis of hypothalamic hamartoma, and molecular profiling revealed a likely pathogenic de novo variant, c.2331C>G (p. H777Q), in GLI3. Magnetic resonance imaging follow-up 1 year later showed some residual tumor, and the patient experienced normal development post operation. Conclusions: We presented a case of PHS that carries a novel GLI3 variant. Hypothalamic hamartoma showed a distinct genetic landscape from germline DNA. These data offer insights into the underlying etiology of hypothalamic hamartoma development in patients with PHS.
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Affiliation(s)
- Yue Yang
- Department of Neurosurgery, Second Affiliated Hospital of Wenzhou Medical University, Wenzhou, China
| | - Fang Shen
- Department of Surgery, Northern Hospital Epping, Epping, VIC, Australia
| | - Xie-Pan Jing
- Department of Neurosurgery, People's Hospital of Mongolian Autonomous Prefecture of Bayingolin, Korla Xinjiang, China
| | - Nu Zhang
- Department of Neurosurgery, Second Affiliated Hospital of Wenzhou Medical University, Wenzhou, China
| | - Shang-Yu Xu
- Department of Neurosurgery, Second Affiliated Hospital of Wenzhou Medical University, Wenzhou, China
| | - Dan-Dong Li
- Department of Neurosurgery, Second Affiliated Hospital of Wenzhou Medical University, Wenzhou, China
| | - Ling-Li Zhou
- Department of Pathology, Second Affiliated Hospital of Wenzhou Medical University, Wenzhou, China
| | - Guang-Hui Bai
- Department of Radiology, Second Affiliated Hospital of Wenzhou Medical University, Wenzhou, China
| | - Huang-Yi Fang
- Department of Neurosurgery, Second Affiliated Hospital of Wenzhou Medical University, Wenzhou, China.,School of the 2nd Clinical Medical Sciences, Wenzhou Medical University, Wenzhou, China
| | - Zhong-Ding Zhang
- Department of Neurosurgery, Second Affiliated Hospital of Wenzhou Medical University, Wenzhou, China
| | - Chen Pang
- Department of Neurosurgery, Second Affiliated Hospital of Wenzhou Medical University, Wenzhou, China.,School of the 2nd Clinical Medical Sciences, Wenzhou Medical University, Wenzhou, China
| | - Jian Lin
- Department of Neurosurgery, Second Affiliated Hospital of Wenzhou Medical University, Wenzhou, China
| | - Han-Song Sheng
- Department of Neurosurgery, Second Affiliated Hospital of Wenzhou Medical University, Wenzhou, China
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Pallister-Hall syndrome with orofacial narrowing and tethered cord: a case report. J Med Case Rep 2018; 12:354. [PMID: 30486853 PMCID: PMC6262955 DOI: 10.1186/s13256-018-1868-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2018] [Accepted: 10/03/2018] [Indexed: 11/14/2022] Open
Abstract
Background Pallister–Hall syndrome is a rare, autosomal dominant, genetic disorder characterized by different congenital abnormalities: hypothalamic hamartoblastoma, bifid or shortened epiglottis, polydactyly, renal anomalies, and imperforate anus. Case presentation In this case report, we describe the case of a 13-year-old Lebanese-Armenian boy born with Pallister–Hall syndrome showing newly associated manifestations (orofacial narrowing and tethered cord), and currently showing a spontaneous puberty with normal growth pattern following management with growth hormones. Conclusions This case report shows a practical approach to this very rare syndrome, mainly with testosterone and growth hormones, and its follow-up in the long term. Being familiar with such cases may allow improvement of our knowledge for better management in the future.
