Characterization of Digestive Manifestations in Patients with Impaired PTH/PTHrP Signaling Disorder/Pseudohypoparathyroidism.

IF 2.6 3区 医学 Q3 ENDOCRINOLOGY & METABOLISM
Bérénice Goy, Jugurtha Berkenou, Anya Rothenbuhler, Christelle Audrain, Agnès Linglart, Béatrice Dubern
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引用次数: 0

Abstract

Introduction: Pseudohypoparathyroidism, newly classified as inactivating PTH/PTHrP signaling disorder (iPPSD) type 2 or type 3, is a rare disease caused by defects in the GNAS imprinted gene that encodes Gsα. The most common phenotype comprises resistance to hormones binding to G protein-coupled receptors such as PTH, PTHrP, or TSH, subcutaneous ossifications, short stature, brachydactyly, and early onset obesity. Uncommon features have been described including sleep apnea, asthma, and resistance to calcitonin. At the national French reference center for rare calcium and phosphate metabolism diseases, a large cohort of patients with iPPSD type 2 and type 3 is followed. Interestingly, digestive manifestations and in particular intractable constipation were regularly reported by families of children with iPPSD type 2 or type 3.

Objective: The aim of our study was therefore to specify the frequency and characteristics of digestive manifestations in children followed up for iPPSD2 or iPPSD3 in our reference center.

Material and methods: Thirty-six patients aged between 2 and 18 years (32 followed up for iPPSD2 and 4 for iPPSD3) were included. Parents completed a specific questionnaire to assess any digestive disorders in their child. The diagnosis of constipation was established using the Bristol visual scale in the event of a score of less than 2 according to stool appearance.

Results: Parents reported constipation through the questionnaires in 22/36 (over 60%) of the children. It was the most frequently reported digestive disorder. Among these 22 children, 19 (87%) had a Bristol score for stool shape and texture between 1 and 2 on a scale of 7, confirming constipation. Dedicated treatment had been initiated for 10 (55%) of them, yet only 3 families (16%) considered this treatment effective. Neonatal vomiting and eating disorders, such as lack of satiety or food selectivity, were also noted in 18 (50%) of patients, as was gastroesophageal reflux present in the neonatal period in 14 (40%) of children. There were no significant differences according to the type of iPPSD or patient age.

Conclusion: Our work shows for the first time that digestive manifestations, including constipation, occur frequently in children followed for iPPSD, suggesting a potential role of Gsα and G protein receptors in the digestive tract. It is well known that constipation and digestive symptoms alter quality of life. Early management is therefore essential to improve the quality of life of children followed for iPPSD. Our data need to be confirmed on a larger cohort.

PTH/PTHrP信号受损(iPPSD)/假性甲状旁腺功能亢进症患者消化系统表现的特征。
简介假性甲状旁腺功能减退症新近被归类为PTH/PTHrP信号失活障碍(iPPSD)2型或3型,是一种由编码Gsα的GNAS印迹基因缺陷引起的罕见疾病。最常见的表型包括对与 G 蛋白偶联受体(如 PTH、PTHrP 或 TSH)结合的激素抵抗、皮下骨化、身材矮小、腕骨发育不良和早发性肥胖。已描述的不常见特征包括睡眠呼吸暂停、哮喘和降钙素抵抗。我们跟踪研究了一大批 2 型和 3 型 iPPSD 患者。有趣的是,iPPSD 2 型或 3 型患儿的家属经常报告消化系统表现,尤其是顽固性便秘:我们的研究旨在明确在我们的参照中心接受随访的iPPSD2型或iPPSD3型儿童中消化系统表现的频率和特征。材料和方法:共纳入36名年龄在2至18岁之间的患者(32名接受iPPSD2型随访,4名接受iPPSD3型随访)。家长填写了一份专门的问卷,以评估孩子是否患有消化系统疾病。根据粪便外观,如果得分低于 2 分,则使用布里斯托尔视觉量表确定便秘诊断:结果:22/36(超过 60%)的儿童通过调查问卷报告了便秘。这是最常见的消化系统疾病。在这 22 名儿童中,19 名儿童(87%)的布里斯托尔粪便形状和质地评分在 1 到 2 分(7 分制)之间,证实患有便秘。其中 10 个家庭(55%)已开始接受专门治疗,但只有 3 个家庭(16%)认为治疗有效。18名(50%)患者出现新生儿呕吐和进食障碍,如缺乏饱腹感或食物选择性,14名(40%)患儿在新生儿期出现胃食管反流。iPPSD的类型和患者年龄没有明显差异:我们的研究首次表明,包括便秘在内的消化系统表现经常出现在接受 iPPSD 治疗的儿童中,这表明 Gsα 和 G 蛋白受体在消化道中可能起着重要作用。众所周知,便秘和消化道症状会改变生活质量。因此,早期治疗对于改善iPPSD患儿的生活质量至关重要。我们的数据需要在更大的群体中得到证实。
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来源期刊
Hormone Research in Paediatrics
Hormone Research in Paediatrics ENDOCRINOLOGY & METABOLISM-PEDIATRICS
CiteScore
4.90
自引率
6.20%
发文量
88
审稿时长
4-8 weeks
期刊介绍: The mission of ''Hormone Research in Paediatrics'' is to improve the care of children with endocrine disorders by promoting basic and clinical knowledge. The journal facilitates the dissemination of information through original papers, mini reviews, clinical guidelines and papers on novel insights from clinical practice. Periodic editorials from outstanding paediatric endocrinologists address the main published novelties by critically reviewing the major strengths and weaknesses of the studies.
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