eMedicine Specialties > Pediatrics: Genetics and Metabolic Disease > Metabolic Diseases
Glutathione Synthetase Deficiency: Differential Diagnoses & Workup
Updated: Oct 14, 2009
- Overview
- Differential Diagnoses & Workup
- Treatment & Medication
- Follow-up
- Multimedia
Differential Diagnoses
Acidosis, Metabolic
Galactose-1-Phosphate Uridyltransferase
Deficiency (Galactosemia)
Methylmalonic Acidemia
Propionic Acidemia (Propionyl CoA Carboxylase
Deficiency)
Other Problems to Be Considered
Distal renal tubular acidosis, autosomal dominant
Cobalamin C disease
Cobalamin D disease
Workup
Laboratory Studies
- Electrolyte and blood gas determinations indicate high anion gap metabolic acidosis. The CBC count demonstrates hemolytic anemia. Diagnosis of glutathione synthetase (GS) deficiency is confirmed by the presence of a large peak of 5-oxoproline in the urine. Concentrations of this metabolite are also increased in the cerebrospinal fluid (CSF) and blood. Diagnosis can be confirmed through enzyme analysis of glutathione synthetase (which is found to be deficient) in cultured skin fibroblasts. Upon routine testing, in addition to a hemolytic anemia, episodic neutropenia may occur. Additional findings include the following:
- Neutrophil bactericidal and iodination defects, which are corrected with vitamin E therapy
- Pyroglutamic aciduria
- Pyroglutamic acidemia
- Decreased glutathione in erythrocytes
- Increased gamma-glutamylcysteine synthetase
- Moderate and severe forms cannot be differentiated based on enzyme activity, which suggests that other factors are involved in the final phenotypic presentation.
More on Glutathione Synthetase Deficiency |
| Overview: Glutathione Synthetase Deficiency |
Differential Diagnoses & Workup: Glutathione Synthetase Deficiency |
| Treatment & Medication: Glutathione Synthetase Deficiency |
| Follow-up: Glutathione Synthetase Deficiency |
| Multimedia: Glutathione Synthetase Deficiency |
| References |
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References
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Shi ZZ, Habib GM, Rhead WJ, et al. Mutations in the glutathione synthetase gene cause 5-oxoprolinuria. Nat Genet. Nov 1996;14(3):361-5. [Medline].
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Webb GC, Vaska VL, Gali RR, et al. The gene encoding human glutathione synthetase (GSS) maps to the long arm of chromosome 20 at band 11.2. Genomics. Dec 10 1995;30(3):617-9. [Medline].
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Simon E, Vogel M, Fingerhut R, et al. Diagnosis of glutathione synthetase deficiency in newborn screening. J Inherit Metab Dis. Sep 2 2009;[Medline].
Further Reading
Keywords
glutathione synthetase deficiency, GS deficiency, 5-oxoprolinemia, 5-oxoprolinuria, pyroglutamicaciduria, pyroglutamic aciduria, pyroglutamic acidemia, high anion gap metabolic acidosis, severe metabolic acidosis, chronic metabolic acidosis, hemolytic anemia, enzyme deficiency, glutathione, neutropenia, GSS, GSHS, inborn error of glutathione metabolism, ataxia, dysarthria, tremors, psychotic behavior
Differential Diagnoses & Workup: Glutathione Synthetase Deficiency