Shapiro syndrome | |
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Other names | Spontaneous periodic hypothermia |
Specialty | Neurology |
Shapiro syndrome is an extremely rare disorder consisting of paroxysmal hypothermia (due to hypothalamic dysfunction of thermoregulation), hyperhydrosis (sweating), and agenesis of the corpus callosum with onset typically in adulthood. The disease affects about 50-60 people worldwide. The duration and frequency of the episodes vary from person to person, with some episodes lasting hours to weeks and occurring from hours to years. Very little is known about the disease due to the small number of people affected. [1] Shapiro syndrome was first described in 1969 by Dr. William Shapiro and his colleagues. While Shapiro Syndrome typically affects adults, it can be prevalent in children as well. In this article, symptoms of Shapiro syndrome, the cause, pathophysiology, and diagnostics will be discussed. Alongside, treatment and management of the disease, prognosis, epidemiology, and research direction.
Common symptoms of Shapiro syndrome are hypothermia and Hyperhidrosis associated with agensis of the corpus callosum. [2] Individuals will present with a core body temperature that is below 35 degrees Celsius. Recurrent hypothermia can occur spontaneously at any time. Individuals will also present with profuse sweating, mainly in the upper body and face. Sweating episodes can last 1-2 hours. Other symptoms can include nausea, vomiting, chills, altered consciousness, and a feeling of weakness.
Some possible causes of Shapiro syndrome include hypothalamic dysfunction, neurotransmitter abnormalities, genetic variation, and endogenous high melatonin. However, the exact cause of Shapiro syndrome is unknown. Hypothalamus is a structure deep within the brain that connects the endocrine and nervous system together. The hypothalamus keeps the body in homeostasis. Dysfunction in the hypothalamus can lead to the body temperature fluctuations. The condition paroxysmal spontenous hypothermia with hyperhidrosis is mainly caused by serotonin dysfunction in the shivering mechanism of the anterior hypothalamus. [2] Melatonin is a hormone that is the secreted from the pineal gland. Melatonin is the regulator of the sleep-wake cycle and plays a role in thermoregulation. In studies for shapiro syndrome, it was shown that hypermelatonemia could be associated with the development of Shapiro Syndrome. However, only one case out of the 50-60 reported had hypermelatonemia. [2] There is a gap of knowledge regarding melatonin and how it impact Shapiro syndrome. Agenesis of the corpus callosum (ACC) is a rare, congenital brain defect that occurs when the corpus callosum does not develop normally. In majority of cases, ACC is caused by genetic factors. Genetic factors can include single gene mutations, multiple gene changes, and chromosomal abberation [3] There is a gap knowledge on how genetic factors impact the development of Shapiro syndrome.
Shapiro syndrome develops when there is hypothalamus dysfunction. The hypothalamus is the body's primary thermostat. A decrease in the "set point" temperature leads to the development of Shapiro syndrome. Agenesis of the corpus callosum can lead to the development of Shapiro syndrome.The corpus callosum ensures that the two brain hemispheres communicate with each other. When the corpus callosum is missing or not formed properly, it can lead to many dysfunctions throughout the body including hypothermia and hyperhidrosis. [4] Agenesis of the corpus callosum has been found in 40% of Shapiro syndrome cases reported. [4] It is theorized that Shapiro syndrome develops based on genetic factors. [1] However, the true mechanism of development of the disease and what causes it remains unknown.
If an individual is suspected of having Shapiro syndrome, a neurologist would be able to confirm the diagnosis. If an individual is experiencing spontaneous episodes of hypothermia along with hyperhidrosis, a neurologist could suspect Shapiro syndrome. In order to confirm the diagnosis of Shapiro syndrome, an MRI of the brain would be conducted. If the MRI confirms agenesis of the corpus callosum, then the individual could be diagnosed with Shapiro Syndrome. Getting diagnosed with Shapiro syndrome is quite difficult because there are no reliable imaging or laboratory test to diagnose it. [2] Since Shapiro syndrome is quite rare, individuals are often misdiagnosed with meningitis or autoimmune encephalitis.
There is limited treatment options for Shapiro syndrome. Studies have shown that some medications can help with management for ongoing symptoms. One of the major symptoms of Shapiro syndrome is the hypothermia. Clonidine, an alpha 2-adrenoreceptor agonist, is a medication commonly used for hypertension. However, clonidine has been found to aid in hypothalamic regulation and is the most effective medication for symptom management in Shapiro syndrome . [5] Medications that can mimic neurotransmitter activity that affect the hypothalamus can be used to help with regulating hypothalamic dysfunction as well. Medications such as gabapentin and venlafaxine may be used to mimic neurotransmitter activity.
