Late-onset n-acetylglutamate synthase deficiency: Report of a paradigmatic adult case presenting with headaches and review of the literature

Paolo Calabresi, Catia Cavicchi, Chiara Chilleri, Antonella Fioravanti, Lorenzo Ferri, Francesco Ripandelli, Cinzia Costa, Paolo Prontera, Francesca Pochiero, Elisabetta Pasquini, Silvia Funghini, Giancarlo La Marca, Maria Alice Donati, Amelia Morrone

Risultato della ricerca: Contributo in rivistaArticolo in rivista

3 Citazioni (Scopus)

Abstract

N-acetylglutamate synthase deficiency (NAGSD) is an extremely rare urea cycle disorder (UCD) with few adult cases so far described. Diagnosis of late-onset presentations is difficult and delayed treatment may increase the risk of severe hyperammonemia. We describe a 52-year-old woman with recurrent headaches who experienced an acute onset of NAGSD. As very few papers focus on headaches in UCDs, we also report a literature review of types and pathophysiologic mechanisms of UCD-related headaches. In our case, headaches had been present since puberty (3-4 days a week) and were often accompanied by nausea, vomiting, or behavioural changes. Despite three previous episodes of altered consciousness, ammonia was measured for the first time at 52 years and levels were increased. Identification of the new homozygous c.344C>T (p.Ala115Val) NAGS variant allowed the definite diagnosis of NAGSD. Bioinformatic analysis suggested that an order/disorder alteration of the mutated form could affect the arginine-binding site, resulting in poor enzyme activation and late-onset presentation. After optimized treatment for NAGSD, ammonia and amino acid levels were constantly normal and prevented other headache bouts. The manuscript underlies that headache may be the presenting symptom of UCDs and provides clues for the rapid diagnosis and treatment of late-onset NAGSD.
Lingua originaleEnglish
pagine (da-a)1-9
Numero di pagine9
RivistaInternational Journal of Molecular Sciences
Volume19
DOI
Stato di pubblicazionePubblicato - 2018

Keywords

  • Headaches
  • Urea Cycle Disorders, Inborn
  • Late-onset UCDs
  • N-acetylglutamate synthase deficiency (NAGSD)
  • N-carbamylglutamate (NCG)
  • NAGS gene mutations
  • Urea cycle disorders (UCDs)
  • Age of Onset
  • Amino-Acid N-Acetyltransferase
  • Biomarkers
  • Brain
  • Electroencephalography
  • Female
  • Glutamates
  • Humans
  • Middle Aged
  • Symptom Assessment
  • Treatment Outcome
  • Hyperammonemic encephalopathy

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