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Pseudopseudohypoparathyroidism(PPHP)

MedGen UID:
10995
Concept ID:
C0033835
Disease or Syndrome
Synonyms: ALBRIGHT HEREDITARY OSTEODYSTROPHY WITHOUT MULTIPLE HORMONE RESISTANCE; PPHP
SNOMED CT: Pseudopseudohypoparathyroidism (237659007)
Modes of inheritance:
Autosomal dominant inheritance
MedGen UID:
141047
Concept ID:
C0443147
Intellectual Product
Source: Orphanet
A mode of inheritance that is observed for traits related to a gene encoded on one of the autosomes (i.e., the human chromosomes 1-22) in which a trait manifests in heterozygotes. In the context of medical genetics, an autosomal dominant disorder is caused when a single copy of the mutant allele is present. Males and females are affected equally, and can both transmit the disorder with a risk of 50% for each child of inheriting the mutant allele.
 
Gene (location): GNAS (20q13.32)
 
Monarch Initiative: MONDO:0012912
OMIM®: 612463
Orphanet: ORPHA79445

Authors:

Additional description

From OMIM
Patients with pseudopseudohypoparathyroidism do not show resistance to parathyroid hormone (PTH; 168450) or other hormones, as is the case with PHP1A (103580), but do manifest the constellation of clinical features referred to as Albright hereditary osteodystrophy (AHO), which includes short stature, obesity, round facies, subcutaneous ossifications, brachydactyly, and other skeletal anomalies. Some patients have mental retardation (Kinard et al., 1979; Fitch, 1982; Mantovani and Spada, 2006). PPHP occurs only after paternal inheritance of the molecular defect, whereas PHP1A occurs only after maternal inheritance of the molecular defect (see Inheritance and Pathogenesis below). This is an example of imprinting, with differential gene expression depending on the parent of origin of the allele (Davies and Hughes, 1993; Wilson et al., 1994). For a general phenotypic description, classification, and a discussion of molecular genetics of pseudohypoparathyroidism, see PHP1A (103580).  http://www.omim.org/entry/612463

