Liza Das1, Ashutosh Rai2, Ravimohan Mavuduru3, Kim Vaiphei4, Akhilesh Sharma5, Vishali Gupta6, Sanjay Kumar Bhadada1, Sailesh Lodha7, Naresh Panda8, Anil Bhansali1, Paramjeet Singh9, Pinaki Dutta10. 1. Department of Endocrinology, PGIMER, Chandigarh, India. 2. Department of Translational and Regenerative Medicine, PGIMER, Chandigarh, India. 3. Department of Urology, PGIMER, Chandigarh, India. 4. Department of Histopathology, PGIMER, Chandigarh, India. 5. Department of Psychiatry, PGIMER, Chandigarh, India. 6. Department of Ophthalmology, PGIMER, Chandigarh, India. 7. Department of Endocrinology, Eternal Heart Care Centre, Jaipur, India. 8. Department of Otorhinolarygology, PGIMER, Chandigarh, India. 9. Department of Radiology, PGIMER, Chandigarh, India. 10. Department of Endocrinology, PGIMER, Chandigarh, India. pinaki_dutta@hotmail.com.
Abstract
BACKGROUND: Wolfram syndrome (WFS) is a rare, monogenic neurodegenerative syndrome characterised by insulin requiring non-autoimmune diabetes mellitus (DM) and optic atrophy which are usually the earliest and commonest manifestations. However, there are other features which are under-recognized, adding to morbidity and premature mortality in these patients. METHODS: Five patients (three males, two females) with genetically confirmed WFS at a single tertiary care centre were prospectively followed up. Their symptomatology, clinical profile, genetic analysis and radiology were analyzed. Multidisciplinary approach was used for comprehensive clinical care of this cohort. Patients with primary gonadal failure were subjected to biopsy and immunohistochemistry (IHC) for wolframin was performed. RESULTS: DM was the earliest presenting manifestation at 6.2 ± 1.3 years followed by optic atrophy at 10.4 ± 2.3 years, diabetes insipidus at 12 ± 2.1 years and deafness at 12.8 ± 2.1 years. All patients were autoantibody negative with low C-peptide(<0.6 ng/ml). Hypoglycemic episodes were frequent (upto 60%) but there was no instance of diabetic ketoacidosis. Optic atrophy was present alongwith proliferative diabetic retinopathy and cataract in 40%. Uncommon manifestations included neuropsychiatric features, parasuicide, cystopathy, brainstem atrophy and hypergonadotropic hypogonadism only in adult males (n = 2). Testicular biopsy revealed partly hyalinised seminiferous tubules and prominence of Leydig cells. IHC confirmed the presence of mutated wolframin, which was not significantly different from normal testis specimen on protein quantification. CONCLUSIONS: WFS requires a multidisciplinary approach with special emphasis on early diagnosis and management of other endocrine and non-endocrine features so as to improve long-term outcomes. Gonadal functions need periodic assessment, especially in adult males.
BACKGROUND:Wolfram syndrome (WFS) is a rare, monogenic neurodegenerative syndrome characterised by insulin requiring non-autoimmune diabetes mellitus (DM) and optic atrophy which are usually the earliest and commonest manifestations. However, there are other features which are under-recognized, adding to morbidity and premature mortality in these patients. METHODS: Five patients (three males, two females) with genetically confirmed WFS at a single tertiary care centre were prospectively followed up. Their symptomatology, clinical profile, genetic analysis and radiology were analyzed. Multidisciplinary approach was used for comprehensive clinical care of this cohort. Patients with primary gonadal failure were subjected to biopsy and immunohistochemistry (IHC) for wolframin was performed. RESULTS:DM was the earliest presenting manifestation at 6.2 ± 1.3 years followed by optic atrophy at 10.4 ± 2.3 years, diabetes insipidus at 12 ± 2.1 years and deafness at 12.8 ± 2.1 years. All patients were autoantibody negative with low C-peptide(<0.6 ng/ml). Hypoglycemic episodes were frequent (upto 60%) but there was no instance of diabetic ketoacidosis. Optic atrophy was present alongwith proliferative diabetic retinopathy and cataract in 40%. Uncommon manifestations included neuropsychiatric features, parasuicide, cystopathy, brainstem atrophy and hypergonadotropic hypogonadism only in adult males (n = 2). Testicular biopsy revealed partly hyalinised seminiferous tubules and prominence of Leydig cells. IHC confirmed the presence of mutated wolframin, which was not significantly different from normal testis specimen on protein quantification. CONCLUSIONS: WFS requires a multidisciplinary approach with special emphasis on early diagnosis and management of other endocrine and non-endocrine features so as to improve long-term outcomes. Gonadal functions need periodic assessment, especially in adult males.
Entities:
Keywords:
DIDMOAD; ER stress; Gonadal failure; Neuropsychiatric manifestations; Wolfram syndrome
Authors: Julia Rohayem; Christian Ehlers; Bärbel Wiedemann; Reinhard Holl; Konrad Oexle; Olga Kordonouri; Giuseppina Salzano; Thomas Meissner; Walter Burger; Edith Schober; Angela Huebner; Min Ae Lee-Kirsch Journal: Diabetes Care Date: 2011-05-20 Impact factor: 19.112