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Mohideen SB, Fernando PMS, Beetz C, Schroder S, Pereira C, Gunatilleke S, Rathnayake P, Jasinge E. Dihydropyrimidinase enzyme deficiency and congenital isolated adrenocorticotrophin deficiency: dual genetic diagnosis in a Sri Lankan boy. Lab Med 2024:lmae058. [PMID: 39126710 DOI: 10.1093/labmed/lmae058] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/12/2024] Open
Abstract
We report on a male patient who was investigated for frequent apneic episodes, feeding problems, hypotonia, and left-sided middle cerebral artery infarction in the magnetic resonance imaging at 2 weeks of age. Primary diagnosis of dihydropyrimidinase (DPYS) deficiency was suspected following the analysis of urine for organic acid; DPYS deficiency was strongly suggested by the presence of dihydrouracil, thymine, and uracil. Subsequent genetic evaluation by whole exome sequencing revealed 2 separate mutations, homozygous pathogenic variant c.1010T>C p.Leu337Pro of the DPYS gene, resulting in DPYS deficiency, and homozygous pathogenic variant c.535C>T p.Arg179* of TBX19 gene, which is associated with autosomal recessive congenital isolated adrenocorticotrophic hormone deficiency. Currently, the patient is 2 years old, and he has gross motor retardation and seizure disorder. We suggest that the clinical phenotype of the proband can be a result of mixed expression of both mutations.
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Affiliation(s)
- Shifaniya Banu Mohideen
- Department of Chemical Pathology, Lady Ridgeway Hospital for Children, Colombo, Sri Lanka
- Department of Chemical Pathology, Medical Research Institute, Colombo, Sri Lanka
| | | | | | | | | | | | - Pyara Rathnayake
- Department of Pediatric Neurology, Lady Ridgeway Hospital for Children, Colombo, Sri Lanka
| | - Eresha Jasinge
- Department of Chemical Pathology, Lady Ridgeway Hospital for Children, Colombo, Sri Lanka
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Yang C, Li X, Ma X. Idiopathic Isolated Adrenocorticotropic Hormone Deficiency: A Single-Center Retrospective Study. Exp Clin Endocrinol Diabetes 2023; 131:523-531. [PMID: 37683667 DOI: 10.1055/a-2135-7708] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 09/10/2023]
Abstract
Idiopathic isolated adrenocorticotrophic hormone deficiency (IIAD) is rare, with high clinical omission and misdiagnosis rates. This study retrospectively collected information on clinical presentation, laboratory findings, and treatment response of 17 patients with IIAD at Jining No. 1 People's Hospital from January 2014 to December 2022. The clinical characteristics were summarized, and the pertinent data were analyzed. As a result, most of the patients with IIAD were male (94.12%), with age at onset ranging from 13 to 80 years. The primary manifestations were anorexia (88.24%), nausea (70.59%), vomiting (47.06%), fatigue (64.71%), and neurological or psychiatric symptoms (88.24%). The median time to diagnosis was 2 months and the longest was 10 years. Laboratory tests mostly showed hyponatremia (88.24%) and hypoglycemia (70.59%). The symptoms and laboratory indicators returned to normal after supplementing patients with glucocorticoids. IIAD has an insidious onset and atypical symptoms; it was often misdiagnosed as gastrointestinal, neurological, or psychiatric disease. The aim of this study was to improve clinicians' understanding of IIAD, patients with unexplained gastrointestinal symptoms, neurological and psychiatric symptoms, hyponatremia, or hypoglycemia should be evaluated for IIAD and ensure early diagnosis and treatment.
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Affiliation(s)
| | - Xinpei Li
- Jining Medical University, Jining, China
| | - Xiaoqing Ma
- Jining No 1 People's Hospital, Jining, China
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Charnay T, Mougel G, Amouroux C, Gueorguieva I, Joubert F, Pertuit M, Reynaud R, Barlier A, Brue T, Saveanu A. A novel TBX19 gene mutation in patients with isolated ACTH deficiency from distinct families with a common geographical origin. Front Endocrinol (Lausanne) 2022; 13:1080649. [PMID: 36890856 PMCID: PMC9987334 DOI: 10.3389/fendo.2022.1080649] [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: 10/26/2022] [Accepted: 12/28/2022] [Indexed: 02/22/2023] Open
Abstract
Isolated ACTH deficiency (IAD) is a life-threatening condition, particularly in the neonatal period, while a main consequence of undiagnosed isolated ACTH deficiency in survivors is cognitive impairment. TBX19 is involved in the differentiation and proliferation of corticotropic cells and TBX19 mutations are responsible for more than 60% of neonatal cases of IAD. We describe a new variant of the main TBX19 transcript (NM 005149.3, c.840del (p.(Glu280Asp fs*27)), classified as pathogenic, whose pathogenicity is assumed to be due to nonsense mediated decay leading to non-expression of T-box transcription factor TBX19. Moreover we summarize the TBX19 mutations published as individual cases since our last large cohort. Interestingly, this pathogenic variant was identified in four patients from three apparently unrelated families. Two of these families were consanguineous, and after investigations all of three were discovered to have roots in the same mountainous region of northern Morocco, suggesting a founder effect. Early diagnosis, timely treatment (hydrocortisone therapy) and preventive education allowed normal development, growth and quality of life in all patients.
