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Pyruvate dehydrogenase deficiency: clinical and biochemical diagnosis.
[pyruvate dehydrogenase deficiency]
A
female
neonate
with
pyruvate
dehydrogenase
(
PDH
)
deficiency
is
presented
with
clinical
,
radiologic
,
biochemical
,
neuropathologic
,
and
molecular
genetic
data
.
She
was
dysmorphic
,
with
a
high
forehead
,
lowset
ears
,
thin
upper
lip
,
upturned
nose
,
and
rhizomelic
limbs
.
Cranial
MRI
revealed
severe
cortical
atrophy
,
ventricular
dilatation
,
and
corpus
callosum
agenesis
.
Pyruvate
and
lactate
levels
were
increased
in
CSF
and
blood
.
Urinary
organic
acid
profile
was
compatible
with
PDH
deficiency
.
PDH
activity
was
normal
in
fibroblasts
,
lymphocytes
,
and
muscle
.
The
PDH
E
1
-
alpha
gene
was
sequenced
and
a
single
base
mutation
was
found
within
the
regulatory
phosphorylation
site
in
exon
10
.
It
is
postulated
that
this
mutation
causes
a
cerebral
form
of
PDH
deficiency
.
Tissue-
specific
expression
of
the
disease
could
be
explained
by
differential
X
chromosome
inactivation
because
the
PDH
E
1
-
alpha
gene
is
located
on
this
chromosome
.
Dysmorphism
with
severe
cerebral
malformations
in
female
patients
merits
a
metabolic
evaluation
,
including
determination
of
lactate
and
pyruvate
levels
in
CSF
.
Diseases
Validation
Diseases presenting
"specific expression of the disease"
symptom
pyruvate dehydrogenase deficiency
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