eMedicine Specialties > Endocrinology > Metabolic Disorders

Glycogen Storage Disease, Type Ib

Author: Wayne E Anderson, DO, Assistant Professor of Internal Medicine/Neurology, Western University of Health Sciences; Assistant Professor of Family Medicine, Touro University College of Osteopathic Medicine; Consulting Staff in Pain Management, Department of Neurology, California Pacific Medical Center; Consulting Staff in Neurology, Department of Neurology, California Pacific Medical Center
Contributor Information and Disclosures

Updated: Nov 13, 2009

Introduction

Background

A glycogen storage disease (GSD) is the result of an enzyme defect. These enzymes normally catalyze reactions that ultimately convert glycogen compounds to glucose. Enzyme deficiency results in glycogen accumulation in tissues. In many cases, the defect has systemic consequences, but, in some cases, the defect is limited to specific tissues. Most patients experience muscle symptoms, such as weakness and cramps, although certain GSDs manifest as specific syndromes, such as hypoglycemic seizures or cardiomegaly. (See image below and Image 1.)

Metabolic pathways of carbohydrates.

Metabolic pathways of carbohydrates.

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Metabolic pathways of carbohydrates.

Metabolic pathways of carbohydrates.


Although at least 14 unique GSDs are discussed in the literature, the 4 that cause clinically significant muscle weakness are Pompe disease (GSD type II, acid maltase deficiency), Cori disease (GSD type III, debranching enzyme deficiency), McArdle disease (GSD type V, myophosphorylase deficiency), and Tarui disease (GSD type VII, phosphofructokinase deficiency). One form, Von Gierke disease (GSD type Ia, glucose-6-phosphatase deficiency), causes clinically significant end-organ disease with significant morbidity. The remaining GSDs are not benign but are less clinically significant; therefore, the physician should consider the aforementioned GSDs when initially entertaining the diagnosis of a GSD. Interestingly, there also is a GSD type 0, which is due to defective glycogen synthase.

These inherited enzyme defects usually present in childhood, although some, such as McArdle disease and Pompe disease, have separate adult-onset forms. In general, GSDs are inherited as autosomal recessive conditions. Several different mutations have been reported for each disorder.

Unfortunately, no specific treatment or cure exists, although diet therapy may be highly effective at reducing clinical manifestations. In some cases, liver transplantation may abolish biochemical abnormalities. Active research continues.

Diagnosis depends on muscle biopsy, electromyelography, ischemic forearm test, creatine kinase levels, patient history, and physical examination. Biochemical assay for enzyme activity is the method of definitive diagnosis.

Acid maltase catalyzes the hydrogenation reaction of maltose to glucose. Acid maltase deficiency is a unique glycogenosis since glycogen accumulation is lysosomal rather than in the cytoplasm. It also has a unique clinical presentation depending on age at onset, ranging from fatal hypotonia and cardiomegaly in the neonate to muscular dystrophy in adults.

Glucose-6-phosphatase (G-6-P) is the specific enzyme deficiency in Von Gierke disease. GSD type 1b is a similar condition with a defective G-6-P transporter protein.1 A newly described form, GSD type 1c, is not thought to be related to a transporter protein mutation.

Recent research
In a 2-year study of 7 patients with GSD type Ib, Melis et al examined whether the administration of vitamin E could improve or prevent the clinical manifestations of neutropenia and neutrophil dysfunction.2 Vitamin E supplementation was provided to patients only during the second year of the study, and neutrophil counts from the first and second years were compared. The investigators found that during the second year, mean neutrophil counts were significantly greater than they were during the first. Reductions in the frequency and severity of infections, mouth ulcers, and perianal lesions also occurred during the second year. However, no changes in neutrophil function were found in association with vitamin E supplementation.

Pathophysiology

With an enzyme defect, carbohydrate metabolic pathways are blocked, and excess glycogen accumulates in affected tissues. Each GSD represents a specific enzyme defect, and each enzyme is in specific, or most, body tissues. The G-6-P transporter protein is found in the liver and kidney.

GSD type Ib is an autosomal recessive condition.

Glucose-6-phosphate is an intermediate in glycogen synthesis and glucose metabolism. GSD type Ib differs from GSD type Ia in that it is not explained by mutations of the phosphohydrolase gene. Veiga-da-Cuhna and colleagues provide evidence that all non-1a cases can be explained by mutations of the glucose-6-phosphate translocase gene.3

Frequency

International

Herling and colleagues studied the incidence and frequency of inherited metabolic conditions in British Columbia. GSDs are found in 2.3 children per 100,000 births per year.

Mortality/Morbidity

  • GSD Ib, unlike GSD Ia, involves bacterial infections including brain abscesses. However, D'Eufemia and colleagues report one case of a 10-year-old boy with GSD II with neutropenia and neutrophil dysfunction but without severe recurrent infections.4
  • Immediate morbidity arises from hypoglycemic seizures.
  • Serious long-term complications include nephropathy and hepatic adenoma.

Age

  • In general, GSDs present in childhood. Later onset correlates with a less severe form. Consider Pompe disease if onset is in infancy.