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Affiliation(s)
- Théo Charnay
- Institut National de la Santé et de la Recherche Médicale (INSERM) U1251, Marseille Medical Genetics (MMG), Institut Marseille Maladies Rares (MarMaRa), Aix-Marseille Université, Marseille, France
- Laboratory of Molecular Biology, Centre Hospitalier Universitaire Conception, Assistance Publique-Hôpitaux de Marseille (AP-HM), Marseille, France
| | - Gregory Mougel
- Institut National de la Santé et de la Recherche Médicale (INSERM) U1251, Marseille Medical Genetics (MMG), Institut Marseille Maladies Rares (MarMaRa), Aix-Marseille Université, Marseille, France
- Laboratory of Molecular Biology, Centre Hospitalier Universitaire Conception, Assistance Publique-Hôpitaux de Marseille (AP-HM), Marseille, France
| | - Cyril Amouroux
- Paediatric Department, Endocrinology Unit, Arnaud de Villeneuve Hospital, Montpellier University Hospital, Montpellier, France
| | - Iva Gueorguieva
- Paediatric Department, Endocrinology Unit, Children’s Center, Jeanne-de-Flandre Hospital, Lille University Hospital, Lille, France
| | - Florence Joubert
- Department of Pediatrics, Centre Hospitalier d’Avignon, Avignon, France
| | - Morgane Pertuit
- Laboratory of Molecular Biology, Centre Hospitalier Universitaire Conception, Assistance Publique-Hôpitaux de Marseille (AP-HM), Marseille, France
| | - Rachel Reynaud
- Institut National de la Santé et de la Recherche Médicale (INSERM) U1251, Marseille Medical Genetics (MMG), Institut Marseille Maladies Rares (MarMaRa), Aix-Marseille Université, Marseille, France
- Department of Multidisciplinary Peadiatrics, Centre de Référence des Maladies Rares d’origine hypophysaire HYPO, Hôpital Timone-Enfants, Assistance Publique-Hôpitaux de Marseille (AP-HM), Marseille, France
| | - Anne Barlier
- Institut National de la Santé et de la Recherche Médicale (INSERM) U1251, Marseille Medical Genetics (MMG), Institut Marseille Maladies Rares (MarMaRa), Aix-Marseille Université, Marseille, France
- Laboratory of Molecular Biology, Centre Hospitalier Universitaire Conception, Assistance Publique-Hôpitaux de Marseille (AP-HM), Marseille, France
| | - Thierry Brue
- Institut National de la Santé et de la Recherche Médicale (INSERM) U1251, Marseille Medical Genetics (MMG), Institut Marseille Maladies Rares (MarMaRa), Aix-Marseille Université, Marseille, France
- Department of Endocrinology, Centre de Référence des Maladies Rares de l’hypophyse HYPO, Hôpital de la Conception, Assistance Publique-Hôpitaux de Marseille (AP-HM), Marseille, France
| | - Alexandru Saveanu
- Institut National de la Santé et de la Recherche Médicale (INSERM) U1251, Marseille Medical Genetics (MMG), Institut Marseille Maladies Rares (MarMaRa), Aix-Marseille Université, Marseille, France
- Laboratory of Molecular Biology, Centre Hospitalier Universitaire Conception, Assistance Publique-Hôpitaux de Marseille (AP-HM), Marseille, France
- *Correspondence: Alexandru Saveanu,
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Kardelen Al AD, Poyrazoğlu Ş, Aslanger A, Yeşil G, Ceylaner S, Baş F, Darendeliler F. A Rare Cause of Adrenal Insufficiency - Isolated ACTH Deficiency Due to TBX19 Mutation: Long-Term Follow-Up of Two Cases and Review of the Literature. Horm Res Paediatr 2020; 92:395-403. [PMID: 32344415 DOI: 10.1159/000506740] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/05/2019] [Accepted: 02/21/2020] [Indexed: 11/19/2022] Open
Abstract