Clinical features

From HPO
Brachydactyly
MedGen UID:
67454
Concept ID:
C0221357
Congenital Abnormality
Digits that appear disproportionately short compared to the hand/foot. The word brachydactyly is used here to describe a series distinct patterns of shortened digits (brachydactyly types A-E). This is the sense used here.
Short metacarpal
MedGen UID:
323064
Concept ID:
C1837084
Anatomical Abnormality
Diminished length of one or more metacarpal bones in relation to the others of the same hand or to the contralateral metacarpal.
Obesity
MedGen UID:
18127
Concept ID:
C0028754
Disease or Syndrome
Accumulation of substantial excess body fat.
Short stature
MedGen UID:
87607
Concept ID:
C0349588
Finding
A height below that which is expected according to age and gender norms. Although there is no universally accepted definition of short stature, many refer to "short stature" as height more than 2 standard deviations below the mean for age and gender (or below the 3rd percentile for age and gender dependent norms).
Cognitive impairment
MedGen UID:
90932
Concept ID:
C0338656
Mental or Behavioral Dysfunction
Abnormal cognition is characterized by deficits in thinking, reasoning, or remembering.
Intellectual disability
MedGen UID:
811461
Concept ID:
C3714756
Mental or Behavioral Dysfunction
Intellectual disability, previously referred to as mental retardation, is characterized by subnormal intellectual functioning that occurs during the developmental period. It is defined by an IQ score below 70.
Osteoporosis
MedGen UID:
14535
Concept ID:
C0029456
Disease or Syndrome
Osteoporosis is a systemic skeletal disease characterized by low bone density and microarchitectural deterioration of bone tissue with a consequent increase in bone fragility. According to the WHO criteria, osteoporosis is defined as a BMD that lies 2.5 standard deviations or more below the average value for young healthy adults (a T-score below -2.5 SD).
Short metatarsal
MedGen UID:
341358
Concept ID:
C1849020
Finding
Diminished length of a metatarsal bone, with resultant proximal displacement of the associated toe.
Enamel hypoplasia
MedGen UID:
3730
Concept ID:
C0011351
Disease or Syndrome
Developmental hypoplasia of the dental enamel.
Delayed eruption of teeth
MedGen UID:
68678
Concept ID:
C0239174
Finding
Delayed tooth eruption, which can be defined as tooth eruption more than 2 SD beyond the mean eruption age.
Round face
MedGen UID:
116087
Concept ID:
C0239479
Finding
The facial appearance is more circular than usual as viewed from the front.
Short neck
MedGen UID:
99267
Concept ID:
C0521525
Finding
Diminished length of the neck.
Depressed nasal bridge
MedGen UID:
373112
Concept ID:
C1836542
Finding
Posterior positioning of the nasal root in relation to the overall facial profile for age.
Full cheeks
MedGen UID:
355661
Concept ID:
C1866231
Finding
Increased prominence or roundness of soft tissues between zygomata and mandible.
Pseudohypoparathyroidism
MedGen UID:
46178
Concept ID:
C0033806
Disease or Syndrome
Disorders of GNAS inactivation include the phenotypes pseudohypoparathyroidism Ia, Ib, and Ic (PHP-Ia, -Ib, -Ic), pseudopseudohypoparathyroidism (PPHP), progressive osseous heteroplasia (POH), and osteoma cutis (OC). PHP-Ia and PHP-Ic are characterized by: End-organ resistance to endocrine hormones including parathyroid hormone (PTH), thyroid-stimulating hormone (TSH), gonadotropins (LH and FSH), growth hormone-releasing hormone (GHRH), and CNS neurotransmitters (leading to obesity and variable degrees of intellectual disability and developmental delay); and The Albright hereditary osteodystrophy (AHO) phenotype (short stature, round facies, and subcutaneous ossifications) and brachydactyly type E (shortening mainly of the 4th and/or 5th metacarpals and metatarsals and distal phalanx of the thumb). Although PHP-Ib is characterized principally by PTH resistance, some individuals also have partial TSH resistance and mild features of AHO (e.g., brachydactyly). PPHP, a more limited form of PHP-Ia, is characterized by various manifestations of the AHO phenotype without the hormone resistance or obesity. POH and OC are even more restricted variants of PPHP: POH consists of dermal ossification beginning in infancy, followed by increasing and extensive bone formation in deep muscle and fascia. OC consists of extra-skeletal ossification that is limited to the dermis and subcutaneous tissues.
Nystagmus
MedGen UID:
45166
Concept ID:
C0028738
Disease or Syndrome
Rhythmic, involuntary oscillations of one or both eyes related to abnormality in fixation, conjugate gaze, or vestibular mechanisms.
Cataract
MedGen UID:
39462
Concept ID:
C0086543
Disease or Syndrome
A cataract is an opacity or clouding that develops in the crystalline lens of the eye or in its capsule.

Term Hierarchy

Professional guidelines

PubMed

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Schneller-Pavelescu L, Vergara de Caso E, Pastor-Tomás N, Gutiérrez Agulló M, Ruiz Pérez L, Betlloch Mas I
Pediatr Dermatol 2019 May;36(3):355-359. Epub 2019 Feb 27 doi: 10.1111/pde.13769. PMID: 30809832
Garcia C, Correia CR, Lopes L
Paediatr Int Child Health 2018 Nov;38(4):281-284. Epub 2017 Jun 26 doi: 10.1080/20469047.2017.1341730. PMID: 28648114
Silve C, Clauser E, Linglart A
Horm Metab Res 2012 Sep;44(10):749-58. Epub 2012 Jul 19 doi: 10.1055/s-0032-1316330. PMID: 22815067
Jüppner H, Bastepe M
J Pediatr Endocrinol Metab 2006 May;19 Suppl 2:641-6. doi: 10.1515/jpem.2006.19.s2.641. PMID: 16789629
Van Dop C, Wang H, Mulaikal RM, Tolo VT, Rosenbaum AE
Pediatr Radiol 1988;18(5):429-31. doi: 10.1007/BF02388057. PMID: 3174285

