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García-Castaño A, Madariaga L, Gómez-Conde S, González P, Grau G, Rica I, de Nanclares GP, De la Hoz AB, Aguayo A, Martínez R, Urrutia I, Gaztambide S, Castaño L. Genetic profile of a large Spanish cohort with hypercalcemia. Front Endocrinol (Lausanne) 2024; 15:1297614. [PMID: 38586466 PMCID: PMC10998451 DOI: 10.3389/fendo.2024.1297614] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/20/2023] [Accepted: 02/27/2024] [Indexed: 04/09/2024] Open
Abstract
Introduction The disorders in the metabolism of calcium can present with manifestations that strongly suggest their diagnosis; however, most of the time, the symptoms with which they are expressed are nonspecific or present only as a laboratory finding, usually hypercalcemia. Because many of these disorders have a genetic etiology, in the present study, we sequenced a selection of 55 genes encoding the principal proteins involved in the regulation of calcium metabolism. Methods A cohort of 79 patients with hypercalcemia were analyzed by next-generation sequencing. Results The 30% of our cohort presented one pathogenic or likely pathogenic variant in genes associated with hypercalcemia. We confirmed the clinical diagnosis of 17 patients with hypocalciuric hypercalcemia (pathogenic or likely pathogenic variants in the CASR and AP2S1 genes), one patient with neonatal hyperparathyroidism (homozygous pathogenic variant in the CASR gene), and another patient with infantile hypercalcemia (two pathogenic variants in compound heterozygous state in the CYP24A1 gene). However, we also found variants in genes associated with primary hyperparathyroidism (GCM2), renal hypophosphatemia with or without rickets (SLC34A1, SLC34A3, SLC9A3R1, VDR, and CYP27B1), DiGeorge syndrome (TBX1 and NEBL), and hypophosphatasia (ALPL). Our genetic study revealed 11 novel variants. Conclusions Our study demonstrates the importance of genetic analysis through massive sequencing to obtain a clinical diagnosis of certainty. The identification of patients with a genetic cause is important for the appropriate treatment and identification of family members at risk of the disease.
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Affiliation(s)
- Alejandro García-Castaño
- Biobizkaia Health Research Institute, Hospital Universitario Cruces, CIBERDEM, CIBERER, EndoERN, Barakaldo, Bizkaia, Spain
| | - Leire Madariaga
- Pediatric Nephrology Department, Biobizkaia Health Research Institute, Hospital Universitario Cruces, University of the Basque Country (UPV/EHU), CIBERDEM, CIBERER, EndoERN, Barakaldo, Bizkaia, Spain
| | - Sara Gómez-Conde
- Biobizkaia Health Research Institute, Hospital Universitario Cruces, University of the Basque Country (UPV/EHU), CIBERDEM, CIBERER, EndoERN, Barakaldo, Bizkaia, Spain
| | - Pedro González
- Endocrinology and Nutrition Department, Biobizkaia Health Research Institute, Hospital Universitario Cruces, EndoERN, Barakaldo, Bizkaia, Spain
| | - Gema Grau
- Pediatric Endocrinology Department, Biobizkaia Health Research Institute, Hospital Universitario Cruces, EndoERN, Barakaldo, Bizkaia, Spain
| | - Itxaso Rica
- Pediatric Endocrinology Department, Biobizkaia Health Research Institute, Hospital Universitario Cruces, CIBERDEM, CIBERER, EndoERN, Barakaldo, Bizkaia, Spain
| | - Gustavo Pérez de Nanclares
- Biobizkaia Health Research Institute, Hospital Universitario Cruces, CIBERDEM, CIBERER, EndoERN, Barakaldo, Bizkaia, Spain
| | - Ana Belén De la Hoz
- Biobizkaia Health Research Institute, Hospital Universitario Cruces, CIBERDEM, CIBERER, EndoERN, Barakaldo, Bizkaia, Spain
| | - Aníbal Aguayo
- Biobizkaia Health Research Institute, Hospital Universitario Cruces, CIBERDEM, CIBERER, EndoERN, Barakaldo, Bizkaia, Spain
| | - Rosa Martínez
- Biobizkaia Health Research Institute, Hospital Universitario Cruces, CIBERDEM, CIBERER, EndoERN, Barakaldo, Bizkaia, Spain
| | - Inés Urrutia
- Biobizkaia Health Research Institute, Hospital Universitario Cruces, CIBERDEM, CIBERER, EndoERN, Barakaldo, Bizkaia, Spain
| | - Sonia Gaztambide
- Endocrinology and Nutrition Department, Biobizkaia Health Research Institute, Hospital Universitario Cruces, University of the Basque Country (UPV/EHU), CIBERDEM, CIBERER, EndoERN, Barakaldo, Bizkaia, Spain
| | | | - Luis Castaño
- Biobizkaia Health Research Institute, Hospital Universitario Cruces, University of the Basque Country (UPV/EHU), CIBERDEM, CIBERER, EndoERN, Barakaldo, Bizkaia, Spain
