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Chen X, Yang L, Li J, Tan H. Hypoparathyroidism and late-onset hypogonadism in an adult male with familial 22q11.2 deletion syndrome: a case report with 3-year follow-up and review of the literature. BMC Endocr Disord 2022; 22:278. [PMID: 36371175 PMCID: PMC9652942 DOI: 10.1186/s12902-022-01150-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/02/2021] [Accepted: 09/14/2022] [Indexed: 11/15/2022] Open
Abstract
BACKGROUND 22q11.2 deletion syndrome (DiGeorge syndrome) is associated with multiple organ dysfunctions such as cardiac defects, immunodeficiency, and hypoplasia of parathyroid glands. Moreover, the phenotype of 22q11.2 DS has clinical variability and heterogeneity. CASE PRESENTATION In this report, we present the case of a 35-year-old patient with a past medical history that included recurrent infections, mild learning difficulties in childhood, pediatric obesity, and cataract. He was admitted to the endocrinology department for the management of hypogonadism and hypocalcemia. During the 3-year follow-up, the patient gradually developed primary hypoparathyroidism, hypogonadism, chronic renal failure, and heart failure, and his medical condition deteriorated. Meanwhile, in order to improve clinicians' awareness of the endocrine manifestations of adult 22q11.2 DS and reduce missed diagnoses, we reviewed 28 case reports of adult 22q11.2 DS to analyze the clinical characteristics. DISCUSSION Here, we report the case of a young man diagnosed with 22q11.2 DS presented a rare combination of multiple endocrine disorders. This is the first time that a patient with 22q11.2DS had late-onset hypogonadism caused by primary testicular failure combined with decreased pituitary gonadotropin reserve in a patient with 22q11.2DS.
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Affiliation(s)
- Xuelian Chen
- Department of Endocrinology and Metabolism, West China Hospital, Sichuan University, Chengdu, 610041, Sichuan, China
- Department of Nephrology, West China Hospital of Sichuan University, Chengdu, 610041, Sichuan, China
| | - Lichuan Yang
- Department of Endocrinology and Metabolism, West China Hospital, Sichuan University, Chengdu, 610041, Sichuan, China
| | - Jianwei Li
- Department of Nephrology, West China Hospital of Sichuan University, Chengdu, 610041, Sichuan, China
| | - Huiwen Tan
- Department of Nephrology, West China Hospital of Sichuan University, Chengdu, 610041, Sichuan, China.
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Manto MU. Endocrine Disorders. HANDBOOK OF THE CEREBELLUM AND CEREBELLAR DISORDERS 2022:2283-2300. [DOI: 10.1007/978-3-030-23810-0_92] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 09/02/2023]
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Manto M, Hampe CS. Endocrine disorders and the cerebellum: from neurodevelopmental injury to late-onset ataxia. HANDBOOK OF CLINICAL NEUROLOGY 2018; 155:353-368. [PMID: 29891071 DOI: 10.1016/b978-0-444-64189-2.00023-8] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
Abstract
Hormonal disorders are a source of cerebellar ataxia in both children and adults. Normal development of the cerebellum is critically dependent on thyroid hormone, which crosses both the blood-brain barrier and the blood-cerebrospinal fluid barrier thanks to specific transporters, including monocarboxylate transporter 8 and the organic anion-transporting polypeptide 1C1. In particular, growth and dendritic arborization of Purkinje neurons, synaptogenesis, and myelination are dependent on thyroid hormone. Disturbances of thyroid hormone may also impact on cerebellar ataxias of other origin, decompensating or aggravating the pre-existing ataxia manifesting with motor ataxia, oculomotor ataxia, and/or Schmahmann syndrome. Parathyroid disorders are associated with a genuine cerebellar syndrome, but symptoms may be subtle. The main conditions combining diabetes and cerebellar ataxia are Friedreich ataxia, ataxia associated with anti-GAD antibodies, autoimmune polyglandular syndromes, aceruloplasminemia, and cerebellar ataxia associated with hypogonadism (especially Holmes ataxia/Boucher-Neuhäuser syndrome). The general workup of cerebellar disorders should include the evaluation of hormonal status, including thyroid-stimulating hormone and free thyroxine levels, and hormonal replacement should be considered depending on the laboratory results. Cerebellar deficits may be reversible in some cases.
