eMedicine Specialties > Pediatrics: Genetics and Metabolic Disease > Metabolic Diseases
Mucopolysaccharidosis Type III: Differential Diagnoses & Workup
Updated: May 14, 2009
- Overview
- Differential Diagnoses & Workup
- Treatment & Medication
- Follow-up
- Multimedia
Differential Diagnoses
| Mucopolysaccharidosis Type I H/S | Mucopolysaccharidosis Type VI |
| Mucopolysaccharidosis Type IH | Mucopolysaccharidosis Type VII |
| Mucopolysaccharidosis Type II | |
| Mucopolysaccharidosis Type IS | |
| Mucopolysaccharidosis Type IV |
Workup
Laboratory Studies
- Biochemical differentiation of the different forms within mucopolysaccharidosis type III (MPS III) is possible, and diagnosis is confirmed by specific enzymatic assay.
- Enzymatic activity for all types of Sanfilippo syndrome may be assayed in cultured skin fibroblasts and in peripheral blood leukocytes. If mucopolysaccharidosis III is suspected, enzymatic cell analysis is the recommended test.
- In all forms of mucopolysaccharidosis III, urinary excretion of heparan sulfate is increased.
- To measure the concentration of GAGs in the urine, a total quantitative test and a fractionation test should be performed using electrophoresis or chromatography.
- A concentrated urine specimen is best to avoid a false-negative result due to a dilute urine. Ideally, a first-morning urine specimen should be analyzed. This is especially important for the diagnosis of mucopolysaccharidosis III because of the low urinary GAG levels and smaller heparan fragments seen in this syndrome.
- Urinary GAG levels are higher in newborns and infants than in older children. Interpretation of results must include age-specific controls and fractionation to properly identify pathologic GAG levels (ie, heparan sulfate) from normal GAG levels present in the urine (ie, chondroitins).
- Prenatal diagnosis can also be performed by measuring for the specific enzymatic activity in cultured amniocytes or chorionic villi cells.8
Imaging Studies
- Neuroimaging to diagnosis hydrocephalus and to look for changes in brain structure
- Echocardiography to assess for asymmetric septal hypertrophy and valvular disease
- Imaging of the abdomen, such as ultrasonography or CT scanning, to evaluate for organomegaly
- Radiographic skeletal survey to identify cases of dysostosis multiplex (the spectrum of skeletal changes seen in patients with mucopolysaccharidosis disorders)
Other Tests
- Electroencephalography (EEG) to diagnose seizure activity
- Audiologic evaluation to identify patients with hearing loss
- Polysomnography for those patients who demonstrate clinical signs of obstructive sleep apnea
More on Mucopolysaccharidosis Type III |
| Overview: Mucopolysaccharidosis Type III |
Differential Diagnoses & Workup: Mucopolysaccharidosis Type III |
| Treatment & Medication: Mucopolysaccharidosis Type III |
| Follow-up: Mucopolysaccharidosis Type III |
| Multimedia: Mucopolysaccharidosis Type III |
| References |
| Further Reading |
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References
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Vitry S, Ausseil J, Hocquemiller M, Bigou S, Dos Santos Coura R, Heard JM. Enhanced degradation of synaptophysin by the proteasome in mucopolysaccharidosis type IIIB. Mol Cell Neurosci. May 2009;41(1):8-18. [Medline].
Ohmi K, Kudo LC, Ryazantsev S, Zhao HZ, Karsten SL, Neufeld EF. Sanfilippo syndrome type B, a lysosomal storage disease, is also a tauopathy. Proc Natl Acad Sci U S A. May 5 2009;[Medline].
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Poorthuis BJ, Wevers RA, Kleijer WJ, et al. The frequency of lysosomal storage diseases in The Netherlands. Hum Genet. Jul-Aug 1999;105(1-2):151-6. [Medline].
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Kleijer WJ, Karpova EA, Geilen GC, et al. Prenatal diagnosis of Sanfilippo A syndrome: experience in 35 pregnancies at risk and the use of a new fluorogenic substrate for the heparin sulphamidase assay. Prenat Diagn. Sep 1996;16(9):829-35. [Medline].