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Zheng Z, Wu Y, Wu H, Jin J, Luo Y, Cao S, Shan X. Clinical heterogeneity and therapeutic options for idiopathic infantile hypercalcemia caused by CYP24A1 pathogenic variant. J Pediatr Endocrinol Metab 2023; 36:999-1011. [PMID: 37768904 DOI: 10.1515/jpem-2023-0147] [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: 05/08/2023] [Accepted: 09/12/2023] [Indexed: 09/30/2023]
Abstract
OBJECTIVES Infantile hypercalcemia-1 (HCINF1) is a rare disease caused by pathogenic variants in the CYP24A1 gene, resulting in the inability to metabolize active vitamin D. This leads to hypercalcemia and severe complications. CONTENT On December 8th, 2022, a systematic literature search was conducted in PubMed, Wanfang, and CNKI using the keywords "hypercalcemia" and "CYP24A1". Data extraction included patient demographics, clinical presentation, treatment medications, and outcomes. The findings were synthesized to identify common patterns and variations among cases and to assess the efficacy of different therapies in reducing serum calcium. Our findings revealed two distinct peaks in the incidence of HCINF1 caused by CYP24A1 pathogenic variant. Kidney stones or renal calcifications were the most common clinical manifestations of the disease, followed by polyuria and developmental delay. Laboratory investigations showed hypercalcemia, elevated vitamin D levels, hypercalciuria, and low parathyroid hormone. Genetic analysis remains the only reliable diagnostic tool. Although there is no definitive cure for HCINF1, multiple drugs, including bisphosphonates, calcitonin, and rifampicin, have been used to control its symptoms. Blocking the production and intake of vitamin D is the preferred treatment option. SUMMARY AND OUTLOOK Our review highlights the basic clinical and biochemical features of HCINF1 and suggests that targeted diagnostic and therapeutic strategies are needed to address the clinical heterogeneity of the disease. The insights gained from this study may facilitate the development of innovative treatments for HCINF1.
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Affiliation(s)
- Zhichao Zheng
- Department of Pediatric Endocrinology, The Second Affiliated Hospital and Yuying Children's Hospital of Wenzhou Medical University, Wenzhou, Zhejiang, P.R. China
| | - Yujie Wu
- The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, Zhejiang, P.R. China
| | - Huiping Wu
- Department of Pediatric Endocrinology, The Second Affiliated Hospital and Yuying Children's Hospital of Wenzhou Medical University, Wenzhou, Zhejiang, P.R. China
| | - Jiahui Jin
- Department of Pediatric Endocrinology, The Second Affiliated Hospital and Yuying Children's Hospital of Wenzhou Medical University, Wenzhou, Zhejiang, P.R. China
| | - Yue Luo
- Department of Pediatric Endocrinology, The Second Affiliated Hospital and Yuying Children's Hospital of Wenzhou Medical University, Wenzhou, Zhejiang, P.R. China
| | - Shunshun Cao
- Department of Pediatric Endocrinology, The Second Affiliated Hospital and Yuying Children's Hospital of Wenzhou Medical University, Wenzhou, Zhejiang, P.R. China
| | - Xiaoou Shan
- Department of Pediatric Endocrinology, The Second Affiliated Hospital and Yuying Children's Hospital of Wenzhou Medical University, Wenzhou, Zhejiang, P.R. China
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Bizerea-Moga TO, Chisavu F, Ilies C, Olah O, Marginean O, Gafencu M, Doros G, Stroescu R. Phenotype of Idiopathic Infantile Hypercalcemia Associated with the Heterozygous Pathogenic Variant of SLC34A1 and CYP24A1. CHILDREN (BASEL, SWITZERLAND) 2023; 10:1701. [PMID: 37892364 PMCID: PMC10605249 DOI: 10.3390/children10101701] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/14/2023] [Revised: 10/12/2023] [Accepted: 10/16/2023] [Indexed: 10/29/2023]
Abstract
Idiopathic infantile hypercalcemia (IIH) is a rare genetic disease, also called hypersensitivity to vitamin D3. The molecular heterogeneity allows for the differentiation between the two forms; IIH type 1 caused by CYP24A1 genetic variants and IIH type 2 associated with SLC34A1 mutations. The affected individuals express a variety of symptoms: hypercalcemia, hypercalciuria, suppressed intact parathormone levels (PTH), nephrocalcinosis, elevated levels of serum 1,25 (OH)2-vitamin D3 or inappropriately normal levels, and kidney phosphate wasting. The present paper describes three cases of IIH with heterozygous mutations in SLC34A1 and CYP24A1 genes, respectively. The genetic diagnosis is of paramount importance for proper treatment and the prediction of long-term outcomes.
