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Identification of a second kindred with familial hypocalciuric hypercalcemia type 3 (FHH3) narrows localization to a <3.5 megabase pair region on chromosome 19q13.3.
[familial hypocalciuric hypercalcemia]
Familial
hypocalciuric
hypercalcemia
(
FHH
)
is
a
genetically
heterogenous
disorder
that
consists
of
three
defined
types
,
FHH
1
,
FHH
2
,
and
FHH
3
whose
chromosomal
locations
are
3
q
21
.
1
,
19
p
,
and
19
q
13
,
respectively
.
FHH
1
,
caused
by
mutations
of
the
calcium-sensing
receptor
(
CASR
)
,
occurs
in
more
than
65
%
of
patients
,
whereas
the
abnormalities
underlying
FHH
2
and
FHH
3
,
which
have
each
been
described
in
single
North
American
kindreds
,
are
unknown
.
The
aim
of
this
study
was
to
determine
the
basis
of
FHH
in
a
proband
,
who
did
not
have
CASR
mutations
,
and
her
kindred
.
The
proband
was
a
43
-
yr
-old
woman
who
presented
with
a
corrected
serum
calcium
of
2
.
74
mmol
/
liter
(
normal
=
2
.
15
-
2
.
55
mmol
/
liter
)
,
a
serum
PTH
of
47
pg
/
ml
(
normal
=
10
-
65
pg
/
ml
)
,
and
a
urinary
calcium
clearance
:
creatinine
clearance
of
0
.
006
.
She
did
not
have
a
CASR
mutation
within
the
coding
region
and
splice
sites
,
and
24
members
from
three
generations
of
her
kindred
were
ascertained
and
investigated
for
serum
abnormalities
and
cosegregation
with
polymorphic
loci
from
chromosomes
3
q
21
.
1
and
19
q
13
using
leukocyte
DNA
.
Sixteen
members
were
hypercalcemic
with
normal
or
elevated
serum
PTH
concentrations
and
mild
hypophosphatemia
,
features
consistent
with
FHH
3
.
Use
of
microsatellite
and
single
nucleotide
polymorphic
loci
from
chromosome
19
q
13
.
3
demonstrated
cosegregation
with
FHH
in
the
kindred
,
with
a
peak
LOD
score
=
5
.
98
at
0
%
recombination
with
D
19
S
412
.
Analysis
of
recombinants
mapped
FHH
to
a
3
.
46
-
Mbp
interval
flanked
centromerically
by
single
nucleotide
polymorphism
rs
1990932
and
telomerically
by
D
19
S
604
.
FHH
3
may
explain
the
calcium
homeostasis
disorder
in
those
FHH
patients
who
do
not
have
CASR
mutations
.
Diseases
Validation
Diseases presenting
"hypercalcemia"
symptom
carcinoma of the gallbladder
cushing syndrome
familial hypocalciuric hypercalcemia
kabuki syndrome
severe combined immunodeficiency
waldenström macroglobulinemia
This symptom has already been validated