title: Wilson disease in children: analysis of 57 cases.
abstract: OBJECTIVE
  Wilson disease (WD) has a wide spectrum of clinical manifestations. Affected children may be entirely asymptomatic and the diagnosis problematic. Herein we present the clinical and laboratory characteristics of 57 children with WD and point out the diagnostic difficulties in a pediatric population.
  
  
  METHODS
  Clinical and laboratory data were collected from 57 consecutive children with WD. Evaluation included detailed physical examination, conventional laboratory testing, genetic analysis, and liver biopsy.
  
  
  RESULTS
  The mean age at diagnosis was 9.27 +/- 3.62 years (range 4 months-18 years). Twenty patients were symptomatic, 19 were referred because of abnormal liver function test results and/or hepatomegaly, and 18 received their diagnoses after family screening. Twenty-two patients had both Kayser-Fleischer ring and decreased serum ceruloplasmin levels, 13 had urinary copper excretion after penicillamine challenge >1600 microg/24 hours, and 3 had liver copper content >250 microg/g dry weight. Of the remaining 19 patients, 17 had both low serum ceruloplasmin <or=20 mg/dL and increased urinary copper excretion, >75 microg/24 hours before, or >1000 microg/24 hours after penicillamine challenge. In 2 patients with equivocal cases who had serum ceruloplasmin 26 mg/dL, the diagnosis was confirmed by genetic analysis. No correlation was found between specific mutations and the disease phenotypic expression. Chelating therapy was well tolerated, and the outcome was satisfactory.
  
  
  CONCLUSIONS
  WD in children may be obscure and requires extensive investigation to establish the diagnosis. Genetic analysis is needed in equivocal cases.
authors.affiliation: First Department of Pediatrics, Athens University, Aghia Sophia Children's Hospital, Athens, Greece.
authors.forename: Nina
authors.initials: N
authors.lastname: Manolaki
authors.forename: Georgia
authors.initials: G
authors.lastname: Nikolopoulou
authors.forename: George L
authors.initials: GL
authors.lastname: Daikos
authors.forename: Eleni
authors.initials: E
authors.lastname: Panagiotakaki
authors.forename: Maria
authors.initials: M
authors.lastname: Tzetis
authors.forename: Eleftheria
authors.initials: E
authors.lastname: Roma
authors.forename: Emmanouel
authors.initials: E
authors.lastname: Kanavakis
authors.forename: Vassiliki P
authors.initials: VP
authors.lastname: Syriopoulou
mesh_terms: D000251:Adenosine Triphosphatases / Q000235:genetics; D000293:Adolescent; D001706:Biopsy; D027682:Cation Transport Proteins / Q000235:genetics; D002570:Ceruloplasmin / Q000032:analysis; D002614:Chelating Agents / Q000627:therapeutic use; D002648:Child; D002675:Child, Preschool; D003300:Copper / Q000032:analysis / Q000652:urine; D000073840:Copper-Transporting ATPases; D005260:Female; D006527:Hepatolenticular Degeneration / Q000175:diagnosis* / Q000188:drug therapy / Q000235:genetics; D006529:Hepatomegaly; D006801:Humans; D007223:Infant; D008099:Liver / Q000737:chemistry / Q000473:pathology; D008111:Liver Function Tests; D008297:Male; D009154:Mutation; D010396:Penicillamine / Q000627:therapeutic use
chemical_list: D027682:Cation Transport Proteins; D002614:Chelating Agents; D003300:Copper; D002570:Ceruloplasmin; D000251:Adenosine Triphosphatases; D000073840:Copper-Transporting ATPases; D010396:Penicillamine