Amelioration of hypophosphatemic rickets and osteoporosis with pamidronate and growth hormone in Lowe syndrome.
The oculocerebrorenal syndrome of Lowe, an X-linked multisystem disorder, was diagnosed in a male patient who presented with typical abnormalities of the eyes, kidneys and nervous system. Besides congenital cataracts, renal tubular dysfunction and psychomotor retardation, the patient had also suffered from profound failure to thrive, growth hormone deficiency, severe osteoporosis with hypophosphatemic rickets, and progressive renal dysfunction since early childhood, which were attributed to the metabolic derangements following Fanconi syndrome. Direct sequencing of the OCRL1 gene (responsible for the oculocerebrorenal syndrome of Lowe) revealed a de novo c.2282_2283insT in exon 20, which resulted in premature termination of translation (D762X). After monthly intravenous administration of pamidronate since the age of 17.8 years, his urine creatinine clearance and tubular resorption of phosphate increased slightly and bone mineral density was much improved (Z score increased from -7.3 to -3.3) without deterioration of renal function. Simultaneous growth hormone therapy enhanced the positive response. The beneficial osseous and renal effects of the bisphosphonate, along with growth hormone treatment in Lowe syndrome with hypophosphatemia, may be related to reduced renal calcium and phosphate excretion.
Hou
Jia-Woei
JW
Department of Pediatrics, Chang Gung Memorial Hospital, Taipei, Taiwan. houjw4876@gmail.com
D000293:Adolescent; D015519:Bone Density; D004164:Diphosphonates / Q000627:therapeutic use*; D053098:Familial Hypophosphatemic Rickets / Q000188:drug therapy*; D040181:Genetic Diseases, X-Linked; D019382:Human Growth Hormone / Q000627:therapeutic use*; D006801:Humans; D008297:Male; D009800:Oculocerebrorenal Syndrome / Q000188:drug therapy*; D010024:Osteoporosis / Q000188:drug therapy*; D000077268:Pamidronate; D010744:Phosphoric Monoester Hydrolases / Q000235:genetics
D004164:Diphosphonates; D019382:Human Growth Hormone; D010744:Phosphoric Monoester Hydrolases; C075695:OCRL protein, human; D000077268:Pamidronate