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Affiliation(s)
- Mario Manto
- Neurology Service, CHU-Charleroi, Charleroi, Belgium; Neuroscience Service, Université de Mons, Mons, Belgium.
| | - Christiane S Hampe
- Department of Medicine, University of Washington, Seattle, United States
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Hoshino Y, Machida M, Shimano SI, Taya T. An Adult Case of Chromosome 22q11.2 Deletion Syndrome Associated with a High-positioned Right Aortic Arch. Intern Med 2017; 56:865-872. [PMID: 28381757 PMCID: PMC5457934 DOI: 10.2169/internalmedicine.56.7558] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
Chromosome 22q11.2 deletion syndrome (22q11.2 DS) has a very wide phenotypic spectrum that includes dysmorphic features, cardiac anomalies, and hypocalcemia arising from hypoparathyroidism. We herein describe an adult case of 22q11.2 DS with associated hypoparathyroidism and anomalies of the aortic arch. Because the patient had been diagnosed with primary hypoparathyroidism at another hospital, a diagnosis of 22q11.2 DS had been overlooked. A chest X-ray examination revealed widening of the mediastinum caused by a high-positioned right aortic arch, and we subsequently confirmed a diagnosis of 22q11.2 DS using fluorescence in situ hybridization. Because primary hypoparathyroidism is a rare disorder, physicians should be aware of the variable phenotypic features of 22q11.2 DS.
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Affiliation(s)
- Yoichi Hoshino
- Department of Internal Medicine, Keiaido Hospital, Japan
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Okazaki T, Hifumi T, Ibata T, Manabe A, Hamaya H, Yoshimoto T, Imachi H, Murao K, Kawakita K, Kuroda Y. Recurrent convulsions, hypocalcemia, and hypoparathyroidism related to delayed diagnosis of 22q11.2 deletion syndrome in a middle-aged man. Acute Med Surg 2016; 3:397-399. [PMID: 29123821 DOI: 10.1002/ams2.216] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2015] [Accepted: 04/06/2016] [Indexed: 11/12/2022] Open
Abstract
Case A 49-year-old man had idiopathic epilepsy with recurrent convulsions and history of cleft palate, mental retardation, schizophrenia, and cataract. He had convulsions the day before and on the day of admission. Fosphenytoin was given i.v.; his convulsion stopped, but he lost consciousness 2 h later and was admitted. Glasgow Coma Scale score on arrival was 3. Cerebral computed tomography showed bilateral calcification in the basal ganglia. Laboratory tests showed decreased serum calcium and albumin and increased creatine kinase. He regained consciousness after i.v. calcium gluconate administration. Additionally, he showed decreased parathyroid hormone and 1,25(OH)2 vitamin D. Suspecting hypoparathyroidism, i.v. calcium gluconate was changed to oral vitamin D. His medical history and physical appearance suggested 22q11.2 deletion syndrome, confirmed by chromosomal analysis. Outcome The patient was discharged after 29 days and remains convulsion-free. Conclusion Hypocalcemia due to hypoparathyroidism should be considered in the differential diagnosis of adult recurrent convulsions.
