A pseudohypoparathyroidism type Ia patient with normocalcemia.
Pseudohypoparathyroidism type Ia (PHP-Ia), one of 4 types of PHP, is a genetic disease characterized by clinical hypoparathyroidism caused by parathyroid hormone (PTH) resistance. In addition, patients with PHP-Ia show resistance to other hormones as well as Albright's hereditary osteodystrophy (AHO), a constellation of features including short stature, obesity, brachydactyly, ectopic ossifications, and/or mental retardation. Hypocalcemia is one of the hallmarks of PHP-Ia, but several PHP-Ia patients have been described to have normocalcemia. We encountered a 10-year-old girl with typical Albright's hereditary osteodystrophy with round face, short stature, brachydactyly, and obesity. Biochemical examination showed normocalcemia and increased PTH levels. Ellsworth-Howard test did not show any responses of urinary cAMP and phosphate. Based on these findings, she was diagnosed as having PHP-Ia with normocalcemia. Sequencing analysis of the GNAS gene identified a heterozygous missense mutation in exon 13 (R385H), which was previously reported in a PHP-Ia patient. The exact reason for her normocalcemia is not determined, but we must recognize heterogeneous biochemical findings even in PHP-Ia.
Tamada
Yasuko
Y
Department of Public Health, Kansai Medical University, Moriguchi, Japan.
Kanda
Seiji
S
Suzuki
Hiroko
H
Tajima
Toshihiro
T
Nishiyama
Toshimasa
T
D002118:Calcium / Q000097:blood*; D002648:Child; D002864:Chromogranins; D004252:DNA Mutational Analysis; D005260:Female; D019205:GTP-Binding Protein alpha Subunits, Gs / Q000235:genetics; D006130:Growth Disorders / Q000150:complications / Q000235:genetics; D006801:Humans; D020125:Mutation, Missense; D011547:Pseudohypoparathyroidism / Q000097:blood* / Q000150:complications / Q000235:genetics; D050277:Toe Phalanges
D002864:Chromogranins; C406732:GNAS protein, human; D019205:GTP-Binding Protein alpha Subunits, Gs; D002118:Calcium