Diagnosis

Csizmar CM, Shah M
Mayo Clin Proc 2021 Sep;96(9):2303-2304. doi: 10.1016/j.mayocp.2021.05.009. PMID: 34481595
Jüppner H
J Clin Endocrinol Metab 2021 May 13;106(6):1541-1552. doi: 10.1210/clinem/dgab060. PMID: 33529330Free PMC Article
Simpson C, Grove E, Houston BA
Lancet 2015 Mar 21;385(9973):1123. Epub 2014 Dec 5 doi: 10.1016/S0140-6736(14)61640-8. PMID: 25484027
Ma RC, Cockram CS
Lancet 2009 Dec 19;374(9707):2090. doi: 10.1016/S0140-6736(09)60293-2. PMID: 20109835
Breslau NA
Am J Med Sci 1989 Aug;298(2):130-40. doi: 10.1097/00000441-198908000-00011. PMID: 2669477

Therapy

Arrigoni P, Minen A
JBJS Case Connect 2019 Apr-Jun;9(2):e0287. doi: 10.2106/JBJS.CC.18.00287. PMID: 31085937
Stirling HF, Barr DG, Kelnar CJ
Arch Dis Child 1991 Apr;66(4):533-5. doi: 10.1136/adc.66.4.533. PMID: 2031618Free PMC Article
Dalinka MK, Melchior EL
Bull N Y Acad Med 1980 Jul-Aug;56(6):539-63. PMID: 6930311Free PMC Article
Gwinn JL, Lee FA
Am J Dis Child 1970 May;119(5):447-8. PMID: 5442444
Nedok AS, Garzicic BS, Soldatovic BM
J Clin Endocrinol Metab 1968 Oct;28(10):1513-4. doi: 10.1210/jcem-28-10-1513. PMID: 5681646

Prognosis

Garcia C, Correia CR, Lopes L
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Ward S, Sugo E, Verge CF, Wargon O
Australas J Dermatol 2011 May;52(2):127-31. Epub 2011 Jan 12 doi: 10.1111/j.1440-0960.2010.00722.x. PMID: 21605097
Rickard SJ, Wilson LC
Am J Hum Genet 2003 Apr;72(4):961-74. Epub 2003 Mar 6 doi: 10.1086/374566. PMID: 12624854Free PMC Article
Davids MS, Crawford E, Weremowicz S, Morton CC, Copeland NG, Gilbert DJ, Jenkins NA, Phelan MC, Comb MJ, Melnick MB
Genomics 2001 Sep;77(1-2):2-4. doi: 10.1006/geno.2001.6605. PMID: 11543625
Barr DG, Stirling HF, Darling JA
Arch Dis Child 1994 Apr;70(4):337-8. doi: 10.1136/adc.70.4.337. PMID: 8185370Free PMC Article

Clinical prediction guides

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Tafaj O, Jüppner H
J Endocrinol Invest 2017 Apr;40(4):347-356. Epub 2016 Dec 19 doi: 10.1007/s40618-016-0588-4. PMID: 27995443
Silve C, Clauser E, Linglart A
Horm Metab Res 2012 Sep;44(10):749-58. Epub 2012 Jul 19 doi: 10.1055/s-0032-1316330. PMID: 22815067
Davids MS, Crawford E, Weremowicz S, Morton CC, Copeland NG, Gilbert DJ, Jenkins NA, Phelan MC, Comb MJ, Melnick MB
Genomics 2001 Sep;77(1-2):2-4. doi: 10.1006/geno.2001.6605. PMID: 11543625
Werder EA, Fischer JA, Illig R, Kind HP, Bernasconi S, Fanconi A, Prader A
J Clin Endocrinol Metab 1978 Jun;46(6):872-9. doi: 10.1210/jcem-46-6-872. PMID: 233700

Recent systematic reviews

Batla A, Tai XY, Schottlaender L, Erro R, Balint B, Bhatia KP
Parkinsonism Relat Disord 2017 Apr;37:1-10. Epub 2016 Dec 27 doi: 10.1016/j.parkreldis.2016.12.024. PMID: 28162874

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