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Affiliation(s)
- Tomoya Okazaki
- Emergency Medical Center Kagawa University Hospital Miki Kita Kagawa Japan
| | - Toru Hifumi
- Emergency Medical Center Kagawa University Hospital Miki Kita Kagawa Japan
| | - Tomohiro Ibata
- Department of Endocrinology Kagawa University Hospital Miki Kita Kagawa Japan
| | - Arisa Manabe
- Emergency Medical Center Kagawa University Hospital Miki Kita Kagawa Japan
| | - Hideyuki Hamaya
- Emergency Medical Center Kagawa University Hospital Miki Kita Kagawa Japan
| | - Takuo Yoshimoto
- Department of Endocrinology Kagawa University Hospital Miki Kita Kagawa Japan
| | - Hitomi Imachi
- Department of Endocrinology Kagawa University Hospital Miki Kita Kagawa Japan
| | - Koji Murao
- Department of Endocrinology Kagawa University Hospital Miki Kita Kagawa Japan
| | - Kenya Kawakita
- Emergency Medical Center Kagawa University Hospital Miki Kita Kagawa Japan
| | - Yasuhiro Kuroda
- Emergency Medical Center Kagawa University Hospital Miki Kita Kagawa Japan
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Lu H. Idiopathic Hypoparathyroidism (IHP) Presenting as "Schizophrenia:" A Case Report. Noro Psikiyatr Ars 2014; 51:401-402. [PMID: 28360661 DOI: 10.5152/npa.2014.7155] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2013] [Accepted: 03/28/2013] [Indexed: 11/22/2022] Open
Abstract
Idiopathic hypoparathyroidism (IHP) with the onset of psychosis is a rare case in the psychiatric clinic. In this case report, we summarize the three facets of IHP, which contains the clinical, biochemical, and radiological features. Besides, the differential diagnosis of this case is supposed to be a highlight that IHP could have the main complaints of psychotic symptoms and featured signs on neuroimaging manifestation.
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Affiliation(s)
- Hanna Lu
- Guangzhou Brain Hospital, Affiliated Hospital of Guangzhou Medical College, Guangzhou, China
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Cirillo E, Giardino G, Gallo V, Puliafito P, Azzari C, Bacchetta R, Cardinale F, Cicalese MP, Consolini R, Martino S, Martire B, Molinatto C, Plebani A, Scarano G, Soresina A, Cancrini C, Rossi P, Digilio MC, Pignata C. Intergenerational and intrafamilial phenotypic variability in 22q11.2 deletion syndrome subjects. BMC MEDICAL GENETICS 2014; 15:1. [PMID: 24383682 PMCID: PMC3893549 DOI: 10.1186/1471-2350-15-1] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/17/2013] [Accepted: 12/27/2013] [Indexed: 12/23/2022]
Abstract
BACKGROUND 22q11.2 deletion syndrome (22q11.2DS) is a common microdeletion syndrome, which occurs in approximately 1:4000 births. Familial autosomal dominant recurrence of the syndrome is detected in about 8-28% of the cases. Aim of this study is to evaluate the intergenerational and intrafamilial phenotypic variability in a cohort of familial cases carrying a 22q11.2 deletion. METHODS Thirty-two 22q11.2DS subjects among 26 families were enrolled. RESULTS Second generation subjects showed a significantly higher number of features than their transmitting parents (212 vs 129, P = 0.0015). Congenital heart defect, calcium-phosphorus metabolism abnormalities, developmental and speech delay were more represented in the second generation (P < 0.05). Ocular disorders were more frequent in the parent group. No significant difference was observed for the other clinical variables. Intrafamilial phenotypic heterogeneity was identified in the pedigrees. In 23/32 families, a higher number of features were found in individuals from the second generation and a more severe phenotype was observed in almost all of them, indicating the worsening of the phenotype over generations. Both genetic and epigenetic mechanisms may be involved in the phenotypic variability. CONCLUSIONS Second generation subjects showed a more complex phenotype in comparison to those from the first generation. Both ascertainment bias related to patient selection or to the low rate of reproductive fitness of adults with a more severe phenotype, and several not well defined molecular mechanism, could explain intergenerational and intrafamilial phenotypic variability in this syndrome.
