2012, Number 1
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Ann Hepatol 2012; 11 (1)
Abnormal liver function tests in a patient with myotonic dystrophy type 1
Kalafateli M, Triantos C, Tsamandas A, Kounadis G, Labropoulou-Karatza C
Language: English
References: 20
Page: 130-133
PDF size: 127.99 Kb.
ABSTRACT
Myotonic dystrophy type 1, also known as Steinert’s disease, is a multisystemic disorder with significant
genetic and clinical heterogeneity. Apart from skeletal muscles’ myotonia and wasting, a variety of system
organs can be affected. We report on a 49 years old female patient with unremarkable medical and family
history, who presented with elevated liver enzymes without signs or symptoms of chronic liver disease neither
neurological features. Initial assessment, including liver biopsy, did not reveal the cause of these abnormalities.
Eight months later, she complained for disequilibrium and eventually electromyography
confirmed the diagnosis of Steinert’s disease. Steinert’s disease should be considered in the differential
diagnosis of patients with elevated liver enzymes, as long as abnormal liver tests may be the initial presentation.
The pathophysiological mechanism of this abnormality remains unclear.
REFERENCES
Ronnemaa T, Alaranta H, Viikari J, Tilvis R, Falck B. Increased activity of serum gamma-glutamyltransferase in myotonic dystrophy. Acta Med Scand 1987; 222: 267-73.
Achiron A, Barak Y, Magal N, et al. Abnormal liver tests results in myotonic dystrophy. J Clin Gastroenterol 1998; 26: 292-95.
Heatwole C, Miller J, Martens B, Moxley R. Laboratoty abnormalities in ambulatory patients with myotonic dystrophy type 1. Arch Neurol 2006; 63: 1149-53.
Siciliano G, Pasquali L, Rocchi A, et al. Advanced oxidation protein products in serum of patients with myotonic disease type 2: association with serum gamma-glutamyltransferase and disease severity. Clin Chem Lab Med 2005; 43: 745-7.
Syn WK, Palejwala AA. Anicteric cholostasis: an unusual presentation of myotonic dystrophy. Intern Med J 2009; 39: 206-7.
Brook JD, McCurrach ME, Harley HG, et al. Molecular basis of myotonic dystrophy: expansion of a trinucleotide (CTG) repeat at the 3' end of a transcript encoding a protein kinase family member. Cell 1992; 69: 385.
Buxton J, Shelbourne P, Davies J, et al. Detection of an unstable fragment of DNA specific to individuals with myotonic dystrophy. Nature 1992; 355: 547.
Fu YH, Pizzuti A, Fenwick RG, et al. An unstable triplet repeat in a gene related to myotonic muscular dystrophy. Science 1992; 255: 1256.
Harley HG, Brook JD, Rundle SA, et al. Expansion of an unstable DNA region and phenotypic variation in myotonic dystrophy. Nature 1992; 355: 545.
Mahadevan M, Tsilfidis C, Sabourin L, et al. Myotonic dystrophy mutation: an unstable CTG repeat in the 3’ untranslated region of the gene. Science 1992; 255: 1253.
Liquori CL, Ricker K, Moseley ML, et al. Myotonic dystrophy type 2 caused by a CCTG expansion in intron 1 of ZNF9. Science 2001; 293: 864.
Cho DH, Tapscott SJ. Myotonic dystrophy: emerging mechanisms for DM1 and DM2. Biochim Biophys Acta 2007; 1772: 195.
Lee JE, Cooper TA. Pathogenic mechanisms of myotonic dystrophy. Biochem Soc Trans 2009; 37: 1281.
Charlet-BN, Savkur RS, Singh G, Philips AV, Grice EA, Cooper TA. Loss of the muscle-specific chloride channel in type 1 myotonic dystrophy due to misregulated alternative splicing. Mol Cell 2002; 10: 45-53.
Savkur RS, Philips AV, Cooper TA. Aberrant regulation of insulin receptor alternative splicing is associated with insulin resistance in myotonic dystrophy. Nat Genet 2001; 29: 40-7.
Philips AV, Timchenko LT, Cooper TA. Disruption of splicing regulated by a CUG-binding protein in myotonic dystrophy. Science 1998; 280: 737.
Ronnblom A, Forsberg H, Danielsson A. Gastrointestinal symptoms in myotonic dystrophy. Scand J Gastroenterol 1996; 31: 654.
Roses AD, Appel SH. Muscle membrane protein kinase in myotonic muscular dystrophy. Nature 1974; 250: 245-47.
Hunter T. Protein kinase classification. Methods Enzymol 1991; 200: 3-37.
Paolicchi A, Minotti G, Tonarelli P, et al. Gamma-glutamyl transpeptidase-dependent iron reduction and LDL oxidation- a potential mechanism in atherosclerosis. J Investig Med 1999; 47: 151-60.