title: Autosomal-recessive syndrome with alopecia, hypogonadism, progressive extra-pyramidal disorder, white matter disease, sensory neural deafness, diabetes mellitus, and low IGF1.
abstract: We explored the manifestations of an autosomal-recessive multisystemic disorder in several Saudi families. Recognized causes of progressive extra-pyramidal disorder and white matter disease were excluded and the neurological, imaging, endocrine, and skin manifestations of this syndrome described. The onset of these symptoms in these patients began in early adolescence and progressed more rapidly in males. All affected patients had total or partial alopecia, clinical and chemical evidence of hypogonadism (low levels of estradiol and testosterone); females had clear evidence of hypogonadism (streak or absent ovaries), and some patients had diabetes mellitus and/or sensorineural deafness. The constant biochemical abnormality was the low IGF-1. The neurological manifestations included moderate to severe intellectual decline and abnormality of muscle tone and posture with choreo-athetoid and dystonic movements resulting in gait difficulty, dysarthria, difficulty swallowing, and scoliosis. The MRI of brain demonstrated white matter involving cerebellum, brain stem, and cerebral structures, as well as abnormal decreased signal intensity in the basal ganglia with involvement of the substantia nigra. We conclude that the association of hypogonadism, alopecia, and persistent low IGF-1 is a significant autosomal recessive syndrome; it is prevalent in Saudi Arabia. We also demonstrate that the progressive extra-pyramidal disorder, white matter disease, and abnormal signals of the basal ganglia are common features of this syndrome. Sensorineural deafness and diabetes mellitus were recognized features.
authors.affiliation: Department of Neurosciences, King Faisal Specialist Hospital & Research Centre, Riyadh, Kingdom of Saudi Arabia.
authors.forename: Abdulaziz
authors.initials: A
authors.lastname: Al-Semari
authors.forename: Saeed
authors.initials: S
authors.lastname: Bohlega
mesh_terms: D000293:Adolescent; D000328:Adult; D000505:Alopecia / Q000235:genetics* / Q000473:pathology; D001480:Basal Ganglia Diseases / Q000235:genetics / Q000473:pathology; D001927:Brain Diseases / Q000235:genetics* / Q000473:pathology; D002648:Child; D003920:Diabetes Mellitus / Q000235:genetics* / Q000473:pathology; D015536:Down-Regulation; D005260:Female; D005808:Genes, Recessive; D006319:Hearing Loss, Sensorineural / Q000235:genetics / Q000473:pathology; D006801:Humans; D007006:Hypogonadism / Q000235:genetics* / Q000473:pathology; D007334:Insulin-Like Growth Factor I / Q000378:metabolism*; D008297:Male; D010375:Pedigree; D013577:Syndrome
chemical_list: D007334:Insulin-Like Growth Factor I