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Affiliation(s)
- Emilia Cirillo
- Department of Translational Medicine, “Federico II” University, Naples, Italy
| | - Giuliana Giardino
- Department of Translational Medicine, “Federico II” University, Naples, Italy
| | - Vera Gallo
- Department of Translational Medicine, “Federico II” University, Naples, Italy
| | - Pamela Puliafito
- Department of Pediatrics, (DPUO), University of Rome Tor Vergata, Rome, Italy
| | - Chiara Azzari
- Department of Pediatrics, Anna Meyer Children’s University Hospital, Florence, Italy
| | - Rosa Bacchetta
- San Raffaele Telethon Institute for Gene Therapy (HSR-TIGET), Milan; Pediatric ImmunoHematology IRCCS San Raffaele Hospital, Milan, Italy
| | - Fabio Cardinale
- Department of Pediatrics, Giovanni XXIII Pediatric Hospital, Bari, Italy
| | | | - Rita Consolini
- Department of Internal and Experimental Medicine, University of Pisa, Pisa, Italy
| | | | - Baldassarre Martire
- Department of Biomedicine and Evolutive Aging, University of Bari, Bari, Italy
| | | | - Alessandro Plebani
- A. Nocivelli Institute for Molecular Medicine, Pediatric Clinic, University of Brescia, Brescia, Italy
| | | | - Annarosa Soresina
- A. Nocivelli Institute for Molecular Medicine, Pediatric Clinic, University of Brescia, Brescia, Italy
| | - Caterina Cancrini
- Department of Pediatrics, (DPUO), University of Rome Tor Vergata, Rome, Italy
| | - Paolo Rossi
- Department of Pediatrics, (DPUO), University of Rome Tor Vergata, Rome, Italy
| | | | - Claudio Pignata
- Department of Translational Medicine, “Federico II” University, Naples, Italy
- Department of Translational Medical Sciences, Unit of Pediatric Immunology, “Federico II” University, via S. Pansini, 5-80131 Naples, Italy
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Ellegood J, Markx S, Lerch J, Steadman P, Genç C, Provenzano F, Kushner S, Henkelman R, Karayiorgou M, Gogos J. Neuroanatomical phenotypes in a mouse model of the 22q11.2 microdeletion. Mol Psychiatry 2014; 19:99-107. [PMID: 23999526 PMCID: PMC3872255 DOI: 10.1038/mp.2013.112] [Citation(s) in RCA: 51] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/16/2013] [Revised: 07/21/2013] [Accepted: 07/22/2013] [Indexed: 12/21/2022]
Abstract
Recurrent deletions at the 22q11.2 locus have been established as a strong genetic risk factor for the development of schizophrenia and cognitive dysfunction. Individuals with 22q11.2 deletions have a range of well-defined volumetric abnormalities in a number of critical brain structures. A mouse model of the 22q11.2 deletion (Df(16)A(+/-)) has previously been utilized to characterize disease-associated abnormalities on synaptic, cellular, neurocircuitry, and behavioral levels. We performed a high-resolution MRI analysis of mutant mice compared with wild-type littermates. Our analysis revealed a striking similarity in the specific volumetric changes of Df(16)A(+/-) mice compared with human 22q11.2 deletion carriers, including in cortico-cerebellar, cortico-striatal and cortico-limbic circuits. In addition, higher resolution magnetic resonance imaging compared with neuroimaging in human subjects allowed the detection of previously unknown subtle local differences. The cerebellar findings in Df(16)A(+/-) mice are particularly instructive as they are localized to specific areas within both the deep cerebellar nuclei and the cerebellar cortex. Our study indicates that the Df(16)A(+/-)mouse model recapitulates most of the hallmark neuroanatomical changes observed in 22q11.2 deletion carriers. Our findings will help guide the design and interpretation of additional complementary studies and thereby advance our understanding of the abnormal brain development underlying the emergence of 22q11.2 deletion-associated psychiatric and cognitive symptoms.
