Phenotypic and molecular genetic aspects of pseudohypoparathyroidism type Ib in a Greek kindred: evidence for enhanced uric acid excretion due to parathyroid hormone resistance

J Clin Endocrinol Metab. 2004 Dec;89(12):5942-7. doi: 10.1210/jc.2004-0249.

Abstract

The predominant feature of pseudohypoparathyroidism (PHP) is renal resistance to PTH. Pseudohypoparathyroidism type Ia (PHP-Ia) is caused by maternally inherited heterozygous mutations in the GNAS exons encoding the alpha-subunit of the stimulatory G protein (Gsalpha). Besides PTH resistance, PHP-Ia patients have Albright's hereditary osteodystrophy and often display resistance to additional hormones. Patients with PHP-Ib lack features of Albright's hereditary osteodystrophy, and PTH resistance is associated with loss of methylation at the maternal GNAS exon A/B. Most individuals with the autosomal dominant form of PHP-Ib have a 3-kb microdeletion within STX16 approximately 220 kb upstream of exon A/B. Here we report on the clinical and genetic aspects of a Greek PHP-Ib kindred with four affected members and three obligate carriers, who had the 3-kb deletion within STX16. Symptomatic hypocalcemia was present only in the proband, but PTH was elevated in all members who had inherited the 3-kb deletion maternally. In all affected family members, urinary phosphate excretion was normal, but 1,25-dihydroxyvitamin D levels were diminished. These findings confirm previous data regarding patient to patient variation in disease severity for autosomal dominant PHP-Ib. Furthermore, affected individuals displayed hypouricemia with increased fractional excretion of uric acid, suggesting possible involvement of PTH in the renal handling of this metabolite.

Publication types

  • Case Reports

MeSH terms

  • Adult
  • Chromogranins
  • Chromosomes, Human, Pair 20
  • Drug Resistance
  • GTP-Binding Protein alpha Subunits, Gs / genetics
  • Genetic Linkage
  • Greece
  • Humans
  • Male
  • Molecular Biology*
  • Parathyroid Hormone / metabolism*
  • Pedigree
  • Phenotype*
  • Pseudohypoparathyroidism / blood
  • Pseudohypoparathyroidism / genetics*
  • Pseudohypoparathyroidism / physiopathology
  • Pseudohypoparathyroidism / urine
  • Uric Acid / blood
  • Uric Acid / urine*
  • Vitamin D / analogs & derivatives*
  • Vitamin D / urine

Substances

  • Chromogranins
  • Parathyroid Hormone
  • Vitamin D
  • Uric Acid
  • 1,25-dihydroxyvitamin D
  • GNAS protein, human
  • GTP-Binding Protein alpha Subunits, Gs