Clinical

History

  • Initial presentation may be hypoglycemic seizures.
  • Although muscle weakness is not a uniform feature of glycogen storage disease (GSD), type I, Schwahn and colleagues report an association between reduced muscle force and poor metabolic control.5
  • Skin and pulmonary infections are frequent.
  • Patients may report symptoms of inflammatory bowel disease including cramps, fever, and abdominal pain.

Physical

  • Physical examination findings may include hepatomegaly. Because many causes of hepatic injury exist, suspicion must be high.
  • Examination findings may suggest infection of lung or skin.
  • Findings also may include acute abdomen and perioral or perianal infections.
  • Hypotonia is found in infants.

More on Glycogen Storage Disease, Type Ib

Overview: Glycogen Storage Disease, Type Ib
Differential Diagnoses & Workup: Glycogen Storage Disease, Type Ib
Treatment & Medication: Glycogen Storage Disease, Type Ib
Follow-up: Glycogen Storage Disease, Type Ib
Multimedia: Glycogen Storage Disease, Type Ib
References
Further Reading
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References

  1. Pan CJ, Chen SY, Lee S, et al. Structure-function study of the glucose-6-phosphate transporter, an eukaryotic antiporter deficient in glycogen storage disease type Ib. Mol Genet Metab. Jan 2009;96(1):32-7. [Medline].

  2. Melis D, Della Casa R, Parini R, et al. Vitamin E supplementation improves neutropenia and reduces the frequency of infections in patients with glycogen storage disease type 1b. Eur J Pediatr. Sep 2009;168(9):1069-74. [Medline].

  3. Veiga-da-Cunha M, Gerin I, Chen YT. The putative glucose 6-phosphate translocase gene is mutated in essentially all cases of glycogen storage disease type I non-a. Eur J Hum Genet. Sep 1999;7(6):717-23. [Medline].

  4. D'Eufemia P, Finocchiaro R, Celli M, Zambrano A, Tetti M, Ferrucci V. Absence of severe recurrent infections in glycogen storage disease type Ib with neutropenia and neutrophil dysfunction. J Inherit Metab Dis. Feb 2007;30(1):105. [Medline].

  5. Schwahn B, Rauch F, Wendel U, Schönau E. Low bone mass in glycogen storage disease type 1 is associated with reduced muscle force and poor metabolic control. J Pediatr. Sep 2002;141(3):350-6. [Medline].

  6. Pierre G, Chakupurakal G, McKiernan P, et al. Bone marrow transplantation in glycogen storage disease type 1b. J Pediatr. Feb 2008;152(2):286-8. [Medline].

  7. Zingone A, Hiraiwa H, Pan CJ. Correction of glycogen storage disease type 1a in a mouse model by gene therapy. J Biol Chem. Jan 14 2000;275(2):828-32. [Medline].

  8. Bijvoet AG, Van Hirtum H, Vermey M. Pathological features of glycogen storage disease type II highlighted in the knockout mouse model. J Pathol. Nov 1999;189(3):416-24. [Medline].

  9. Matern D, Starzl TE, Arnaout W. Liver transplantation for glycogen storage disease types I, III, and IV. Eur J Pediatr. Dec 1999;158 Suppl 2:S43-8. [Medline].

  10. Pinsk M, Burzynski J, Yhap M, et al. Acute myelogenous leukemia and glycogen storage disease 1b. J Pediatr Hematol Oncol. Dec 2002;24(9):756-8. [Medline].

  11. Amato AA. Acid maltase deficiency and related myopathies. Neurol Clin. Feb 2000;18(1):151-65. [Medline].

  12. Applegarth DA, Toone JR, Lowry RB. Incidence of inborn errors of metabolism in British Columbia, 1969-1996. Pediatrics. Jan 2000;105(1):e10. [Medline].

  13. Chen Y. Glycogen Storage Diseases. The Metabolic and Molecular Bases of Inherited Disease. 2001;1521-1551.

  14. Chou JY, Mansfield BC. Gene therapy for type I glycogen storage diseases. Curr Gene Ther. Apr 2007;7(2):79-88. [Medline].

  15. Dieckgraefe BK, Korzenik JR, Husain A, Dieruf L. Association of glycogen storage disease 1b and Crohn disease: results of a North American survey. Eur J Pediatr. Oct 2002;161 Suppl 1:S88-92. [Medline].

  16. Fernandes J, Smit G. The Glycogen-Storage Diseases. Inborn Metabolic Diseases. 2000;87-102.

  17. Goldberg T, Slonim AE. Nutrition therapy for hepatic glycogen storage diseases. J Am Diet Assoc. Dec 1993;93(12):1423-30. [Medline].

  18. Hou DC, Kure S, Suzuki Y. Glycogen storage disease type Ib: structural and mutational analysis of the microsomal glucose-6-phosphate transporter gene. Am J Med Genet. Sep 17 1999;86(3):253-7. [Medline].

  19. Kishnani PS, Boney A, Chen YT. Nutritional deficiencies in a patient with glycogen storage disease type Ib. J Inherit Metab Dis. Oct 1999;22(7):795-801. [Medline].