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Dunham C, McFadden D, Dahlgren L, Butler B, Hamilton S, McKinnon M. Congenital Hypothalamic "Hamartoblastoma" Versus "Hamartoma": Suggestions for Neuropathologic Terminology Emanating From a Mid-gestational Autopsy Case of Pallister-Hall Syndrome. Pediatr Dev Pathol 2018; 21:324-331. [PMID: 28429635 DOI: 10.1177/1093526617701338] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Pallister-Hall syndrome (PHS) is a rare malformative disorder that is due to truncating functional repressor mutations in GLI3. Since the seminal publication in 1980, hypothalamic tumors have been recognized to be a cardinal feature of PHS. In their original description of the neuropathologic features of PHS, Clarren et al. coined the term "hamartoblastoma" to characterize what they deemed to be a dual malformative and neoplastic mass of the hypothalamus. In subsequent published cases/series of PHS, the term "hamartoma" was often substituted for hamartoblastoma given what appeared to be a benign natural history of this lesion. Additional confusion in the literature has ensued since most hypothalamic hamartomas (HH) encountered on the clinical neuropathology service are "isolated" in nature (ie, no other congenital malformations) and present in a very different and stereotypical fashion with gelastic seizures and/or precocious puberty. While genomic investigations of isolated HH have begun to uncover a mutational profile of these cases, GLI3 mutations have only been recognized in a small subset of isolated HH. Herein, we describe the autopsy findings from a 21-week gestational age fetus with features of PHS. Moreover, we provide a detailed description of the hypothalamic tumor affecting this fetus and propose a novel subclassification of HH, distinguishing syndromic from isolated forms based upon the presence or absence of neocortical-like areas.
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Affiliation(s)
- C Dunham
- 1 Department of Pathology and Laboratory Medicine, Children and Women's Health Centre of BC, Vancouver, British Columbia, Canada
| | - D McFadden
- 1 Department of Pathology and Laboratory Medicine, Children and Women's Health Centre of BC, Vancouver, British Columbia, Canada
| | - L Dahlgren
- 2 Department of Obstetrics and Gynecology, Children and Women's Health Centre of BC, Vancouver, British Columbia, Canada
| | - B Butler
- 2 Department of Obstetrics and Gynecology, Children and Women's Health Centre of BC, Vancouver, British Columbia, Canada
| | - S Hamilton
- 3 Department of Medical Genetics, Children and Women's Health Centre of BC, Vancouver, British Columbia, Canada
| | - M McKinnon
- 3 Department of Medical Genetics, Children and Women's Health Centre of BC, Vancouver, British Columbia, Canada
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Ito S, Kitazawa R, Haraguchi R, Kondo T, Ouchi A, Ueda Y, Kitazawa S. Novel GLI3 variant causing overlapped Greig cephalopolysyndactyly syndrome (GCPS) and Pallister-Hall syndrome (PHS) phenotype with agenesis of gallbladder and pancreas. Diagn Pathol 2018; 13:1. [PMID: 29368652 PMCID: PMC6389258 DOI: 10.1186/s13000-017-0682-8] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2017] [Accepted: 12/22/2017] [Indexed: 12/21/2022] Open
Abstract
Background A proper balance between the activator and the repressor form of GLI3, a zinc-finger transcription factor downstream of hedgehog signaling, is essential for proper development of various organs during development. Mutations in different domains of the GLI3 gene underlie several congenital diseases including Greig cephalopolysyndactyly syndrome (GCPS) and Pallister-Hall syndrome (PHS). Case presentation Here, we describe the case of an overlapped phenotype of these syndromes with agenesis of the gallbladder and the pancreas, bearing a c.2155 C > T novel likely pathogenic variant of GLI3 gene by missense point mutation causing p.P719S at the proteolytic cleavage site. Conclusions Although agenesis of the gallbladder and the pancreas is uncommon in GLI3 morphopathy, a slight difference in the gradient or the balance between activator and repressor in this case may hinder sophisticated spatial and sequential hedgehog signaling that is essential for proper development of gallbladder and pancreas from endodermal buds.
