Hypoglycemia caused by AKT2 gene mutation:a case report and literature review / 中华全科医师杂志

A 15-month-old baby girl presenting with hypoglycemia was admitted in Children′s Hospital of Capital Institute of Pediatrics in October 2019. The blood glucose level was 2.4 mmol/L at admission, she showed asymmetry of left and right limbs. The levels of D-3-hydroxybutyric acid, urinary ketone body and free fatty acid were all decreased during hypoglycemia attack, the hyperglycemic hormone was increased, but insulin level was<0.2 μIU/ml. The whole exon gene testing showed that the patient had heterozygous mutation of AKT2 gene c.49G>A (p.E17K), which was mosaicism; then the patients was diagnosed as hypoinsulinemic hypoketotic hypo-fatty-acidemic hypoglycemia due to mutation of AKT2 gene. Blood glucose levels were dynamically monitored, high carbohydrate diet was administered and raw corn starch supplementation was given before bedtime. After 18 months of treatment, the growth and development of the patient was normal, the frequency of hypoglycemia attacks decreased, and bilateral limb asymmetry improved. The relevant literature was searched from Wanfang Database, CNKI and PubMed from January 1980 to March 2021 by using search term"hypoglycemia"and"AKT2 gene". Five cases of hypoglycemia caused by AKT2 mutation were retrieved, all were reported from other countries, no one case from China. The clinical manifestation of this disease is similar to hyperinsulinemic hypoglycemia, but insulin could not be detected during the attack of hypoglycemia, and the patients may have hemihypertrophy. The study suggests that if the patient has hypoglycemia accompanied by hypoinsulinemia and hemihypertrophy, we should consider the possibility of AKT2 gene mutation, and genetic testing should be recommended.

Síndrome Rusell Silver. Presentación de caso / Russell-Silver syndrome. Presentation of a case

RESUMEN El síndrome Russell Silver es una enfermedad genética de baja frecuencia, caracterizada por retardo del crecimiento prenatal y postnatal, dismorfias faciales y digitales, así como asimetría corporal. Se presenta una paciente femenina de dos años de edad, remitida a consulta de Genética Clínica, por retardo en el desarrollo pondoestatural psicomotor, dismorfias faciales y asimetría corporal. Se realizño el diagnóstico clínico de esta afección. Es importante establecer un diagnóstico precoz para la estimulación temprana, seguimiento multidisciplinario y se brindó un adecuado asesoramiento genético a los familiares (AU).

ABSTRACT The Russell-Silver syndrome is a low-frequency genetic disease, characterized by a pre-natal growth retardation and postnatal digital and facial dysmorphia, and also body asymmetry. We present a female patient, aged 2 years, who was remitted to the consultation of Clinical Genetics because of a retardation in the psychomotor, height-weight development, facial dysmorphia and body asymmetry. The disease was clinically diagnosed. It is important to arrive to a precocious diagnosis for the early stimulation, multidisciplinary follow-up and adequate genetic advice to the relatives (AU).

Proteus syndrome: Clinical profile of six patients and review of literature.

OBJECTIVE: Proteus syndrome (PS) is characterized by patchy or segmental overgrowth and hyperplasia of multiple tissues and organs, along with susceptibility to development of tumors. Very few cases are reported in literature from developing countries. Due to certain overlapping features with other overgrowth syndromes, diagnosis is usually delayed. Our aim was to describe clinical profile of this rare condition in six patients. MATERIALS AND METHODS: Retrospective case sheet review of patients followed in a Pediatric Genetic and Metabolic clinic at a tertiary care institute of North India with a diagnosis of hemihypertrophy/overgrowth syndrome. RESULTS: Six cases presented with asymmetric overgrowth and peculiar features suggestive of PS were included in this study. Age at presentation was 2 months to 10 years; two were males and four were females. Hemihypertrophy was noticed in only one case at birth, and focal overgrowths in rest of other patients were seen later during childhood. CONCLUSION: Due to certain overlapping features with other overgrowth syndromes, diagnosis of PS is usually delayed. Pediatricians are the first persons who come across such patients and they should be aware about this rare condition.

