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Pseudohypoparathyroidism

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Title: Pseudohypoparathyroidism  
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Subject: Albright's hereditary osteodystrophy, Disorders of calcium metabolism, Hypoparathyroidism, ICD-10 Chapter IV: Endocrine, nutritional and metabolic diseases, Inborn errors of metal metabolism
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Pseudohypoparathyroidism

Pseudohypoparathyroidism
Classification and external resources
Specialty Endocrinology
ICD-10 E20.1
ICD-9-CM 275.49
OMIM 103580 603233 203330
DiseasesDB 10835 10851
MedlinePlus 000364
eMedicine med/1940
MeSH D011547

Pseudohypoparathyroidism is a condition associated primarily with resistance to the parathyroid hormone.[1] Those with the condition have a low serum calcium and high phosphate, but the parathyroid hormone level (PTH) is actually appropriately high (due to the low level of calcium in the blood). Its pathogenesis has been linked to dysfunctional G Proteins (in particular, Gs alpha subunit). The condition is extremely rare, with an estimated overall prevalence of 7.2/1,000,000 or approximately 1/140000.

Contents

  • Types 1
  • Related conditions 2
  • Presentation and differential 3
  • Biochemical Findings 4
  • See also 5
  • References 6

Types

Types include:

Type Description OMIM Gene
Type 1a Has a characteristic phenotypic appearance (Albright's hereditary osteodystrophy), including short fourth and fifth metacarpals and a rounded facies. It is most likely an autosomal dominant disorder.[2] It is also associated with thyroid stimulating hormone resistance.[3] 103580 GNAS1
Type 1b Lacks the physical appearance of type 1a, but is biochemically similar.[4] It is associated with a methylation defect.[5][6] 603233 GNAS1, STX16
Type 2 Also lacks the physical appearance of type 1a.[7] Since the genetic defect in type 2 is further down the signalling pathway than in type 1, there is a normal cAMP response to PTH stimulation despite the inherent abnormality in calcium regulation. 203330 ?

While biochemically similar, type 1 and 2 disease may be distinguished by the differing urinary excretion of cyclic AMP in response to exogenous PTH.

Some sources also refer to a "type 1c".[8]

Related conditions

The term pseudopseudohypoparathyroidism is used to describe a condition where the individual has the phenotypic appearance of pseudohypoparathyroidism type 1a, but is biochemically normal.

Condition Appearance PTH levels Calcitriol Calcium Phosphates Imprinting
Hypoparathyroidism Normal Low Low Low High Not applicable
Pseudohypoparathyroidism Type 1A Skeletal defects High Low Low High Gene defect from mother (GNAS1)
Type 1B Normal High Low Low High Gene defect from mother (GNAS1 and STX16)
Type 2 Normal High Low Low High ?
Pseudopseudohypoparathyroidism Skeletal defects Normal Normal Normal[9] Normal gene defect from father

Presentation and differential

Patients may present with features of hypocalcaemia including carpo-pedal muscular spasms, cramping, tetany, and if the calcium deficit is severe, generalized seizures. IQ is typically mildly depressed or unaffected. Additional characteristics include short stature, obesity, developmental delay, and calcification of the basal ganglia in the deep white matter of the brain.

Type 1a Pseudohypoparathyroidism is clinically manifest by bone resorption with blunting of the fourth and fifth knuckles of the hand, most notable when the dorsum of the hand is viewed in closed fist position. This presentation is known as 'knuckle knuckle dimple dimple' sign (Archibald's Sign). This is as opposed to Turner syndrome which is characterized by blunting of only the fourth knuckle, and Down's syndrome, which is associated with a hypoplastic middle phalanx.

Biochemical Findings

See also

References

  1. ^ Bastepe M (2008). "The GNAS locus and pseudohypoparathyroidism". Adv. Exp. Med. Biol. 626: 27–40.  
  2. ^ Online 'Mendelian Inheritance in Man' (OMIM) 103580
  3. ^ de Nanclares GP, Fernández-Rebollo E, Santin I, et al. (June 2007). "Epigenetic defects of GNAS in patients with pseudohypoparathyroidism and mild features of Albright's hereditary osteodystrophy". J. Clin. Endocrinol. Metab. 92 (6): 2370–3.  
  4. ^ Online 'Mendelian Inheritance in Man' (OMIM) 603233
  5. ^ Laspa E, Bastepe M, Jüppner H, Tsatsoulis A (December 2004). "Phenotypic and molecular genetic aspects of pseudohypoparathyroidism type Ib in a Greek kindred: evidence for enhanced uric acid excretion due to parathyroid hormone resistance". J. Clin. Endocrinol. Metab. 89 (12): 5942–7.  
  6. ^ Fröhlich LF, Bastepe M, Ozturk D, Abu-Zahra H, Jüppner H (June 2007). "Lack of Gnas epigenetic changes and pseudohypoparathyroidism type Ib in mice with targeted disruption of syntaxin-16". Endocrinology 148 (6): 2925–35.  
  7. ^ Online 'Mendelian Inheritance in Man' (OMIM) 203330
  8. ^ Aldred MA (May 2006). "Genetics of pseudohypoparathyroidism types Ia and Ic". J. Pediatr. Endocrinol. Metab. 19 (Suppl 2): 635–40.  
  9. ^ Shahid Hussain; Sharif Aaron Latif; Adrian Hall (1 July 2010). Rapid Review of Radiology. Manson Publishing. pp. 262–.  
  10. ^ Levine, Michael. "Pseudohypoparathyroidism: A Variation on the Theme of Hypoparathyroidism" (PDF). 
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