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Affiliation(s)
- Saki Ito
- Department of Molecular Pathology, Ehime University Graduate School of Medicine, Shitsukawa, Toon City, Ehime, 791-0295, Japan
| | - Riko Kitazawa
- Department of Molecular Pathology, Ehime University Graduate School of Medicine, Shitsukawa, Toon City, Ehime, 791-0295, Japan.,Division of Diagnostic Pathology, Ehime University Hospital, Toon City, Ehime, 791-0295, Japan
| | - Ryuma Haraguchi
- Department of Molecular Pathology, Ehime University Graduate School of Medicine, Shitsukawa, Toon City, Ehime, 791-0295, Japan
| | - Takeshi Kondo
- Division of Legal Medicine, Kobe University Graduate School of Medicine, Kobe City, Hyogo, 650-0017, Japan
| | - Ayaka Ouchi
- Department of Molecular Pathology, Ehime University Graduate School of Medicine, Shitsukawa, Toon City, Ehime, 791-0295, Japan.,Division of Diagnostic Pathology, Ehime University Hospital, Toon City, Ehime, 791-0295, Japan
| | - Yasuo Ueda
- Department of Molecular Pathology, Ehime University Graduate School of Medicine, Shitsukawa, Toon City, Ehime, 791-0295, Japan.,Division of Diagnostic Pathology, Ehime University Hospital, Toon City, Ehime, 791-0295, Japan
| | - Sohei Kitazawa
- Department of Molecular Pathology, Ehime University Graduate School of Medicine, Shitsukawa, Toon City, Ehime, 791-0295, Japan.
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Abstract
Clinical genetics is the application of advances in genetics and medicine to real human families. It involves diagnosis, care, and counseling concerning options available to affected individuals and their family members. Advances in medicine and genetics have led to dramatic changes in the scope and responsibilities of clinical genetics. This reflection on the last 50+ years of clinical genetics comes from personal experience, with an emphasis on the important contributions that clinical geneticists have made to the understanding of disease/disorder processes and mechanisms. The genetics clinic is a research laboratory where major advances in knowledge can and have been made.
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Affiliation(s)
- Judith G. Hall
- Department of Medical Genetics and Department of Pediatrics, University of British Columbia and BC Children's Hospital, Vancouver V6H 3N1, Canada
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Al-Qattan MM, Shamseldin HE, Salih MA, Alkuraya FS. GLI3-related polydactyly: a review. Clin Genet 2017; 92:457-466. [PMID: 28224613 DOI: 10.1111/cge.12952] [Citation(s) in RCA: 41] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2016] [Revised: 10/28/2016] [Accepted: 12/06/2016] [Indexed: 12/20/2022]
Abstract
GLI3 mutations are known to be associated with nine syndromes/conditions in which polydactyly is a feature. In this review, the embryology, pathogenesis, and animal models of GLI3-related polydactyly are discussed first. This is followed by a detailed review of the genotype-phenotype correlations. Based on our review of the literature and our clinical experiences, we recommend viewing GLI3-related syndromes/conditions as four separate entities; each characterized by a specific pattern of polydactyly. These four entities are: the preaxial polydactyly type IV-Greig-acrocallosal spectrum, postaxial polydactyly types A/B, Pallister-Hall syndrome (PHS), and oral-facial-digital overlap syndrome. We also provide illustrative clinical examples from our practice including a family with a novel GLI3 mutation causing PHS. The review also introduces the term 'Forme Fruste' preaxial polydactyly and gives several conclusions/recommendations including the recommendation to revise the current criteria for the clinical diagnosis of PHS.
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Affiliation(s)
- M M Al-Qattan
- Department of Surgery, College of Medicine, King Saud University, Riyadh, Saudi Arabia
| | - H E Shamseldin
- Department of Genetics, King Faisal Specialist Hospital and Research Center, Jeddah, Saudi Arabia
| | - M A Salih
- Department of Pediatrics, College of Medicine, King Saud University, Riyadh, Saudi Arabia
| | - F S Alkuraya
- Department of Genetics, King Faisal Specialist Hospital and Research Center, Jeddah, Saudi Arabia.,Department of Anatomy and Cell Biology, College of Medicine, Alfaisal University, Riyadh, Saudi Arabia
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Bifid epiglottis in a patient with Pallister-Hall syndrome. Can J Anaesth 2016; 63:1197-1198. [PMID: 27339091 DOI: 10.1007/s12630-016-0686-y] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2016] [Revised: 06/08/2016] [Accepted: 06/14/2016] [Indexed: 10/21/2022] Open
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