INTRODUCTION Isolated adrenocorticotropic hormone (ACTH) deficiency (IAD) is a rare cause of adrenal insufficiency and T-box pituitary restricted transcription factor (TBX19) mutations are responsible for two-thirds of the neonatal onset form of the disease. IAD presents with hypoglycemia and prolonged jaundice in the neonatal period. TBX19 is important for both pro-opiomelanocortin (POMC) gene transcription and differentiation of POMC-expressing cells. We describe 2 patients, 1 with a reported and 1 with a novel TBX19 mutation, and present information about the long-term follow-up of these patients. CASE PRESENTATION Both patients had critical illnesses, recurrent hypoglycemia, convulsions, and neonatal hyperbilirubinemia. They also had low cortisol and ACTH levels, while other pituitary hormones were within the normal range. Pituitary imaging was normal. After hydrocortisone treatment, there was resolution of the hypoglycemia and the convulsions were controlled. Genetic studies of the patients revealed both had inherited a homozygous mutation of the TBX19 gene. The first patient had an alteration of NM_005149.3:c.856C>T (p.R286*) and the second patient had a novel NM_005149.3:c.584C>T (p.T195I) mutation, analyzed by next-generation sequencing. The noteworthy findings of the patients at follow-up were: short stature, microcephaly, and decreased pubic hair in the first, and dysmorphic features, Chiari type 1 malformation, tall stature, and low bone mineral density (BMD) in the second. CONCLUSION Congenital IAD can be life-threatening if it is not recognized and treated early. TBX19 mutations should be considered in the differential diagnosis of IAD. Further cases or functional analyses are needed for genotype-phenotype correlations. Low BMD, dysmorphic features, Chiari type 1 malformation, and sparse pubic hair are some of the important features in these patients.
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Affiliation(s)
- Aslı Derya Kardelen Al
- Department of Pediatric Endocrinology, Istanbul Faculty of Medicine, Istanbul University, Istanbul, Turkey,
| | - Şükran Poyrazoğlu
- Department of Pediatric Endocrinology, Istanbul Faculty of Medicine, Istanbul University, Istanbul, Turkey
| | - Ayça Aslanger
- Department of Medical Genetics, School of Medicine, Bezmialem Vakıf University, Istanbul, Turkey
| | - Gözde Yeşil
- Department of Medical Genetics, School of Medicine, Bezmialem Vakıf University, Istanbul, Turkey
| | | | - Firdevs Baş
- Department of Pediatric Endocrinology, Istanbul Faculty of Medicine, Istanbul University, Istanbul, Turkey
| | - Feyza Darendeliler
- Department of Pediatric Endocrinology, Istanbul Faculty of Medicine, Istanbul University, Istanbul, Turkey
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Peng C, Sun G, Tang Z, Hou X. Congenital Isolated ACTH Deficiency Caused by TBX19 Gene Mutation: A Family Report. Front Pediatr 2019; 7:546. [PMID: 31998673 PMCID: PMC6967416 DOI: 10.3389/fped.2019.00546] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/31/2019] [Accepted: 12/13/2019] [Indexed: 11/13/2022] Open
Abstract
Congenital isolated adrenocorticotropic hormone deficiency (CIAD) is a rare disorder that may be conducive to hypoglycemia, cholestasis, and seizures. We reported on two siblings with a homozygous mutation of the TBX19 gene, C.377 (exon2) C>T, p. P126L. Their parents had heterozygous mutations on the same locus. Glucocorticoid supplementary therapy was effective, but the treatment became delayed due to inaccessibility, which resulted in entirely different clinical outcomes for the siblings. The older brother developed subdural hematoma, intractable epilepsy, and developmental delays. In contrast, the younger sister received timely glucocorticoid replacement therapy and had no long-term complications while maintaining a good quality of life. In summary, when CIAD is confirmed, early intervention is essential to achieve the optimal outcome.
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Affiliation(s)
- Cheng Peng
- Department of Neonatal Ward, Peking University First Hospital, Beijing, China
| | - Guoyu Sun
- Department of Neonatal Ward, Peking University First Hospital, Beijing, China
| | - Zezhong Tang
- Department of Neonatal Ward, Peking University First Hospital, Beijing, China
| | - Xinlin Hou
- Department of Neonatal Ward, Peking University First Hospital, Beijing, China
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