Hemihiperplasia aislada: A propósito de un caso

Objetivo: El objetivo es dar a conocer un caso de hemihiperplasia aislada. Caso Clínico: Escolar femenina de 7 años de edad con antecedente patológico de tumor de Wilms diagnosticado a los 11 meses, quien es referida a la Unidad de Endocrinología del IAHULA por presentar asimetría congénita del hemicuerpo derecho. Al examen físico se evidencia un peso de 25,500 Kg(P75-90), talla 137 cm(˃P97), índice de masa corporal 13,6 Kg/m2(P25-50), brazada 135 cm. Facies asimétricas, raíz y puente nasal anchos, narinas asimétricas, labios gruesos, paladar alto, asimetría de lengua, encías hipertróficas. Vello púbico y mamas Tanner I, labios mayores asimétricos. longitud de las extremidades inferiores: derecha 74 cm, izquierda 70,5 cm. Escoliosis con asimetría de omóplatos. La radiografía de mano y muñeca izquierda reporta una edad ósea de 8 años. Se solicita eco pélvico que reporta útero de longitud 1,4 cm, antero-posterior 0,8 cm, transversal 1,7 cm, sin alteraciones. Conclusiones: La paciente fue diagnosticada con hemihiperplasia, un crecimiento asimétrico de una o más regiones del cuerpo, y su incidencia se estima en 1 de cada 86.000 nacidos vivos. Esta entidad clínica es de aparición esporádica y ocurre por alteraciones en 11p15, principalmente por disomía uniparental paterna, o por defectos en la metilación de los genes LIT1 y H19, lo cual puede provocar sobreexpresión del IGF-2 causando talla alta y mayor predisposición a neoplasias malignas de estirpe embrionario como tumor de Wilms.

Objective: The objective of this paper is to divulge a case of isolated hemyhiperplasia. Clinical Case: A seven-year old schoolgirl with pathological history of Wilms’ tumor, diagnosed at 11 months, was referred to the Endocrinology Unit of Los Andes University Hospital because of congenital asymmetry of right hemicorpus. At clinical examination she exhibited: weight 25.5 kg (P75-90); height 137 cm (>P97); body mass index 13.6 kg/m2 (P25-50); arm span 135 cm; asymmetrical facies; broad radix and nasal bridge; asymmetrical nostrils; thick lips; high palate; asymmetry of the tongue; gingival enlargement; pubic hair and breasts at Tanner stage I; asymmetrical labia majora; unequal length of lower extremities, the right lower limb measuring 74 cm and the left, 70.5 cm; scoliosis and scapular asymmetry. X-ray of left hand and wrist yielded bone age of 8 years. Pelvic ultrasound evaluation revealed uterine length of 1.4 cm, anteroposterior diameter of 0.8 cm, and transverse diameter of 1.7 cm with no alterations. Conclusion: Patient was diagnosed with hemihyperplasia, an asymmetrical growth of one or more regions of the body, whose incidence is estimated at one in 86,000 live births. This condition is sporadic and occurs as a result of alterations at 11p15, mainly due to paternal uniparental disomy or L1T1 and H19 methylation abnormalities, which can cause IGF-2 overexpression, resulting in excessively tall stature and greater propensity to malignant embryonic neoplasia such as Wilm’s tumor.

Unusual Thymic Hyperplasia Mimicking Lipomatous Tumor in an Eight-Year-Old Boy with Concomitant Pericardial Lipomatosis and Right Facial Hemihypertrophy

We report a case of thymic hyperplasia accompanied by pericardial lipomatosis and right facial hemihypertrophy in an 8-year-old boy. On imaging studies, the hyperplastic thymus had prominent curvilinear and nodular fatty areas simulating a fat-containing anterior mediastinal mass, which is an unusual finding in children. To our knowledge, this is the first report on a child with a combination of thymic hyperplasia, pericardial lipomatosis, and right facial hemihypertrophy. The radiologic findings are presented with a brief discussion.

Arnold-Chiari Type I Malformation with Hemihypertrophy: A case report

The association between Arnold-Chiari type 1 malformation and hemihypertrophy has not been appreciated but a few case reports have suggested their association and proposed a common pathogenesis of dysembryoplasia of mesoderm. We report a case of 17 year-old girl presenting with left side hemihypertrophy and scoliosis. Magnetic resonance imaging (MRI) study of brain and spine revealed underlying Arnold- Chiari type 1 malformation and syringomyelia. The purpose of this paper is to emphasize the need for central nervous system evaluation in patients with hemihypertrophy.

A case of hemimegalencephaly with congenital foot deformity / 대한주산의학회잡지

Hemimegalencephaly is a rare congenital malformation of the cortical development arising from abnormal proliferation of anomalous neuronal and glial cells. The characteristic clinical manifestations are macrocephaly, psycomotor retardation, intractable seizure and hemihypertrophy of face, body and extremities, but musculoskeletal deformities are reported only in case of epidermal nevus syndrome. We report a case of hemimegalencephaly that was associated with foot deformity, without symptoms and signs of epidermal nevus syndrome.

A Case of Klippel-Trenaunay-Weber Syndrome with Facial Hemihypertrophy and Hemimegalencephaly / 대한소아신경학회지

Klippel-Trenaunay-Weber syndrome(KTWS) is a rare, and sporadically occurring disorder characterized by hemihypertrophy(unilateral limb hypertrophy), varicose veins, hemangiomas and occasionally arteriovenous malformations. In 1900, noted French physicians Klippel and Trenaunay first described the syndrome in 2 patients presenting with port-wine stains and varicosities of extremities associated with hypertrophy of the affected limb's bones and soft tissues. There are other, and less frequent abnormalities. These may include limbs that are atrophic, fingers and toes that are disproportionately large or small, digits that are webbed(syndactyly), and too many digits(polydactyly), or too few digits(oligodactyly). The hemangiomas can occur in internal organs including the intestinal and the urinary tract systems. The exact cause of KTWS remains to be elucidated, although several theories exist. Most cases are sporadic, although a few cases in the literature report a multifactorial patterns of inheritance. We report a case of Klippel-Trenaunay-Weber syndrome in a 3-year-old boy who had hypertrophy of the left facial bones and tissues, large hemangiomas on the right trunk and back, and hypertrophy of the right upper and lower limb's soft tissues.

