[Contiguous gene deletion syndrome in Xp21: the association between glycerol kinase deficiency, congenital suprarenal hypoplasia and Duchenne's muscular dystrophy]. / Sindrome de deleción de genes contiguos en Xp21: asociación de deficiencia de glicerolcinasa, hipoplasia suprarrenal congénita y distrofia muscular de Duchenne.

INTRODUCTION: Complex glycerol kinase (GK) deficiency is a contiguous deletion of genes in Xp21 with loss of the locus for GK, for congenital adrenal hypoplasia (AHC) and/or for Duchenne's muscular dystrophy (DMD). We report the case of a 7-year-old patient with this rare disease. CASE REPORT: Our patient was a full-term male, with normal gestation and delivery, and no relevant family history. At the age of 11 days he presented a clinical picture of salt loss with lethargy, vomiting, metabolic acidosis, hypoglycaemia, hyponatraemia and hyperpotassaemia. Fluid therapy and treatment with corticoids was established. The patient's condition developed with moderate mental retardation and progressive muscular weakness. In the physical examination, the skull and face were seen to be 'hourglass' shaped. Decompensations associated to infectious processes and fasting hypoglycaemia, hydroelectrolytic disorders and ketoacidosis are all frequent. Lab findings showed a drop in cortisol levels, elevation of muscle enzymes, 'pseudohypertriglyceridaemia' and raised levels of glycerol in plasma and urine. Karyotype and neuroimaging tests were normal. A myopathic pattern was observed in the electromyogram. The genetic study confirmed the deletion in Xp21 of the genes responsible for DMD, the GK deficit and AHC. CONCLUSIONS: Early identification of this disease makes it possible to foresee the acute metabolic decompensations and to establish suitable genetic counselling. CK and triglyceride counts should be performed in all male patients that present a suprarenal hypoplasia; if levels are high, then it is necessary to confirm the raised glycerol values and to carry out a confirmatory genetic study.

Síndrome de deleción de genes contiguos en Xp21: asociación de deficiencia de glicerolcinasa, hipoplasia suprarrenal congénita y distrofia muscular de Duchenne / contiguous gene deletion syndrome in Xp21: the association between glycerol kinase deficiency, congenital suprarrenal hypoplasia and Duchenne´s muscular dystrophy

Introducción. El déficit complejo de glicerocinasa (GK) corresponde a una deleción contigua de genes en Xp21 con pérdida del locus de la GK, de la hipoplasia adrenal congénita (AHC) y/o de la distrofia muscular de Duchenne (DMD). Presentamos un paciente de 7 años con esta rara enfermedad. Caso clínico. Varón nacido a término, con gestación y parto normales, sin antecedentes familiares de interés. Presentó a los 11 días de vida un cuadro de pérdida salina con letargia, vómitos, acidosis metabólica, hipoglucemia, hiponatremia e hiperpotasemia. Se instauró un tratamiento con fluidoterapia y corticoides. Evolucionó con un retraso mental moderado y una debilidad muscular progresiva. En la exploración se objetivó un aspecto craneofacial ‘en reloj de arena’. Son frecuentes las descompensaciones asociadas a procesos infecciosos y ayuno con hipoglucemia, alteraciones hidroelectrolíticas y cetoacidosis. En la analítica destacó el descenso de cortisol, la elevación de enzimas musculares, una ‘pseudohipertrigliceridemia’ y la elevación de glicerol en plasma y orina. El cariotipo y la neuroimagen fueron normales. En el electromiograma se observó un patrón miopático. El estudio genético confirmó la deleción en Xp21 de los genes responsables de la DMD, el déficit de GK y la AHC. Conclusiones. La identificación precoz de esta enfermedad permite prever las descompensaciones metabólicas agudas y establecer un consejo genético adecuado. En todo paciente varón que presente una hipoplasia suprarrenal, se debe realizar una determinación de creatincinasa y triglicéridos, y en el caso de estar aumentados, confirmar la elevación de glicerol y realizar el estudio genético confirmatorio

Introduction. Complex glycerol kinase (GK) deficiency is a contiguous deletion of genes in Xp21 with loss of the locus for GK, for congenital adrenal hypoplasia (AHC) and/or for Duchenne’s muscular dystrophy (DMD). We report the case of a 7-year-old patient with this rare disease. Case report. Our patient was a full-term male, with normal gestation and delivery, and no relevant family history. At the age of 11 days he presented a clinical picture of salt loss with lethargy, vomiting, metabolic acidosis, hypoglycaemia, hyponatraemia and hyperpotassaemia. Fluid therapy and corticoids treatment was established. The patient’s condition developed with moderate mental retardation and progressive muscular weakness. In the physical examination, the skull and face were seen to be ‘hourglass’ shaped. Decompensations associated to infectious processes and fasting hypoglycaemia, hydroelectrolytic disorders and ketoacidosis are all frequent. Lab findings showed a drop in cortisol levels, elevation of muscle enzymes, ‘pseudohypertriglyceridaemia’ and raised levels of glycerol in plasma and urine. Karyotype and neuroimaging tests were normal. A myopathic pattern was observed in the electromyogram. The genetic study confirmed the deletion in Xp21 of the genes responsible for DMD, the GK deficit and AHC. Conclusions. Early identification of this disease makes it possible to foresee the acute metabolic decompensations and to establish suitable genetic counselling. creatin kinase and triglyceride counts should be performed in all male patients that present a suprarenal hypoplasia; if levels are high, then it is necessary to confirm the raised glycerol values and to carry out a confirmatory genetic study

Nódulos subcutáneos en la infancia: granuloma anular subcutáneo / Subcutaneous nodules in the childhood: subcutaneous granuloma annulare

El granuloma anular subcutáneo es una lesión inflamatoria crónica de carácter benigno y típica de la edad pediátrica. Puede ser única o múltiple y su localización habitual es el cuero cabelludo o las extremidades. Su etiología es desconocida y no se ha relacionado con ninguna enfermedad sistémica. Una historia clínica detallada y la normalidad en las exploraciones complementarias son suficientes para su diagnóstico, si bien el estudio histológico permite el diagnóstico de certeza. Su evolución natural es a la desaparición, por lo que no precisa tratamiento. Presentamos el caso de un niño de tres años que fue remitido por presentar lesiones, induradas en cuero cabelludo, indoloras, de larga evolución y sin otros antecedentes de interés. Se practicó estudio radiológico simple y analítica básica (hemograma, bioquímica básica y VSG) que resultaron normales. Dos meses después se apreció un aumento de tamaño en una de la lesiones, por lo que se practicó su exéresis-biopsia. El estudio histológico fue diagnóstico de granuloma anular subcutáneo. Tras 10 meses de seguimiento no se han apreciado cambios en las lesiones restantes. (AU)

[Subcutaneous nodules in children: subcutaneous granuloma annulare]. / Nódulos subcutáneos en la infancia: granuloma anular subcutáneo.

Subcutaneous granuloma annulare is a benign, chronic inflammatory lesion located usually at scalp or extremities and typical of childhood. Its etiology is unknown and no link with systemic diseases has been found. A thorough clinical history and normality at complementary tests are enough for its identification. It tends to dissaparition, so no therapy is needed although histologic study will let a definitive diagnosis. A case in a three years-old boy is reported. He was submitted because of four asymptomatic, long-lasting tough lesions at his scalp, without other antecedents. Radiologic and hematologic tests found no alteration. Two months later a larger size was appreciated in one of them, so it was removed and its histology was diagnostic for granuloma annulare. After a 10 months follow-up, no change in size has been detected in the remaining ones.