Presentation
Subclinical hypothyroidism was present in 70%, increased parathormone (PTH) in 83%, and hyperphosphatemia in 50%. Only one case presented with hypocalcemia. [ncbi.nlm.nih.gov]
Mild TSH resistance is often present at birth and may be diagnosed through neonatal screening of congenital hypothyroidism (see this term). It is usually asymptomatic. [orpha.net]
These symptoms had been present for years and she was only recently unable to walk. [hkmj.org]
Entire Body System
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Short Stature
Our data indicate that GH deficiency is common (69%) in PHP type 1a and may contribute to the obesity and short stature typical of AHO. We propose that GH status be evaluated in all patients with PHP type 1a. [ncbi.nlm.nih.gov]
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Fatigue
Treatment with recombinant GH could lead to improvements in height in children, as well as other physical (eg, obesity, hyperlipidemia, osteoporosis, reduced renal function) and psychological (fatigue and diminished sense of well-being) parameters in [ncbi.nlm.nih.gov]
[…] formation of cAMP normal appearance Presentation Symptom symptoms of hypocalcemia paresthesia fingertip, toes, perioral abdominal pain, biliary colic muscle cramps, tetany dyspnea (laryngospasm, bronchospasm) convulsions mental status changes anxiety, fatigue [orthobullets.com]
There was a history of general fatigue, poor school performance and tingling in the hands that began 2 months earlier. Physical examination showed truncal obesity, round face but no other phenotypic features of AHO. [elsevier.es]
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Weight Gain
Abnormal weight gain continued despite a caloric intake of about 65 kcal/kg per day. [ncbi.nlm.nih.gov]
The abnormality in energy expenditure and/or energy intake responsible for this weight gain is unknown.Objective: The aim of this study was to evaluate energy expenditure in children with PHP-1a compared with obese controls.Patients:We studied 6 obese [experts.umich.edu]
PHP may be connected to other hormone problems, resulting in: Low sex drive Slow sexual development Low energy levels Weight gain Contact your provider if you or your child have any symptoms of a low calcium level or pseudohypoparathyroidism. [medlineplus.gov]
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Severe Pain
Daily activities were restricted due to severe pain. She improved only when calcium supplements were stopped and 1,25-dihydroxyvitamin D (One Alpha 25 ng/kg per day) was started. Analgesia and orthotics were an essential part of management. [abstracts.eurospe.org]
Ectopic ossifications may range from absent to extensive and generate severe pain. Developmental delay is highly variable, even in families with the same mutation. [orpha.net]
Skin
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Subcutaneous Nodule
Two years later, skin examination revealed subcutaneous nodules and acanthosis nigricans.Investigations. [ncbi.nlm.nih.gov]
The patient was a 13-year-old female with subcutaneous nodules in arms and abdomen, lifelong short stature and intellectual disability. Both parents (Ecuadorian in origin) were healthy. [analesdepediatria.org]
Ears
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Hearing Impairment
impairment 0000407 Short 3rd metacarpal Shortened 3rd long bone of hand 0010041 Spinal cord compression Pressure on spinal cord 0002176 Strabismus Cross-eyed Squint Squint eyes [ more ] 0000486 1%-4% of people have these symptoms Elevated calcitonin [rarediseases.info.nih.gov]
Face, Head & Neck
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Round Face
He also had congenital hypothyroidism, round face, full cheeks, shortness of limbs, mild developmental delay, and muscular hypotonia. [ncbi.nlm.nih.gov]
[…] navigation Jump to search osteochondrodysplasia that has material basis in lack of responsiveness to parathyroid hormone which results in shortening and widening of long bones of the located in hand or located in foot along with short stature, obesity, and rounded [wikidata.org]
AHO is characterized by short stature, obesity, round face with flat nasal bridge, brachydactyly, subcutaneous ossification and possible / variable developmental delay. [hopkinsmedicine.org]
This defect also causes short stature, a round face, and short hand bones, which is referred to as Albright's hereditary osteodystrophy. Source: Genetic and Rare Diseases Information Center (GARD), supported by ORDR-NCATS and NHGRI. [diseaseinfosearch.org]
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Short Neck
Her physical examination noted a stocky physique, broad chest, short neck and short digits. Two years later, skin examination revealed subcutaneous nodules and acanthosis nigricans.Investigations. [ncbi.nlm.nih.gov]
Short stature with a short neck, a round face, chubby cheeks, and a depressed nasal bridge are usually present. There may be cognitive deficits and some patients are considered to be mentally retarded. [disorders.eyes.arizona.edu]
The patient had a singular phenotype ( Fig. 1 ) with a rounded face, short neck, and shortening of the first toe in both feet as well as of the fourth metacarpal and metatarsal bones in both hands and feet, respectively. [analesdepediatria.org]
neck Short hand bones, especially the bone below the 4th finger Short height Your health care provider will recommend calcium and vitamin D supplements to maintain a proper calcium level. [medlineplus.gov]
neck Decreased length of neck 0000470 Thickened calvaria Increased thickness of skull cap Thickened skull cap [ more ] 0002684 5%-29% of people have these symptoms Abdominal symptom 0011458 Abnormal platelet function 0011869 Anxiety Excessive, persistent [rarediseases.info.nih.gov]
Neurologic
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Unable to Walk
