eMedicine Specialties > Pediatrics: Genetics and Metabolic Disease > Metabolic Diseases

Glutathione Synthetase Deficiency: Differential Diagnoses & Workup

Author: Darius J Adams, MD, Assistant Professor, Department of Pediatrics, Section of Genetics and Metabolism, Albany Medical Center
Coauthor(s): Melissa P Wasserstein, MD, Associate Professor, Departments of Genetics and Genomic Sciences and Pediatrics, Mount Sinai School of Medicine
Contributor Information and Disclosures

Updated: Oct 14, 2009

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

References

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  2. Manning NJ, Davies NP, Olpin SE, et al. Prenatal diagnosis of glutathione synthase deficiency. Prenat Diagn. Jun 1994;14(6):475-8. [Medline].

  3. Atkuri KR, Mantovani JJ, Herzenberg LA, Herzenberg LA. N-Acetylcysteine--a safe antidote for cysteine/glutathione deficiency. Curr Opin Pharmacol. Aug 2007;7(4):355-9. [Medline].

  4. Boxer LA, Oliver JM, Spielberg SP, et al. Protection of granulocytes by vitamin E in glutathione synthetase deficiency. N Engl J Med. Oct 25 1979;301(17):901-5. [Medline].

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  9. Jellum E, Kluge T, Borresen HC, et al. Pyroglutamic aciduria--a new inborn error of metabolism. Scand J Clin Lab Invest. Dec 1970;26(4):327-35. [Medline].

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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

Contributor Information and Disclosures

Author

Darius J Adams, MD, Assistant Professor, Department of Pediatrics, Section of Genetics and Metabolism, Albany Medical Center
Darius J Adams, MD is a member of the following medical societies: American Academy of Pediatrics
Disclosure: Nothing to disclose.

Coauthor(s)

Melissa P Wasserstein, MD, Associate Professor, Departments of Genetics and Genomic Sciences and Pediatrics, Mount Sinai School of Medicine
Melissa P Wasserstein, MD is a member of the following medical societies: American Society of Human Genetics
Disclosure: Nothing to disclose.

Medical Editor

Robert D Steiner, MD, Professor, Departments of Pediatrics and Molecular and Medical Genetics, Vice Chair for Research, Department of Pediatrics, Oregon Health & Science University; Director and Consulting Staff, Metabolic Bone Disease Clinic, Shriner's Hospital and Doernbecher Children's Hospital; Co-Director: Pediatric and Child Health Research, Oregon Clinical and Translational Research Institute (CTSA).
Robert D Steiner, MD is a member of the following medical societies: American Academy of Pediatrics, American Association for the Advancement of Science, American College of Medical Genetics, American Society of Human Genetics, Oregon Medical Association, Society for Inherited Metabolic Disorders, Society for Pediatric Research, Society for the Study of Inborn Errors of Metabolism, and Western Society for Pediatric Research
Disclosure: Genzyme Honoraria Speaking and teaching; Genzyme Grant/research funds Other; Shire Honoraria Speaking and teaching; Actelion Honoraria Speaking and teaching; Biomarin Honoraria Speaking and teaching; Biomarin Consulting fee Consulting; Amicus  Consulting

Pharmacy Editor

Mary L Windle, PharmD, Adjunct Assistant Professor, University of Nebraska Medical Center College of Pharmacy, Pharmacy Editor, eMedicine
Disclosure: Pfizer Inc Stock Investment from financial planner; Avanir Pharma Stock Investment from financial planner ; WebMD Salary and stock Employment and investment from financial planner

Managing Editor

Leonard G Feld, MD, PhD, MMM, FAAP, Sara H Bissell and Howard C Bissell Endowed Chair in Pediatrics, Chief Medical Officer, Levine Children's Hospital, Carolinas Medical Center
Leonard G Feld, MD, PhD, MMM, FAAP is a member of the following medical societies: American Academy of Pediatrics, American College of Physician Executives, American Society of Nephrology, American Society of Pediatric Nephrology, International Society of Nephrology, and Juvenile Diabetes Foundation International
Disclosure: Nothing to disclose.

CME Editor

Paul D Petry, DO, FACOP, FAAP, Consulting Staff, Freeman Pediatric Care, Freeman Health System
Paul D Petry, DO, FACOP, FAAP is a member of the following medical societies: American Academy of Osteopathy, American Academy of Pediatrics, American College of Osteopathic Pediatricians, and American Osteopathic Association
Disclosure: Nothing to disclose.

Chief Editor

Bruce Buehler, MD, Professor, Department of Pediatrics, Pathology and Microbiology, Executive Director, Hattie B Munroe Center for Human Genetics, University of Nebraska Medical Center
Bruce Buehler, MD is a member of the following medical societies: American Academy for Cerebral Palsy and Developmental Medicine, American Academy of Pediatrics, American Association on Mental Retardation, American College of Medical Genetics, American College of Physician Executives, American Medical Association, and Nebraska Medical Association
Disclosure: Nothing to disclose.

 
 
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