title: Menkes disease: importance of diagnosis with molecular analysis in the neonatal period.
abstract: Menkes disease is a congenital disorder caused by changes in copper metabolism derived from mutations in the ATP7A gene. It is characterized by physical and neurological alterations. In the neonatal period, these alterations can be nonspecific, which makes early diagnosis a challenge. Diagnosis can be suspected when there are low levels of ceruloplasmin and serum copper. Molecular analysis confirms the diagnosis. Treatment is parenteral administration of copper histidine. We report a familial case with molecular confirmation. The proband had clinical and biochemical suspicious. Treatment with copper histidine was indicated, but initiated at the age of 2 months and 27 days only. He did not present improvements and died at 6 months. The mother became pregnant again, a male fetus was identified and copper histidine was manufactured during pregnancy. He was born healthy, biochemical markers were reduced and treatment was indicated. Molecular analysis was performed confirming mutation in both the mother and the proband, while the other son did not have mutation, so treatment was discontinued. We support the clinical relevance of molecular confirmation for the correct diagnosis and genetic counseling, once clinical findings in the neonatal period are nonspecific and early treatment with parenteral copper histidine must be indicated.
authors.affiliation: Hospital das Clínicas, Faculdade de Medicina, Universidade de São Paulo, São Paulo, SP, Brazil.
authors.forename: Larissa Sampaio de Athayde
authors.initials: LS
authors.lastname: Costa
authors.affiliation: Hospital das Clínicas, Faculdade de Medicina, Universidade de São Paulo, São Paulo, SP, Brazil.
authors.forename: Stephanie Pucci
authors.initials: SP
authors.lastname: Pegler
authors.affiliation: Patology Department, Instituto de Infectologia Emílio Ribas, São Paulo, SP, Brazil.
authors.forename: Rute Facchini
authors.initials: RF
authors.lastname: Lellis
authors.affiliation: HC, FM, Universidade de São Paulo, São Paulo, SP, Brazil.
authors.forename: Vera Lúcia Jornada
authors.initials: VL
authors.lastname: Krebs
authors.affiliation: Department of Women and Children's Health, Dunedin School of Medicine, University of Otago, Dunedin, New Zeland.
authors.forename: Stephen
authors.initials: S
authors.lastname: Robertson
authors.affiliation: Department of Women and Children's Health, Dunedin School of Medicine, University of Otago, Dunedin, New Zeland.
authors.forename: Tim
authors.initials: T
authors.lastname: Morgan
authors.affiliation: Hospital das Clínicas, Faculdade de Medicina, Universidade de São Paulo, São Paulo, SP, Brazil.
authors.forename: Rachel Sayuri
authors.initials: RS
authors.lastname: Honjo
authors.affiliation: Hospital das Clínicas, Faculdade de Medicina, Universidade de São Paulo, São Paulo, SP, Brazil.
authors.forename: Débora Romeo
authors.initials: DR
authors.lastname: Bertola
authors.affiliation: Hospital das Clínicas, Faculdade de Medicina, Universidade de São Paulo, São Paulo, SP, Brazil.
authors.forename: Chong Ae
authors.initials: CA
authors.lastname: Kim
mesh_terms: D000251:Adenosine Triphosphatases / Q000235:genetics; D027682:Cation Transport Proteins / Q000235:genetics; D002570:Ceruloplasmin / Q000032:analysis; D003300:Copper / Q000032:analysis; D000073840:Copper-Transporting ATPases; D017809:Fatal Outcome; D005260:Female; D006201:Hair Diseases / Q000175:diagnosis; D006639:Histidine / Q000031:analogs & derivatives* / Q000627:therapeutic use; D006801:Humans; D007231:Infant, Newborn; D008297:Male; D007706:Menkes Kinky Hair Syndrome / Q000175:diagnosis / Q000188:drug therapy / Q000235:genetics*; D025202:Molecular Diagnostic Techniques / Q000379:methods*; D009942:Organometallic Compounds / Q000627:therapeutic use*; D011247:Pregnancy
chemical_list: D027682:Cation Transport Proteins; D009942:Organometallic Compounds; D006639:Histidine; D003300:Copper; C098468:copper histidine; D002570:Ceruloplasmin; D000251:Adenosine Triphosphatases; C081184:ATP7A protein, human; D000073840:Copper-Transporting ATPases