Chen Jiao, Yuan Ke, He Min-Fei, Wang Chun-Lin, Chen Chun, Fang Yan-Lan, Zhu Jian-Fang, Liang Li
Department of Pediatrics, First Affiliated Hospital of Zhejiang University, Hangzhou 310003, China.
Zhongguo Dang Dai Er Ke Za Zhi. 2018 Nov;20(11):925-929. doi: 10.7499/j.issn.1008-8830.2018.11.009.
Kallmann syndrome (KS) is a rare pediatric disease with major manifestations of olfactory dysfunction and hypogonadotropic hypogonadism. Five children (4 boys and 1 girl) with KS reported in this article were aged between 6 months and 19 years at the time when they attended the hospital. All the children had the clinical manifestation of hypogonadotropic hypogonadism; in addition, three children had olfactory dysfunction (two were found to have olfactory bulb dysplasia on magnetic resonance imaging), one had cleft lip and palate, and one had micropenis and cryptorchidism with right renal agenesis during infancy. All the five children had normal karyotype and their parents had normal clinical phenotypes. The uncle of one child had underdeveloped secondary sexual characteristics and olfactory disorder since childhood. High-throughput sequencing found two known heterozygous missense mutations in the FGFR1 gene, i.e., c.1097C>T(p.P366L) and c.809G>C(p.G270A), in two children. One child had a novel frameshift mutation, c.1877_1887/p.S627Tfs*6, in the KAL1 gene; this deletion mutation caused a frameshift in base sequence and produced truncated proteins, which led to a significant change in protein structure, and thus it was highly pathogenic. It is concluded that KS has great clinical and genetic heterogeneity and can be accompanied by incomplete dominant inheritance and that gene detection helps with the diagnosis of this disease.
卡尔曼综合征(KS)是一种罕见的儿科疾病,主要表现为嗅觉功能障碍和低促性腺激素性性腺功能减退。本文报道的5例KS患儿就诊时年龄在6个月至19岁之间。所有患儿均有低促性腺激素性性腺功能减退的临床表现;此外,3例患儿有嗅觉功能障碍(2例磁共振成像显示嗅球发育不良),1例有唇腭裂,1例婴儿期有小阴茎、隐睾伴右肾缺如。5例患儿染色体核型均正常,其父母临床表型也正常。其中1例患儿的叔叔自幼有第二性征发育不全和嗅觉障碍。高通量测序在2例患儿中发现FGFR1基因有2个已知的杂合错义突变,即c.1097C>T(p.P366L)和c.809G>C(p.G270A)。1例患儿在KAL1基因中有一个新的移码突变,即c.1877_1887/p.S627Tfs*6;这种缺失突变导致碱基序列移码并产生截短蛋白,从而导致蛋白质结构发生显著变化,因此具有高度致病性。结论是KS具有很大的临床和遗传异质性,可伴有不完全显性遗传,基因检测有助于该病的诊断。