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Affiliation(s)
- J. Ellegood
- Mouse Imaging Centre, Hospital for Sick Children, Toronto, Ontario, Canada
| | - S. Markx
- Department of Psychiatry, College of Physicians and Surgeons, Columbia University, New York, New York, USA
| | - J.P. Lerch
- Mouse Imaging Centre, Hospital for Sick Children, Toronto, Ontario, Canada
,Department of Medical Biophysics, University of Toronto, Toronto, Ontario Canada
| | - P.E. Steadman
- Mouse Imaging Centre, Hospital for Sick Children, Toronto, Ontario, Canada
,Department of Medical Biophysics, University of Toronto, Toronto, Ontario Canada
| | - C. Genç
- Department of Psychiatry, Erasmus Medical Center, The Netherlands
| | - F Provenzano
- Department of Department of Biomedical Engineering, College of Physicians and Surgeons, Columbia University, New York, New York, USA
| | - S.A. Kushner
- Department of Psychiatry, Erasmus Medical Center, The Netherlands
| | - R.M. Henkelman
- Mouse Imaging Centre, Hospital for Sick Children, Toronto, Ontario, Canada
,Department of Medical Biophysics, University of Toronto, Toronto, Ontario Canada
| | - M. Karayiorgou
- Department of Psychiatry, College of Physicians and Surgeons, Columbia University, New York, New York, USA
| | - J.A. Gogos
- Department of Psychiatry, College of Physicians and Surgeons, Columbia University, New York, New York, USA
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9
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Manto M. Endocrine Disorders. HANDBOOK OF THE CEREBELLUM AND CEREBELLAR DISORDERS 2013:2009-2025. [DOI: 10.1007/978-94-007-1333-8_92] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 09/02/2023]
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10
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Rana AQ, Rana AN, Adlul A, Khan A. Chorea and seizures in iatrogenic hypocalcaemia caused by accidental parathyroidectomy. Br J Hosp Med (Lond) 2012; 73:470-1. [PMID: 22875527 DOI: 10.12968/hmed.2012.73.8.470] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Affiliation(s)
- Abdul Q Rana
- Parkinson's Clinic of Eastern Toronto, Toronto, ON, Canada.
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Kambo JS, Girgis CM, Champion BL, Wall JR. Delayed-onset hypoparathyroidism in an adolescent with chromosome 22Q11 deletion syndrome. Endocr Pract 2011; 17:e123-5. [PMID: 21803718 DOI: 10.4158/ep11102.cr] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
OBJECTIVE To describe the first case of established chromosome 22q11 deletion syndrome with late onset presentation of hypocalcemia secondary to hypoparathyroidism. METHODS We present the history, clinical and laboratory investigations, and management of a 17-year-old adolescent boy who presented with 3 separate seizures secondary to hypocalcemia. This patient had an established diagnosis of chromosome 22q11 deletion syndrome at the time of the seizure presentations, but had previously normal calcium levels. RESULTS Hypocalcemia was noted during each seizure, with corrected calcium levels ranging from 6.64 to 7.76 mg/dL (reference range, 8.52 to 10.52 mg/dL). The hypocalcemia was secondary to hypoparathyroidism, with parathyroid hormone levels < 2.75 pg/mL (reference range, 22.9 to 68.75 pg/mL). He was treated with calcitriol, 0.5 μg daily, and calcium carbonate, 2,400 mg daily, leading to normalization of serum calcium and resolution of seizures. CONCLUSION Chromosome 22q11 deletion syndrome is a relatively common genetic disorder with a wide variety of phenotypic manifestations including cardiac abnormalities, abnormal facies, thymic dysfunction, cleft palate, and hypocalcemia. This case shows that medical practitioners should be aware that hypocalcemia can present after an established diagnosis, which has implications for the management of this disorder.
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Affiliation(s)
- Jaspreet S Kambo
- Department of Endocrinology, University of Sydney Nepean Clinical School, Penrith, NSW, Australia.
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