Methylmalonic acidemia and hyperglycemia: An unusual association
Department of Pediatrics, Advanced Pediatric Centre (APC), Postgraduate Institute of Medical Education and Research (PGIMER), Chandigarh 160012, India.Brain & development (Impact Factor: 1.88). 06/2012; 35(2). DOI: 10.1016/j.braindev.2012.05.001
Introduction: Hyperglycemia is an exceptional manifestation of methylmalonic acidemia (MMA). We describe a patient with MMA in whom we observed a hyperglycemia which improved under treatment of the metabolic crisis. Case report: A 14month-old boy presented with an acute generalized dystonia and lethargy preceded by fever, vomiting and lethargy at the age of 13months. Biological investigations showed a hyperglycemia, a lactic acidosis and a hyperammonemia. Urinary organic acid analysis showed accumulation of methylmalonic acid, tiglylglycine and methylcitrate leading to the diagnosis of MMA. The patient underwent symptomatic treatment with rapid improvement of general condition, consciousness and gradual normalization of biological parameters especially glycemia after 6days without using insulinotherapy. Discussion: MMA is an autosomal recessive disorder caused by a deficiency of methylmalonyl-CoA mutase resulting in methylmalonic acid accumulation. Biochemically, the disorder is typically characterized by: metabolic acidosis, ketonemia or ketonuria, hyperammonemia, leukopenia, thrombocytopenia and anemia. Hypoglycemia is a frequent manifestation of MMA. Our patient presented a hyperglycemia, which is unusual in MMA, since we found only three patients reported with this association. Pathophysiology remains unknown. In reported cases, hyperglycemia was treated by insulin therapy and reducing glucose intravenous infusion, with fatal outcome. In our patient glycemia spontaneously normalized after treatment of the metabolic crisis. Conclusion: Hyperglycemia is an exceptional manifestation of MMA and could be a seriousness marker.
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ABSTRACT: Methylmalonic acidemia (MMA) is most common inherited type of organic acidemia. It has diverse presentation in older infants without any initial apparent symptoms. MMA sometimes present with sudden metabolic decompensation, which may mimics common emergencies like septic shock and diabetic ketoacidosis (DKA) without early recognition can be fatal. In born error of metabolism especially organic acidemia should be suspected in any infant presented with severe high anion gap metabolic acidosis. We report two cases of MMA in infants presented acutely mimicking DKA and septic shock.
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ABSTRACT: Methyl malonic acidemia is an autosomal recessive disease with presentations of mental retardation, recurrent vomiting, ketoacidotic attacks, dehydration, shock, hypoglycemia and hyperamonemia. It will lead to coma and death if unrecognized and untreated. Methyl malonic acidemia may have different skin manifestations. The involvement of blood cells leads to neutropenia, thrombocytopenia and pancytopenia. Most patients have hypoglycemia which in rare cases may be associated with hyperglycemia. The association of mucormycosis, neutropenia and hyperglycemia has been reported in some cases. The case reported in this article carried all three complications together. © 2015, Zanjan University of Medical Sciences and Health Services.
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