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      ¿Se puede diagnosticar una enfermedad genética en base a caracteres fenotípicos? A propósito de un caso de pseudohipoparatiroidismo en Ecuador Translated title: Can a genetic condition be diagnosed based on phenotypic characteristics? A case of pseudohypoparathyroidism in Ecuador

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          Abstract

          Resumen El pseudohipoparatiroidismo es una endocrinopatía poco frecuente, pero no debe descartarse su diagnóstico cuando la hipocalcemia se acompaña de hiperfosfatemia y elevación de hormona paratiroidea en ausencia de insuficiencia renal o deficiencia de vitamina D. Aunque el diagnóstico definitivo se obtiene con estudios genéticos, los estudios bioquímicos que evidencien la resistencia hormonal y las características fenotípicas nos permiten establecer el diagnóstico. La literatura es escasa en América Latina y se han descrito pocos casos. Informamos un caso de un hombre de 18 años con pseudohipoparatiroidismo, y discutimos sus características clínicas, hallazgos bioquímicos y radiográficos, junto con el tratamiento.

          Translated abstract

          Summary Pseudohypoparathyroidism is a rare disease of the endocrine gland. Its diagnosis should not be dismissed when hypocalcemia is accompanied by hyperphosphatemia and high levels of parathyroid hormone even if kidney failure and vitamin D deficiency do not occur. Although genetic studies provide a definitive diagnosis, biochemical tests that show hormonal resistance and phenotypic characteristics allow us to establish a diagnosis. Literature is limited in Latin America and few cases have been described. Here we report an 18-year-old male suffering pseudohypoparathyroidism and we discuss clinical characteristics, biochemical and radiographic findings, as well as treatment.

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          Most cited references18

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          Diagnosis and management of pseudohypoparathyroidism and related disorders: first international Consensus Statement

          This Consensus Statement covers recommendations for the diagnosis and management of patients with pseudohypoparathyroidism (PHP) and related disorders, which comprise metabolic disorders characterized by physical findings that variably include short bones, short stature, a stocky build, early-onset obesity and ectopic ossifications, as well as endocrine defects that often include resistance to parathyroid hormone (PTH) and TSH. The presentation and severity of PHP and its related disorders vary between affected individuals with considerable clinical and molecular overlap between the different types. A specific diagnosis is often delayed owing to lack of recognition of the syndrome and associated features. The participants in this Consensus Statement agreed that the diagnosis of PHP should be based on major criteria, including resistance to PTH, ectopic ossifications, brachydactyly and early-onset obesity. The clinical and laboratory diagnosis should be confirmed by a molecular genetic analysis. Patients should be screened at diagnosis and during follow-up for specific features, such as PTH resistance, TSH resistance, growth hormone deficiency, hypogonadism, skeletal deformities, oral health, weight gain, glucose intolerance or type 2 diabetes mellitus, and hypertension, as well as subcutaneous and/or deeper ectopic ossifications and neurocognitive impairment. Overall, a coordinated and multidisciplinary approach from infancy through adulthood, including a transition programme, should help us to improve the care of patients affected by these disorders.
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            Pseudohypoparathyroidism and GNAS epigenetic defects: clinical evaluation of albright hereditary osteodystrophy and molecular analysis in 40 patients.

            The two main subtypes of pseudohypoparathyroidism (PHP), PHP-Ia and -Ib, are caused by mutations in GNAS exons 1-13 and methylation defects in the imprinted GNAS cluster, respectively. PHP-Ia patients show Albright hereditary osteodystrophy (AHO) and resistance toward PTH and additional hormones, whereas PHP-Ib patients do not have AHO, and hormone resistance appears to be limited to PTH and TSH. Recently, methylation defects have been detected in few patients with PHP and mild AHO, indicating a molecular overlap between the two forms. The aim of the study was to screen patients with clinically diagnosed PHP-Ia for methylation defects and to investigate the presence of correlations between the molecular findings and AHO severity. We investigated differential methylation of GNAS regions and STX16 microdeletions in genomic DNA from 40 patients with sporadic AHO and multihormone resistance, with no mutations in Gsalpha-coding GNAS exons. Molecular analysis showed GNAS cluster imprinting defects in 24 of the 40 patients analyzed. No STX16 deletion was detected. The presence of imprinting defects was not associated with the severity of AHO or with specific AHO signs. We report the largest series of the literature of patients with clinical AHO and multihormone resistance and no mutation in the Gsalpha gene. Our findings of frequent GNAS imprinting defects further confirm the existence of an overlap between molecular and clinical features of PHP-Ia and PHP-Ib and highlight the necessity of a new clinical classification of the disease that takes into account the recent knowledge on the molecular basis underlying these defects.
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              Prevalence of idiopathic hypoparathyroidism and pseudohypoparathyroidism in Japan.

              A nationwide epidemiologic survey of idiopathic hypoparathyroidism and pseudohypoparathyroidism was conducted in 1998 to clarify the prevalence of the two disorders in Japan. From a total of 14,100 departments of pediatrics, internal medicine, neurology, and endocrinology in whole Japan, 2952 (20.9%) study departments were selected at random. Of these departments receiving the first questionnaire, 1855 (62.8%) responded. From these departments 390 patients with idiopathic hypoparathyroidism and 203 with pseudohypoparathyroidism who visited the hospitals in 1997 were reported. The total numbers of patients were estimated to be 900 (690-1100) for idiopathic hypoparathyroidism and 430 (330-520) for pseudohypoparathyroidism (95% confidence intervals in parentheses). Using these data, the period prevalence of the diseases were 7.2 (5.5-8.8) per million population in idiopathic hypoparathyroidism, and 3.4 (2.6-4.2) in pseudohypoparathyroidism (95% confidence intervals in parentheses).
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                Author and article information

                Journal
                romm
                Revista de Osteoporosis y Metabolismo Mineral
                Rev Osteoporos Metab Miner
                Sociedad Española de Investigaciones Óseas y Metabolismo Mineral (Madrid, Madrid, Spain )
                1889-836X
                2173-2345
                December 2020
                : 12
                : 4
                : 141-145
                Affiliations
                [01] orgnameAsociación de Endocrinólogos Clínicos del Ecuador orgdiv1Grupo de Investigación AECE Ecuador
                [03] Guayaquil orgnameHospital Docente de la Policía Nacional Guayaquil orgdiv1Servicio de Endocrinología Ecuador
                [02] Guayaquil orgnameHospital Abel Gilbert Pontón orgdiv1Servicio de Endocrinología Ecuador
                Article
                S1889-836X2020000400006 S1889-836X(20)01200400006
                10.4321/s1889-836x2020000400006
                4645f115-cfea-4aae-a626-a96044f701f8

                This work is licensed under a Creative Commons Attribution-NonCommercial 3.0 International License.

                History
                : 03 December 2020
                : 25 September 2020
                Page count
                Figures: 0, Tables: 0, Equations: 0, References: 18, Pages: 5
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                SciELO Spain

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                Nota Clínica

                trastorno inactivante de la señalización PTH/PTHrP,pseudohypoparathyroidism,inactivating PTH/PTHrP signaling disorder,hypocalcemia,brachydactyly,Ecuador,osteodistrofia hereditaria de Albright,resistencia hormona paratiroidea,pseudohipoparatiroidismo,Albright's hereditary osteodystrophy,parathyroid hormone resistance,hipocalcemia,braquidactilia

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