These symptoms had been present for years and she was only recently unable to walk. [hkmj.org]
Urogenital
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Oligomenorrhea
Herein, we report a case of of PHP1A with atypical clinical manifestations (oligomenorrhea, subclinical hypothyroidism, and normocalcemia) and explore the underlying genetic cause in this patient. [ncbi.nlm.nih.gov]
Gonadal dysfunction with delayed or incomplete sexual maturation, amenorrhea or oligomenorrhea and/or infertility is very frequent. [orpha.net]
[…] frontalis interna 0004438 Hypertension 0000822 Hypocalcemic tetany 0003472 Hyporeflexia Decreased reflex response Decreased reflexes [ more ] 0001265 Irritability Irritable 0000737 Laryngeal dystonia 0012049 Muscle spasm 0003394 Myoclonic spasms 0003739 Oligomenorrhea [rarediseases.info.nih.gov]
Workup
Clinical inquiries: what is the best workup for hypocalcemia? J Fam Pract. 2008;57(10):677-9. Kuzel AR, Lodhi MU, Rahim M. Classic and Non-Classic Features in Pseudohypoparathyroidism: Case Study and Brief Literature Review. [revistas.unal.edu.co]
Because of her clinical and biochemical presentation we suspected pseudohypoparathyroidism and additional workup confirmed our diagnosis. [omicsonline.org]
Treatment
However, it is possible that a subset of these patients may qualify for GH treatment based on another FDA approved indication, and certain patients may qualify for treatment on a research basis in the future. [bioportfolio.com]
Management and treatment Treatment is based on maintaining normocalcemia and, when possible, normalizing serum levels of PTH, with an active form of vitamin D (alfacalcidol or calcitriol) and calcium supplementation. [orpha.net]
The skeletal age was not delayed at the age of 5 months in spite of the hypothyroid state, and it advanced following thyroxine and vitamin D treatments. [ncbi.nlm.nih.gov]
Treatment Treatment Options: Treatment focuses on normalization of calcium and phosphate serum levels. A deficiency of vitamin D should also be corrected and has been reported to correct at least some of the lens opacities. [disorders.eyes.arizona.edu]
Make the best clinical decisions with an enhanced emphasis on evidence-based practice and expert opinions on treatment strategies. Zero in on the most relevant and useful references with the aid of a more focused, concise bibliography. [books.google.com]
Prognosis
Prognosis With proper treatment, prognosis is good, but quality of life may be affected by subcutaneous ossifications and the presence of severe short stature and obesity. [orpha.net]
Etiology
Etiology In about 70-80% of cases, PHP-Ia is caused by haploinsufficiency due to maternally-inherited heterozygous inactivating mutations in the GNAS gene (20q13). [orpha.net]
Hypoparathyroidism and pseudohypoparathyroidism: etiology, laboratory features and complications. Arch Endocrinol Metab. 2016;60(6):532-6. . Underbjerg L, Sikjaer T, Mosekilde L, Rejnmark L. [revistas.unal.edu.co]
This suggests that GNAS signaling has a more extensive role in chondrocyte maturation than was previously believed. [8] Etiology PHP type 1a Several other peptide hormones, including thyroid-stimulating hormone (thyrotropin), antidiuretic hormone, gonadotropins [emedicine.medscape.com]
Epidemiology
Clinical and biochemical parameters along with epidemiological data were extracted and analyzed. [ncbi.nlm.nih.gov]
It opens by addressing in detail the anatomy and physiology of the parathyroids and describing the epidemiology and clinical presentation of hypoparathyroidism. [books.google.com]
Summary Epidemiology Prevalence of PHP (1a and 1b) has been estimated at 1/295,000 in a Japanese study. The prevalence of PHP (1a, 1b and pseudopseudohypoparathyroidism (PPHP); see these terms) has been estimated at 1/150,000in Italy. [orpha.net]
Pseudohypoparathyroidism - epidemiology, mortality and risk of complications. Clin Endocrinol (Oxf). 2016;84(6):904-11. . [revistas.unal.edu.co]
Epidemiology and Diagnosis of Hypoparathyroidism. J Clin Endocrinol Metab. 2016 Jun. 101 (6):2284-99. [Medline]. [Full Text]. Underbjerg L, Sikjaer T, Mosekilde L, Rejnmark L. [emedicine.medscape.com]
Pathophysiology
We report a new case with both clinical entities and discuss the potential pathophysiological mechanisms of this association (protein kinase A hypoactivation, parathyroid hormone, hypocalcemia, protein kinase C activation, vitamin D deficiency). [ncbi.nlm.nih.gov]
Brenner/Rector remains the go-to resource for practicing and training nephrologists and internists who wish to master basic science, pathophysiology, and clinical best practices. [books.google.com]
Pathophysiology Genetics A heterozygous mutation of the GNAS gene that encodes the G stimulatory α subunit (Gsα) of guanine nucleotide-binding protein leads to a loss of expression or function of the Gsα, which impairs the transmission of stimulatory [emedicine.medscape.com]
Prevention
Screening for sleep apnea in this population may be warranted to prevent adverse health outcomes. 2015 S. Karger AG, Basel. [ncbi.nlm.nih.gov]
Even when the calcium level is normal, administration of calcitriol and calcium is recommended to suppress the PTH production and prevent osseous lesions secondary to elevated blood PTH. 6 References [1] M.A. Levine. [analesdepediatria.org]
Screening for sleep apnea in this population may be warranted to prevent adverse health outcomes. 2015 S. [karger.com]
Diseases (1 回) ICG (1 回) OCT (1 回) 2016 Aqueous Angiography with Fluorescein and Indocyanine Green in Bovine Eyes. 16 Arrow Hands-Off thermodilution catheter (1 回) Critical Care 救急医学 (1 回) SIAPAC (1 回) TC (1 回) 1998 The "hands-off" catheter and the prevention [allie.dbcls.jp]
Fujimura M, Niizuma K, Inoue T, Sato K, Endo H, Shimizu H, et al : Minocycline prevents focal neurologic deterioration due to cerebral hyperperfusion after extracranial-intracranial bypass for moyamoya disease. [jkns.or.kr]