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Affiliation(s)
- Teofana Otilia Bizerea-Moga
- Department XI of Pediatrics—1st Pediatric Discipline, Center for Research on Growth and Developmental Disorders in Children, ‘Victor Babeș’ University of Medicine and Pharmacy Timișoara, Eftimie Murgu Sq. No. 2, 300041 Timișoara, Romania; (T.O.B.-M.); (O.M.); (R.S.)
- 1st Pediatric Clinic, ‘Louis Țurcanu’ Children’s Clinical and Emergency Hospital, Iosif Nemoianu 2, 300011 Timișoara, Romania; (C.I.); (O.O.)
| | - Flavia Chisavu
- 4th Pediatric Clinic, ‘Louis Țurcanu’ Children’s Clinical sand Emergency Hospital, Iosif Nemoianu 2, 300011 Timișoara, Romania; (M.G.); (G.D.)
- Centre for Molecular Research in Nephrology and Vascular Disease, Faculty of Medicine ‘Victor Babes’, 300041 Timișoara, Romania
| | - Cristina Ilies
- 1st Pediatric Clinic, ‘Louis Țurcanu’ Children’s Clinical and Emergency Hospital, Iosif Nemoianu 2, 300011 Timișoara, Romania; (C.I.); (O.O.)
- Department III of Functional Sciences—Pathophysiology Discipline, ‘Victor Babeș’ University of Medicine and Pharmacy Timișoara, Eftimie Murgu Sq. No. 2, 300041 Timișoara, Romania
| | - Orsolya Olah
- 1st Pediatric Clinic, ‘Louis Țurcanu’ Children’s Clinical and Emergency Hospital, Iosif Nemoianu 2, 300011 Timișoara, Romania; (C.I.); (O.O.)
- Department VIII of Neuroscience—Psychology Discipline, ‘Victor Babeș’ University of Medicine and Pharmacy Timișoara, Eftimie Murgu Sq. No. 2, 300041 Timișoara, Romania
| | - Otilia Marginean
- Department XI of Pediatrics—1st Pediatric Discipline, Center for Research on Growth and Developmental Disorders in Children, ‘Victor Babeș’ University of Medicine and Pharmacy Timișoara, Eftimie Murgu Sq. No. 2, 300041 Timișoara, Romania; (T.O.B.-M.); (O.M.); (R.S.)
- 1st Pediatric Clinic, ‘Louis Țurcanu’ Children’s Clinical and Emergency Hospital, Iosif Nemoianu 2, 300011 Timișoara, Romania; (C.I.); (O.O.)
| | - Mihai Gafencu
- 4th Pediatric Clinic, ‘Louis Țurcanu’ Children’s Clinical sand Emergency Hospital, Iosif Nemoianu 2, 300011 Timișoara, Romania; (M.G.); (G.D.)
- Department XI of Pediatrics—3rd Pediatric Discipline, ‘Victor Babeș’ University of Medicine and Pharmacy Timișoara, Eftimie Murgu Sq. No. 2, 300041 Timișoara, Romania
| | - Gabriela Doros
- 4th Pediatric Clinic, ‘Louis Țurcanu’ Children’s Clinical sand Emergency Hospital, Iosif Nemoianu 2, 300011 Timișoara, Romania; (M.G.); (G.D.)
