Congenital central diabetes insipidus and optic atrophy in a Wolfram newborn: is there a role for WFS1 gene in neurodevelopment?

Background Wolfram syndrome (WS) is an autosomal recessive neurodegenerative disorder characterized by diabetes mellitus (DM), optic atrophy (OA), central diabetes insipidus (CDI) and deafness (D). The phenotype of the disease has been associated with several mutations in the WFS1 gene, a nuclear ge...
Ausführliche Beschreibung

Background Wolfram syndrome (WS) is an autosomal recessive neurodegenerative disorder characterized by diabetes mellitus (DM), optic atrophy (OA), central diabetes insipidus (CDI) and deafness (D). The phenotype of the disease has been associated with several mutations in the WFS1 gene, a nuclear gene localized on chromosome 4. Since the discovery of the association between WFS1 gene and Wolfram syndrome, more than 150 mutations have been identified in WS patients. We previously described the first case of perinatal onset of Wolfram syndrome newborn carrying a segmental uniparental heterodysomy affecting the short arm of chromosome 4 responsible for a significant reduction in wolframin expression. Here we review and discuss the pathophysiological mechanisms that we believe responsible for the perinatal onset of Wolfram syndrome as these data strongly suggest a role for WFS1 gene in foetal and neonatal neurodevelopment. Case presentation We described a male patient of 30 weeks’ gestation with intrauterine growth restriction and poly-hydramnios. During the first days of life, the patient showed a 19% weight loss associated with polyuria and hypernatremia. The presence of persistent hypernatremia (serum sodium 150 mEq/L), high plasma osmolarity (322 mOsm/L) and low urine osmolarity (190 mOsm/l) with a Uosm/Posm ratio < 1 were consistent with CDI. The diagnosis of CDI was confirmed by the desmopressin test and the brain magnetic resonance imaging (MRI) at 34 weeks of age, that showed the lack of posterior pituitary hyperintense signal. In addition, a bilateral asymmetrical optic nerve hypoplasia associated with right orbital bone hypoplasia was observed, suggesting the diagnosis of WF. During the five years follow-up the patient did not developed glucose intolerance or diabetes mellitus. By the end of the second year of life, primary non-autoimmune central hypothyroidism and mild neurodevelopment retardation were diagnosed. Conclusions The analysis of our case, in the light of the most recent literature, suggests a possible role for WFS1 gene in the development of certain brain structures during the fetal period. Wolfram syndrome should be considered in the differential diagnosis of the rare cases of congenital central diabetes insipidus developed in the neonatal period. Ausführliche Beschreibung

Autor*in:	Ghirardello, Stefano [verfasserIn] Dusi, Elisa Castiglione, Bianca Fumagalli, Monica Mosca, Fabio

Format:	E-Artikel
Sprache:	Englisch

Erschienen:	2014

Schlagwörter:	Endoplasmic Reticulum Stress Unfold Protein Response Optic Atrophy Central Sleep Apnea Central Diabetes Insipidus

Anmerkung:	© Ghirardello et al.; licensee BioMed Central Ltd. 2014

Übergeordnetes Werk:	Enthalten in: The Italian journal of pediatrics - London : BioMed Central, 2008, 40(2014), 1 vom: 26. Sept.
Übergeordnetes Werk:	volume:40 ; year:2014 ; number:1 ; day:26 ; month:09

Links:	Volltext

DOI / URN:	10.1186/s13052-014-0076-4

Katalog-ID:	SPR029708494