  20. Orho M, Bosshard NU, Buist NR. Mutations in the liver glycogen synthase gene in children with hypoglycemia due to glycogen storage disease type 0. J Clin Invest. Aug 1 1998;102(3):507-15. [Medline].

  21. Reitsma-Bierens WC. Renal complications in glycogen storage disease type I. Eur J Pediatr. 1993;152 Suppl 1:S60-2. [Medline].

  22. Salapata Y, Laskaris G, Drogari E. Oral manifestations in glycogen storage disease type 1b. J Oral Pathol Med. Mar 1995;24(3):136-9. [Medline].

  23. Saltik-Temizel IN, Koçak N, Ozen H, et al. Inflammatory bowel disease-like colitis in a young Turkish child with glycogen storage disease type 1b and elevated platelet count. Turk J Pediatr. Apr-Jun 2005;47(2):180-2. [Medline].

  24. Selby R, Starzl TE, Yunis E. Liver transplantation for type I and type IV glycogen storage disease. Eur J Pediatr. 1993;152 Suppl 1:S71-6. [Medline].

  25. Seydewitz HH, Matern D. Molecular genetic analysis of 40 patients with glycogen storage disease type Ia: 100% mutation detection rate and 5 novel mutations. Hum Mutat (Online). Jan 2000;15(1):115-6. [Medline].

  26. Smit GP, Fernandes J, Leonard JV. The long-term outcome of patients with glycogen storage diseases. J Inherit Metab Dis. 1990;13(4):411-8. [Medline].

  27. Spiegel R, Rakover-Tenenbaum Y, et al. Secondary diabetes mellitus: late complication of glycogen storage disease type 1b. J Pediatr Endocrinol Metab. Jun 2005;18(6):617-9. [Medline].

  28. Stevens AN, Iles RA, Morris PG. Detection of glycogen in a glycogen storage disease by 13C nuclear magnetic resonance. FEBS Lett. Dec 27 1982;150(2):489-93. [Medline].

  29. Wolfsdorf JI, Holm IA, Weinstein DA. Glycogen storage diseases. Phenotypic, genetic, and biochemical characteristics, and therapy. Endocrinol Metab Clin North Am. Dec 1999;28(4):801-23. [Medline].

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Further Reading

Clinical guidelines:
AASLD practice guidelines: evaluation of the patient for liver transplantation. American Association for the Study of Liver Diseases - Private Nonprofit Research Organization. 2000 Jan (revised 2005 Jun). 26 pages. NGC:004333

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Keywords

glycogen storage disease type Ib, glycogen storage disease, glycogen storage, glycogen storage disease, glucose-6-phosphate, glucose-6-phosphatase, glycogen storage type, glycogen metabolism, glycogen storage diseases, glycogen diseases

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Contributor Information and Disclosures

Author

Wayne E Anderson, DO, Assistant Professor of Internal Medicine/Neurology, Western University of Health Sciences; Assistant Professor of Family Medicine, Touro University College of Osteopathic Medicine; Consulting Staff in Pain Management, Department of Neurology, California Pacific Medical Center; Consulting Staff in Neurology, Department of Neurology, California Pacific Medical Center
Wayne E Anderson, DO is a member of the following medical societies: American Academy of Neurology, American Medical Association, American Society of Law Medicine and Ethics, California Medical Association, and San Francisco Medical Society
Disclosure: Cephalon Honoraria Speaking and teaching; Pfizer Honoraria Speaking and teaching; King Honoraria Consulting

Medical Editor

Barry J Goldstein, MD, PhD, Director, Division of Endocrinology, Diabetes and Metabolic Diseases, Professor, Department of Internal Medicine, Thomas Jefferson University
Barry J Goldstein, MD, PhD is a member of the following medical societies: Alpha Omega Alpha, American College of Clinical Endocrinologists, American College of Physicians-American Society of Internal Medicine, American Diabetes Association, and Endocrine Society
Disclosure: Nothing to disclose.

Pharmacy Editor

Francisco Talavera, PharmD, PhD, Senior Pharmacy Editor, eMedicine
Disclosure: eMedicine Salary Employment

Managing Editor

Kent Wehmeier, MD, Professor, Department of Internal Medicine, Division of Endocrinology, Diabetes, and Metabolism, St Louis University School of Medicine
Kent Wehmeier, MD is a member of the following medical societies: American Society of Hypertension, Endocrine Society, and International Society for Clinical Densitometry
Disclosure: Nothing to disclose.

CME Editor

Mark Cooper, MBBS, PhD, FRACP, Head, Diabetes & Metabolism Division, Baker Heart Research Institute, Professor of Medicine, Monash University
Disclosure: Nothing to disclose.

Chief Editor

George T Griffing, MD, Professor of Medicine, St Louis University School of Medicine
George T Griffing, MD is a member of the following medical societies: American Association for the Advancement of Science, American College of Medical Practice Executives, American College of Physician Executives, American College of Physicians, American Diabetes Association, American Federation for Medical Research, American Heart Association, Central Society for Clinical Research, Endocrine Society, International Society for Clinical Densitometry, and Southern Society for Clinical Investigation
Disclosure: Nothing to disclose.

 
 
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