- Department XI of Pediatrics—3rd Pediatric Discipline, ‘Victor Babeș’ University of Medicine and Pharmacy Timișoara, Eftimie Murgu Sq. No. 2, 300041 Timișoara, Romania
| | - Ramona Stroescu
- Department XI of Pediatrics—1st Pediatric Discipline, Center for Research on Growth and Developmental Disorders in Children, ‘Victor Babeș’ University of Medicine and Pharmacy Timișoara, Eftimie Murgu Sq. No. 2, 300041 Timișoara, Romania; (T.O.B.-M.); (O.M.); (R.S.)
- 4th Pediatric Clinic, ‘Louis Țurcanu’ Children’s Clinical sand Emergency Hospital, Iosif Nemoianu 2, 300011 Timișoara, Romania; (M.G.); (G.D.)
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Janiec A, Halat-Wolska P, Obrycki Ł, Ciara E, Wójcik M, Płudowski P, Wierzbicka A, Kowalska E, Książyk JB, Kułaga Z, Pronicka E, Litwin M. Long-term outcome of the survivors of infantile hypercalcaemia with CYP24A1 and SLC34A1 mutations. Nephrol Dial Transplant 2021; 36:1484-1492. [PMID: 33099630 PMCID: PMC8311581 DOI: 10.1093/ndt/gfaa178] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2020] [Accepted: 05/25/2020] [Indexed: 11/12/2022] Open
Abstract
Background Infantile hypercalcaemia (IH) is a vitamin D3 metabolism disorder. The molecular basis for IH is biallelic mutations in the CYP24A1 or SLC34A1 gene. These changes lead to catabolism disorders (CYP24A1 mutations) or excessive generation of 1,25-dihydroxyvitamin D3 [1,25(OH)2D3] (SLC34A1 mutations). The incidence rate of IH in children and the risk level for developing end-stage renal disease (ESRD) are still unknown. The aim of this study was to analyse the long-term outcome of adolescents and young adults who suffered from IH in infancy. Design Forty-two children (23 girls; average age 10.7 ± 6.3 years) and 26 adults (14 women; average age 24.2 ± 4.4 years) with a personal history of hypercalcaemia with elevated 1,25(OH)2D3 levels were included in the analysis. In all patients, a genetic analysis of possible IH mutations was conducted, as well as laboratory tests and renal ultrasonography. Results IH was confirmed in 20 studied patients (10 females). CYP24A1 mutations were found in 16 patients (8 females) and SLC34A1 in 4 patients (2 females). The long-term outcome was assessed in 18 patients with an average age of 23.8 years (age range 2–34). The average glomerular filtration rate (GFR) was 72 mL/min/1.73 m2 (range 15–105). Two patients with a CYP24A1 mutation developed ESRD and underwent renal transplantation. A GFR <90 mL/min/1.73 m2 was found in 14 patients (77%), whereas a GFR <60 mL/min/1.73 m2 was seen in 5 patients (28%), including 2 adults after renal transplantation. Three of 18 patients still had serum calcium levels >2.6 mmol/L. A renal ultrasound revealed nephrocalcinosis in 16 of 18 (88%) patients, however, mild hypercalciuria was detected in only one subject. Conclusions Subjects who suffered from IH have a greater risk of progressive chronic kidney disease and nephrocalcinosis. This indicates that all survivors of IH should be closely monitored, with early implementation of preventive measures, e.g. inhibition of active metabolites of vitamin D3 synthesis.
