Skeletal features and growth patterns in 14 patients with haploinsufficiency of SHOX: Implications for the development of Turner syndrome

被引:128
作者
Kosho, T
Muroya, K
Nagai, T
Fujimoto, M
Yokoya, S
Sakamoto, H
Hirano, T
Terasaki, H
Ohashi, H
Nishimura, G
Sato, S
Matsuo, N
Ogata, T
机构
[1] Keio Univ, Sch Med, Dept Pediat, Shinjuku Ku, Tokyo 1608582, Japan
[2] Dokkyo Univ, Sch Med, Koshigaya Hosp, Dept Pediat, Koshigaya 3430845, Japan
[3] St Marianna Univ, Sch Med, Dept Pediat, Kawasaki, Kanagawa 2110063, Japan
[4] Toranomon Gen Hosp, Dept Pediat, Tokyo 105, Japan
[5] Hyogo Coll Med, Dept Genet, Nishinomiya, Hyogo 663, Japan
[6] Ibaraki Childrens Med Ctr, Div Endocrinol & Metab, Mito, Ibaraki 311, Japan
[7] Mitsubishi Kagaku Bioclin Labs Inc, Tokyo 174, Japan
[8] Saitama Childrens Med Ctr, Div Med Genet, Iwatsuki, Saitama 339, Japan
[9] Nishitama Hosp, Dept Radiol, Hamura 205, Japan
关键词
D O I
10.1210/jc.84.12.4613
中图分类号
R5 [内科学];
学科分类号
1002 ; 100201 ;
摘要
We report on clinical features in 14 Japanese patients (4 males and 10 females) with partial monosomy of the short arm pseudoautosomal region involving SHOX (n = 11) or total monosomy of the pseudoautosomal region with no involvement of disease genes on the sex-differential regions (n = 3). Skeletal assessment showed that three patients had no discernible skeletal abnormalities, one patient exhibited short 4th metacarpals and borderline cubitus valgus, and the remaining 10 patients had Madelung deformity and/or mesomelia characteristic of Leri-Weill dyschondrosteosis (LWD), together with short 4th metacarpals and/or cubitus valgus. Skeletal lesions were more severe in females and became obvious with age. Growth evaluation revealed that patients without LWD grew along by the -2 SD growth curve before puberty and showed a normal or exaggerated pubertal growth spurt, whereas those with LWD grew along by the standard growth curves before puberty but exhibited an attenuated pubertal growth spurt and resultant short stature. Maturational assessment indicated a tendency of relatively early maturation in patient; with LWD. There was no correlation between the clinical phenotype and the deletion size. These findings suggest that haploinsufficiency of SHOX causes not only short stature but also Turner skeletal anomalies (such as short 4th metacarpals, cubitus valgus, and LWD) and that growth pattern is primarily dependent on the presence or absence of LWD. Because skeletal lesions have occurred in a female-dominant and age-influenced fashion, it is inferred that estrogens exert a maturational effect on skeletal tissues that are susceptible to premature fusion of growth plates because of haploinsufficiency of SHOX, facilitating the development of skeletal lesions.
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页码:4613 / 4621
页数:9
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