Kawashima-Sonoyama Yuki, Hotsubo Tomoyuki, Hamajima Takashi, Hamajima Naoki, Fujimoto Masanobu, Namba Noriyuki, Kanzaki Susumu
Division of Pediatrics & Perinatology, Tottori University Faculty of Medicine, Yonago, Japan.
Department of Pediatrics, Shimane University Faculty of Medicine, Izumo, Japan.
Clin Pediatr Endocrinol. 2022;31(2):59-67. doi: 10.1297/cpe.2021-0064. Epub 2022 Feb 7.
Type 1 insulin-like growth factor receptor (IGF1R) plays an important role in normal fetal and postnatal growth. Over 30 pathogenic variants of have been identified in patients with short stature. Yet, 20 years after the first report, a variety of phenotypes remain poorly defined. We analyzed the genetic and clinical data and responses to GH therapy in 11 patients using results from questionnaires. Eight of the 11 patients have already been reported in previous articles, and all of the identified mutations were heterozygous. The patients exhibited various phenotypes. At least two patients did not meet the criteria for GH treatment for small for gestational age (SGA) short stature, and two more patients showed lower serum IGF1 levels. Nine of the 11 patients had thin upper lips. Five patients with heterozygous treated with GH exhibited similar height gains to those reported in previous Japanese studies on SGA short stature, which also led to extremely high serum IGF1 levels. Patients with short stature due to mutations exhibit various phenotypes. Their presentation at diagnosis may be indistinguishable from common short stature. More specific clinical scoring that considers elevated IGF1 levels after GH treatment is needed to better detect mutations.
1型胰岛素样生长因子受体(IGF1R)在胎儿期和出生后的正常生长中起着重要作用。在身材矮小的患者中已鉴定出超过30种致病变体。然而,在首次报告20年后,各种表型仍未得到很好的定义。我们使用问卷调查结果分析了11例患者的遗传和临床数据以及对生长激素(GH)治疗的反应。11例患者中有8例已在先前的文章中报道过,所有鉴定出的突变均为杂合子。这些患者表现出各种表型。至少有两名患者不符合小于胎龄(SGA)身材矮小的GH治疗标准,另外两名患者的血清IGF1水平较低。11例患者中有9例上唇较薄。5例接受GH治疗的杂合子患者的身高增长与先前日本关于SGA身材矮小的研究报告相似,这也导致血清IGF1水平极高。由于IGF1R突变导致身材矮小的患者表现出各种表型。他们在诊断时的表现可能与常见的身材矮小难以区分。需要更具体的临床评分来考虑GH治疗后IGF1水平的升高,以便更好地检测IGF1R突变。