Leg Length Discrepancy Associated with Idiopathic Hemihypertrophy / 대한정형외과학회잡지

PURPOSE: To evaluate the changes in the leg length discrepancy in idiopathic hemihypertrophy as a function of time. MATERIALS AND METHODS: A lower extremity scannogram was performed on 33 patients (16 boys and 17 girls) who were clinically diagnosed with idiopathic hemihypertrophy from September, 1985 to December, 1996. The leg length discrepancy was compared every 6 months. The mean age of the patients on the first visit was 1.6 years (range, 1 to 5 years) and the average follow up period was 9.1 years (range, 8 to 15 years). RESULTS: Not all the discrepancies continued to increase at a constant rate with time. The developmental discrepancy patterns identified were classified as follows: type I, increasing pattern; type II, increasing-plateau pattern; type III, plateau pattern; type IV, increasing-decreasing pattern; type V, decreasing pattern. Twenty five patients (75%) had types I and II discrepancy patterns. CONCLUSION: A continual periodic follow up of the leg length is important in idiopathic hemihypertrophy patients because the developmental patterns of a discrepancy in the length of a lower extremity can vary.

A Case of Linear and Whorled Nevoid Hypermelanosis Associated with Congenital Hemihypertrophy / 대한피부과학회지

Linear and whorled nevoid hypermelanosis(LWNH) is a congenital disorder characterized by hyperpigmented macules in a linear and whorled pattern along Blaschko's lines, and develops a few weeks after birth. Skin manifestations closely resemble hypomelanosis of Ito with inverse pigmentation. There is no preceding inflammatory event and no pigmentary incontinence histologically. It may be associated with various congenital abnormalities. We report a case of linear and whorled nevoid hypermelanosis associated with congenital hemihypertrophy of left extremities in a 10-year old boy.

Proteus Syndrome: A Natural Clinical Course of Proteus Syndrome

A 16-year-old Korean male patient presented with macrodactyly, hemihypertrophy of the face and extremities, plantar cerebriform hyperplasia, a subcutaneous mass of the left chest, macrocephaly and verrucous epidermal nevi. These findings are consistent with Proteus Syndrome. The clinical features, etiology, management, natural course and differential diagnosis of this case are discussed.

Hemihypertrophy with hypomelanosis of Ito: A new syndrome combination

A female hemihypertrophy patient with hypomelanosis of Ito is presented as a rare case combining classical features of both the syndrome. Chromosomal profile has been based on longitudinal study of repeated lymphocyte cultures during 1984-1992. The propositus has exhibited chromosomal mosaicism both hypoploid (42+/-1) and hyperploid (48+/-2 chromosome) counts, but the major stem line presented 46XX chromosomes. Ring chromosome with simple and complex translocations with marker dots appear to be the major cytogenetic assemblage of this child to posses unequal left and right halves of the body. Each and every organ from toe to the head has grown up unequally and lately the patient had been exhibiting different dark and light shapes of melanin on the skin. We believe that the patient had inherited, through her male parent, "a few" mutated loci on some chromosomes so as to generate different cell lines within the developing child. All sibs and the mother showed normal karyotype with no apparent aberration.

Congenital Hemihypertrophy: A case report

Congenital hemihypertrophy is a rare idiopathic condition, first described by Meckel in 1822 and represents enlargement of a part or entire side of the body without associated vascular or neurologic disease. Wagner recorded the first case in the 1839. Hemihypertrophy is to be differentiated from hemiatrophy (which involves unilateral subnormal development, muscle weakness, or neurologic deficit) and the syndromes of hemidystrophy. Approximately 25 - 50% of the reported cases of hemihypertrophy have been associated with hamartomas or congenital defects, especially genitourinary anomalies. The early detection of asymptomatic intraabdominal tumor in patients with congenital hemihypertrophy is important We report 3 cases of congenital hemihypertrophy with discussion of the clinical manifestations and associated anomalies, which were rarely reported in domestic literatures.

Proteus Syndrome: A Case Report

The Proteus syndrome is a recently described congenital harmatosis consisting of numerous clinical features of great variety. Mainly affected are the musculoskeletal system, primarily by hemihypertrophy, macrodactyly, exostoses and kyphoscoliosis, and the skin and the subcutaneous tissue, primarily by pigmented nevi and subcutaneous tumors. These findings are diagnostic features of Proteus syndrome. We report typical manifestations of Proteus syndrome in a 12-year-old boy with brief review of literature.