Glucose-6-phosphatase deficiency
| Autor: | François Petit, Pascale Trioche Eberschweiler, Alix Mollet Boudjemline, Christine Vianey-Saban, Monique Piraud, Roseline Froissart, Philippe Labrune, Vincent Gajdos, Aurélie Hubert-Buron |
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| Přispěvatelé: | Laboratoire des Maladies Héréditaires du Métabolisme et Dépistage Néonatal, Hospices Civils de Lyon (HCL), Métabolomique et maladies métaboliques, Université Claude Bernard Lyon 1 (UCBL), Université de Lyon-Université de Lyon-Institut National de la Santé et de la Recherche Médicale (INSERM), Centre de Référence Maladies Héréditaires du Métabolisme Hépatique, Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-AP-HP - Hôpital Antoine Béclère [Clamart], Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP), Service de pédiatrie [Béclère], Biothérapies Hépatiques, Université de Nantes (UN)-Institut National de la Santé et de la Recherche Médicale (INSERM), BMC, Ed. |
| Rok vydání: | 2011 |
| Předmět: |
Delayed puberty
medicine.medical_specialty MESH: Mutation medicine.medical_treatment lcsh:Medicine [SDV.GEN] Life Sciences [q-bio]/Genetics Review Glycogen Storage Disease Type I Liver transplantation Neutropenia Hypoglycemia Gastroenterology 03 medical and health sciences 0302 clinical medicine Internal medicine medicine Humans Genetics(clinical) Pharmacology (medical) Genetic Testing Genetics (clinical) Kidney transplantation 030304 developmental biology Medicine(all) [SDV.GEN]Life Sciences [q-bio]/Genetics 0303 health sciences Kidney Glycogen storage disease type I MESH: Humans MESH: Genetic Testing MESH: Glycogen Storage Disease Type I medicine.diagnostic_test business.industry lcsh:R General Medicine medicine.disease 3. Good health medicine.anatomical_structure Endocrinology Liver biopsy Mutation medicine.symptom business 030217 neurology & neurosurgery |
| Zdroj: | Orphanet Journal of Rare Diseases Orphanet Journal of Rare Diseases, BioMed Central, 2011, 6 (1), pp.27. ⟨10.1186/1750-1172-6-27⟩ Orphanet Journal of Rare Diseases, Vol 6, Iss 1, p 27 (2011) |
| ISSN: | 1750-1172 |
| DOI: | 10.1186/1750-1172-6-27 |
| Popis: | Glucose-6-phosphatase deficiency (G6P deficiency), or glycogen storage disease type I (GSDI), is a group of inherited metabolic diseases, including types Ia and Ib, characterized by poor tolerance to fasting, growth retardation and hepatomegaly resulting from accumulation of glycogen and fat in the liver. Prevalence is unknown and annual incidence is around 1/100,000 births. GSDIa is the more frequent type, representing about 80% of GSDI patients. The disease commonly manifests, between the ages of 3 to 4 months by symptoms of hypoglycemia (tremors, seizures, cyanosis, apnea). Patients have poor tolerance to fasting, marked hepatomegaly, growth retardation (small stature and delayed puberty), generally improved by an appropriate diet, osteopenia and sometimes osteoporosis, full-cheeked round face, enlarged kydneys and platelet dysfunctions leading to frequent epistaxis. In addition, in GSDIb, neutropenia and neutrophil dysfunction are responsible for tendency towards infections, relapsing aphtous gingivostomatitis, and inflammatory bowel disease. Late complications are hepatic (adenomas with rare but possible transformation into hepatocarcinoma) and renal (glomerular hyperfiltration leading to proteinuria and sometimes to renal insufficiency). GSDI is caused by a dysfunction in the G6P system, a key step in the regulation of glycemia. The deficit concerns the catalytic subunit G6P-alpha (type Ia) which is restricted to expression in the liver, kidney and intestine, or the ubiquitously expressed G6P transporter (type Ib). Mutations in the genes G6PC (17q21) and SLC37A4 (11q23) respectively cause GSDIa and Ib. Many mutations have been identified in both genes,. Transmission is autosomal recessive. Diagnosis is based on clinical presentation, on abnormal basal values and absence of hyperglycemic response to glucagon. It can be confirmed by demonstrating a deficient activity of a G6P system component in a liver biopsy. To date, the diagnosis is most commonly confirmed by G6PC (GSDIa) or SLC37A4 (GSDIb) gene analysis, and the indications of liver biopsy to measure G6P activity are getting rarer and rarer. Differential diagnoses include the other GSDs, in particular type III (see this term). However, in GSDIII, glycemia and lactacidemia are high after a meal and low after a fast period (often with a later occurrence than that of type I). Primary liver tumors and Pepper syndrome (hepatic metastases of neuroblastoma) may be evoked but are easily ruled out through clinical and ultrasound data. Antenatal diagnosis is possible through molecular analysis of amniocytes or chorionic villous cells. Pre-implantatory genetic diagnosis may also be discussed. Genetic counseling should be offered to patients and their families. The dietary treatment aims at avoiding hypoglycemia (frequent meals, nocturnal enteral feeding through a nasogastric tube, and later oral addition of uncooked starch) and acidosis (restricted fructose and galactose intake). Liver transplantation, performed on the basis of poor metabolic control and/or hepatocarcinoma, corrects hypoglycemia, but renal involvement may continue to progress and neutropenia is not always corrected in type Ib. Kidney transplantation can be performed in case of severe renal insufficiency. Combined liver-kidney grafts have been performed in a few cases. Prognosis is usually good: late hepatic and renal complications may occur, however, with adapted management, patients have almost normal life span. Disease name and synonyms Glucose-6-phosphatase deficiency or G6P deficiency or glycogen storage disease type I or GSDI or type I glycogenosis or Von Gierke disease or Hepatorenal glycogenosis. |
| Databáze: | OpenAIRE |
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