TY  - JOUR
U1  - Zeitschriftenartikel, wissenschaftlich - begutachtet (reviewed)
A1  - Grünert, Sarah C.
A1  - Villavicencio-Lorini, Pablo
A1  - Wermuth, Bendicht
A1  - Lehnert, Willy
A1  - Sass, Jörn Oliver
A1  - Schwab, K. Otfried
T1  - Ornithine transcarbamylase deficiency combined with type 1 diabetes mellitus - a challenge in clinical and dietary management
JF  - Journal of Diabetes & Metabolic Disorders
N2  - Ornithine transcarbamylase (OTC) deficiency is the most common urea cycle defect. The clinical presentation in female manifesting carriers varies both in onset and severity. We report on a female with insulin dependent diabetes mellitus and recurrent episodes of hyperammonemia. Since OTC activity measured in a liver biopsy sample was within normal limits, OTC deficiency was initially excluded from the differential diagnoses of hyperammonemia. Due to moderately elevated homocitrulline excretion, hyperornithinemia-hyperammonemia-homocitrullinuria-syndrome was suggested, but further assays in fibroblasts showed normal ornithine utilization. Later, when mutation analysis of the OTC gene became available, a known pathogenic missense mutation (c.533C>T) in exon 5 leading to an exchange of threonine-178 by methionine (p.Thr178Met) was detected. Skewed X-inactivation was demonstrated in leukocyte DNA. In the further clinical course the girl developed marked obesity. By initiating physical activities twice a week, therapeutic control of both diabetes and OTC deficiency improved, but obesity persisted. In conclusion, our case confirms that normal hepatic OTC enzyme activity measured in a single liver biopsy sample does not exclude a clinical relevant mosaic of OTC deficiency because of skewed X-inactivation. Mutation analysis of the OTC gene in whole blood may be a simple way to establish the diagnosis of OTC deficiency. The joint occurrence of OTC deficiency and diabetes in a patient has not been reported before.
SN  - 2251-6581
SS  - 2251-6581
U6  - https://doi.org/10.1186/2251-6581-12-37
DO  - https://doi.org/10.1186/2251-6581-12-37
PM  - 23829977
N1  - © 2013 Grünert et al. This is an Open Access article distributed under the terms of the Creative Commons Attribution License.
VL  - 12
IS  - 1
SP  - 37
PB  - BioMed Central
ER  -