Man TT, Tsai PS, Rau RH, et al. Children with mucopolysaccharidoses--three cases report. Acta Anaesthesiol Sin. Jun 1999;37(2):93-6. [Medline].
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Jablonski S. Jablonski's Dictionary of Syndromes and Eponymic Diseases. 2nd ed. Melbourne, FL: Krieger Publishing Co; 1991.
Jones KL. Storage disorders. In: Smith's Recognizable Patterns of Human Malformation. 5th ed. Philadelphia, Pennsylvania: WB Saunders Company; 1997:464-5.
Kakkis E, Wraith E. Clinical features and diagnosis of the mucopolysaccharidoses. UpToDate. Available at http://www.utdol.com. Accessed November 6, 2007.
Lindor NM, Hoffman A, O'Brien JF, Hanson NP, Thompson JN. Sanfilippo syndrome type A in two adult sibs. Am J Med Genet. Nov 15 1994;53(3):241-4. [Medline].
Mucopolysaccharidosis III (MPS III) Disease (Sanfilippo Syndrome). Genzyme Corporation. Available at www.lysosomallearning.com/healthcare/about/lsd_hc_abt_mps3. Accessed 04/01/2009.
Mucopolysaccharidosis Type III. National Organization for Rare Disorders, Inc. Available at http://www.rarediseases.org. Accessed 03/31/2009.
National Center for Biotechnology Information. Mucopolysaccharidosis Type IIIA, IIIB, IIIC, and IIID. Online Mendelian Inheritance in Man. Available at http://www.ncbi.nlm.nih.gov. Accessed April 1, 2009.
National Institutes of Health. Mucopolysaccharidosis Type III (Sanfilippo Syndrome). GeneTests. Available at http://www.geneclinics.org. Accessed 03/31/2009.
Scriver CR, Beaudet AL, Sly WL, et al. The Metabolic Basis of Inherited Disease. 7th ed. New York, NY: McGraw-Hill; 1995.
Spitz JL. Genodermatoses. In: A Full Color Clinical Guide to Genetic Skin Disorders. Baltimore, Md: Williams and Wilkins; 1995.
Sutton VR. Presenting features of inborn errors of metabolism. UpToDate. Available at www.utdol.com. Accessed November 6, 2007.
Therapeutic Approaches. Alliance Sanfilippo. Available at http://www.alliancesanfilippo.com/us/approaches.php. Accessed 04/01/2009.
Thoene JG, ed. Physician's Guide to Rare Diseases. 2nd ed. Montvale, NJ: Dowden Publishing Co; 1995.
Toone JR, Applegarth DA. Carrier detection in Sanfilippo A syndrome. Clin Genet. Jun 1988;33(6):401-3. [Medline].
van de Kamp JJ, Niermeijer MF, von Figura K, Giesberts MA. Genetic heterogeneity and clinical variability in the Sanfilippo syndrome (types A, B, and C). Clin Genet. Aug 1981;20(2):152-60. [Medline].
Further Reading
The American Academy of Pediatrics have established the following relevant clinical guidelines: Hearing assessment in infants and children: recommendations beyond neonatal screening.
Keywords
mucopolysaccharidosis, MPS, MPS III, mucopolysaccharide storage disease type III, Sanfilippo syndrome, Sanfilippo disease, MPS IIIA, Sanfilippo A, MPS IIIB, Sanfilippo B, MPS IIIC, Sanfilippo C, MPS IIID, Sanfilippo D, lysosomal storage disorders, heparan sulfate, clear corneas, dysostosis multiplex, mucopolysaccharides, glycosaminoglycans, GAGs, lysosomal storage disorder, cardiovascular functional impairments, hepatosplenomegaly, dysostosis multiplex, mental retardation, Hurler syndrome, Hunter syndrome, Sanfilippo syndrome, organomegaly, diarrhea, respiratory compromise, airway obstruction, upper respiratory tract infections, synophrys, clear corneas, splenomegaly, inguinal hernia, umbilical hernia, enzyme replacement therapy, ERT, treatment, diagnosis


Differential Diagnoses & Workup: Mucopolysaccharidosis Type III