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Affiliation(s)
- Agnieszka Janiec
- Department of Paediatrics, Nutrition and Metabolic Diseases, Children's Memorial Health Institute, Warsaw, Poland
| | - Paulina Halat-Wolska
- Department of Medical Genetics, Children's Memorial Health Institute, Warsaw, Poland
| | - Łukasz Obrycki
- Department of Nephrology, Kidney Transplantation and Arterial Hypertension, Children's Memorial Health Institute, Warsaw, Poland
| | - Elżbieta Ciara
- Department of Medical Genetics, Children's Memorial Health Institute, Warsaw, Poland
| | - Marek Wójcik
- Department of Biochemistry, Radioimmunology and Experimental Medicine, Children's Memorial Health Institute, Warsaw, Poland
| | - Paweł Płudowski
- Department of Biochemistry, Radioimmunology and Experimental Medicine, Children's Memorial Health Institute, Warsaw, Poland
| | - Aldona Wierzbicka
- Department of Biochemistry, Radioimmunology and Experimental Medicine, Children's Memorial Health Institute, Warsaw, Poland
| | - Ewa Kowalska
- Department of Biochemistry, Radioimmunology and Experimental Medicine, Children's Memorial Health Institute, Warsaw, Poland
| | - Janusz B Książyk
- Department of Paediatrics, Nutrition and Metabolic Diseases, Children's Memorial Health Institute, Warsaw, Poland
| | - Zbigniew Kułaga
- Department of Public Health, Children's Memorial Health Institute, Warsaw, Poland
| | - Ewa Pronicka
- Department of Paediatrics, Nutrition and Metabolic Diseases, Children's Memorial Health Institute, Warsaw, Poland.,Department of Medical Genetics, Children's Memorial Health Institute, Warsaw, Poland
| | - Mieczysław Litwin
- Department of Nephrology, Kidney Transplantation and Arterial Hypertension, Children's Memorial Health Institute, Warsaw, Poland
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Gurevich E, Levi S, Borovitz Y, Alfandary H, Ganon L, Dinour D, Davidovits M. Childhood Hypercalciuric Hypercalcemia With Elevated Vitamin D and Suppressed Parathyroid Hormone: Long-Term Follow Up. Front Pediatr 2021; 9:752312. [PMID: 34858904 PMCID: PMC8631469 DOI: 10.3389/fped.2021.752312] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/02/2021] [Accepted: 09/23/2021] [Indexed: 11/13/2022] Open
Abstract
Purpose: Hypercalcemia with low parathyroid hormone (PTH) level, hypercalciuria, nephrocalcinosis, or nephrolithiasis, was recently reported as caused by mutations in CYP24A1 and SLC34A genes. These encode for vitamin D-24A-hydroxylase and for the renal phosphate transporters NaPiIIa and NaPiIIc, respectively. We aimed to describe the clinical course of these monogenic disorders in patients with and without found mutations during long-term follow-up. Methods: Ten patients with hypercalcemia, hypercalciuria, elevated 1,25-(OH)2D levels and suppressed PTH were followed in our center during 1998-2019. Relevant laboratory and imaging data and results of genetic evaluation were retrieved from medical files. Results: The median age at presentation was 9.5 months (range 1 month-11 years), six were males, and the median follow-up time was 3.8 (1.1-14) years. Mutations in CYP24A1 and SLC34A3 were identified in three and one patients, respectively. Five patients presented with nephrocalcinosis, three with nephrolithiasis, and two had normal renal ultrasound. High blood calcium and 1,25-(OH)2D levels at presentation decreased during follow-up [11.1 ± 1 vs. 9.9 ± 0.5 mg/dl (p = 0.012), and 307 ± 130 vs. 209 ± 65 pmol/l (p = 0.03), respectively]; this paralleled an increase in suppressed PTH levels (5.8 ± 0.9 vs. 11.8 ± 7.3 pg/ml, p = 0.2). Substantial improvements in hypercalciuria and renal sonography findings were not observed. Two patients had impaired renal function (eGFR 84-88 ml/min/1/73 m2) at the last follow up. Interventions included appropriate diet, citrate supplementation, and thiazides. Conclusion: Despite improvement in hypercalcemia and 1,25-(OH)2D levels, not all the patients showed improvements in hypercalciuria and nephrocalcinosis. Deterioration of renal function was also observed. Long-term follow up and intervention to prevent nephrocalcinosis and nephrolithiasis are recommended in these children.
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Affiliation(s)
- Evgenia Gurevich
- Schneider Children's Medical Center of Israel, Pediatric Nephrology Institute, Petach Tikva, Israel.,Faculty of Health Sciences, Ben Gurion University of the Negev, Beer Sheva, Israel
| | - Shelly Levi
- Schneider Children's Medical Center of Israel, Pediatric Nephrology Institute, Petach Tikva, Israel
| | - Yael Borovitz
- Schneider Children's Medical Center of Israel, Pediatric Nephrology Institute, Petach Tikva, Israel
| | - Hadas Alfandary
- Schneider Children's Medical Center of Israel, Pediatric Nephrology Institute, Petach Tikva, Israel.,Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Liat Ganon
- Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel.,Department of Nephrology and Hypertension, The Chaim Sheba Medical Center, Tel-Hashomer, Israel
| | - Dganit Dinour
- Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel.,Department of Nephrology and Hypertension, The Chaim Sheba Medical Center, Tel-Hashomer, Israel
| | - Miriam Davidovits
- Schneider Children's Medical Center of Israel, Pediatric Nephrology Institute, Petach Tikva, Israel.,Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
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