ABSTRACT
Resumen La deficiencia de fructosa-1,6-bisfosfatasa (deficiencia de FBPasa) es un defecto metabólico congénito poco común que afecta la gluconeogénesis. Es una enfermedad genética autosómica recesiva. El paciente se presenta con hipoglucemia en ayunas y acidosis metabólica, y puede tener hiperventilación, apnea y cetosis. Aunque la enfermedad puede ser fatal en el período neonatal, el tratamiento adecuado puede producir un pronóstico excelente. A continuación, presentamos una paciente de 21 años con déficit de fructosa-1,6-bisfosfatasa, quien presentó cuadro gastroenteritis viral que provocó descompensación de su patológica de base, la paciente presentó evolución satisfactoria al manejo con cristaloides y dextrosa endovenosa. Se expone este caso porque es una entidad de baja frecuencia, con escasos reportes en adultos y con adecuada respuesta al tratamiento dietario.
Abstract Fructose-1,6-bisphosphatase deficiency (FBPase deficiency) is a rare congenital metabolic defect affecting gluconeogenesis. It is an autosomal recessive genetic disease. The patient presents with fasting hypoglycemia and metabolic acidosis, and may have hyperventilation, apnea, hypoglycemia, and ketosis. Although the disease can be fatal in the neonatal period, appropriate treatment can produce an excellent prognosis. Here we present the case of a 21-year-old patient with fructose-1,6-bisphosphatase deficiency, who presented with viral gastroenteritis that caused decompensation of her underlying pathology, the patient presented satisfactory evolution with crystalloids and intravenous dextrose. This case is presented because of its low frequency, with few reports in adults and with adequate response to dietary treatment.
ABSTRACT
OBJECTIVE: To analyze the clinical and molecular genetic characteristics of 2 cases of fructose-1,6-bisphosphatase deficiency in the same family to provide evidence for the precise treatment,genetic counseling and prenatal diagnosis.METHODS: Clinical data were collected from 2 patients with hypoglycemia encephalopathy,and molecular genetic analysis was performed using targeted capture next-generation sequencing. RESULTS: The 2 patients were siblings,the male proband was 7 years old,mainly manifested with convulsions after hunger or ingestion of a large amount of fructose,accompanied by ketoacidosis;clinical diagnosis was hypoglycemia encephalopathy,and fructose metabolism abnormalities was suspected. The younger brother was 4 years old,mainly showing hunger and sweating in the morning,stomach ache after eating fruit,and convulsion episode once after hunger. Next-generation sequencing results showed that the siblings had c.333+1＿2 delinsTC and c.490 G>A compound heterozygous mutations in the FBP1 gene,and their parents were carriers with normal phenotype.The c.333+1＿2 delins TCis a novel mutation,c.490 G>A is a reported pathogenic mutation,and the two patients were diagnosed with fructose-1,6-bisphosphatase deficiency genetically. CONCLUSION: For children with unexplained hypoglycemia,convulsions and metabolic acidosis,the fructose-1,6-bisphosphatase deficiency should be considered. Early genetic analysis is helpful to clarify the cause,make precise treatment and improve prognosis.
ABSTRACT
During 2 years,a 6-year-old girl was hospitalized for 2 times with recurrent onset of episodes of vomiting,weakness and fever after eating dessert at the Department of Neurology & Endocrine Pediatrics,the Affiliated Hospital of Qingdao University.The arterial blood gas analysis revealed severe hypoglycemia,lacticacidemia and metabolic acidosis,the urine ketone body was positive.After intravenous infusion of glucose,bicarbonate and antibiotics,there was a dramatic clinical improvement in a short time.Physical examination showed tachypnea and mild hepatomegaly,and she had normal physical and mental development.The laboratory findings revealed transient hyperuricacidemia.Urine organic acids analysis repeatedly showed an elevation of lactic acid,ketone and glycerol.Glyceroluria was a very distinctive trait.The literatures in PubMed was searched with glyceroluria as keyword.Three related diseases were identified:FBPase deficiency,glycerol kinase (GK) deficiency and complex GK deficiency.Further reading of related literatures to understand the characteristics of diseases and laboratory tests,the clinical diagnosis of GK deficiency and complex GK deficiency was excluded.The mutation analysis of FBPase gene (FBP1) was performed by Sanger sequencing and a novel compound heterozygous mutations of c.355G ＞A and c.960delG was discovered.Full analysis of disease-related traits and targeted gene testing is one of the effective methods for accurate diagnosis and treatment of inherited metabolic disorders.