Shapiro syndrome cases have been reported in individuals from 8 months to 80 years old. Studies have shown that Shapiro syndrome development might be associated with genetic factors, however data is limited on the impact of the genetics on Shapiro syndrome. Hypothermia episodes in individuals with Shapiro syndrome can be expected to reoccur throughout their lifetimes. However, medications that regulate the hypothalamus, such as clonidine, can help with alleviating the hypothermic episodes. [5] Prognosis data is limited for Shapiro syndrome since less than 60 cases have been reported worldwide.
Due to Shapiro syndrome being extremely rare and its underdiagnosis, its prevalence is not well defined. Through studies, it has been shown that genetic background can have an influence on the development of Shapiro syndrome. Limited research has explored how environmental influence might interact with genetic predispositions to trigger or exacerbate symptoms. The disease can manifest in any age, gender, and ethnicity. However, most cases that were reported were present in adulthood.
Studies have been conducted to determine what leads to the development of Shapiro syndrome. Some studies have linked the development of the disorder to hypothalamic dysfunction, neurotransmitter abornmalities, and agensis of the corpus callosum. [2] In 2022, a case study reported that hypoglycemia can be a potential manifestation of Shapiro syndrome. [6] However, this was only found in one the patients worldwide diagnosed with Shapiro syndrome. There is no current drug development for Shapiro syndrome, but some medications have been able to help with alleviating symptoms. There are no confirmed current/upcoming clinical trials for this syndrome.
Joubert syndrome is a rare autosomal recessive genetic disorder that affects the cerebellum, an area of the brain that controls balance and coordination.
Colpocephaly is a cephalic disorder involving the disproportionate enlargement of the occipital horns of the lateral ventricles and is usually diagnosed early after birth due to seizures. It is a nonspecific finding and is associated with multiple neurological syndromes, including agenesis of the corpus callosum, Chiari malformation, lissencephaly, and microcephaly. Although the exact cause of colpocephaly is not known yet, it is commonly believed to occur as a result of neuronal migration disorders during early brain development, intrauterine disturbances, perinatal injuries, and other central nervous system disorders. Individuals with colpocephaly have various degrees of motor disabilities, visual defects, spasticity, and moderate to severe intellectual disability. No specific treatment for colpocephaly exists, but patients may undergo certain treatments to improve their motor function or intellectual disability.
Holoprosencephaly (HPE) is a cephalic disorder in which the prosencephalon fails to develop into two hemispheres, typically occurring between the 18th and 28th day of gestation. Normally, the forebrain is formed and the face begins to develop in the fifth and sixth weeks of human pregnancy. The condition also occurs in other species.
Developmental disorders comprise a group of psychiatric conditions originating in childhood that involve serious impairment in different areas. There are several ways of using this term. The most narrow concept is used in the category "Specific Disorders of Psychological Development" in the ICD-10. These disorders comprise developmental language disorder, learning disorders, developmental coordination disorders, and autism spectrum disorders (ASD). In broader definitions, attention deficit hyperactivity disorder (ADHD) is included, and the term used is neurodevelopmental disorders. Yet others include antisocial behavior and schizophrenia that begins in childhood and continues through life. However, these two latter conditions are not as stable as the other developmental disorders, and there is not the same evidence of a shared genetic liability.
Aicardi syndrome is a rare genetic malformation syndrome characterized by the partial or complete absence of a key structure in the brain called the corpus callosum, the presence of retinal lacunes, and epileptic seizures in the form of infantile spasms. Other malformations of the brain and skeleton may also occur. The syndrome includes intellectual disability that is usually severe or moderate. So far, the syndrome has only been diagnosed in girls and in boys with two X chromosomes.
Optic nerve hypoplasia (ONH) is a medical condition arising from the underdevelopment (hypoplasia) of the optic nerve(s). This condition is the most common congenital optic nerve anomaly. The optic disc appears abnormally small, because not all the optic nerve axons have developed properly. It is often associated with endocrinopathies, developmental delay, and brain malformations. The optic nerve, which is responsible for transmitting visual signals from the retina to the brain, has approximately 1.2 million nerve fibers in the average person. In those diagnosed with ONH, however, there are noticeably fewer nerves.
Kallmann syndrome (KS) is a genetic disorder that prevents a person from starting or fully completing puberty. Kallmann syndrome is a form of a group of conditions termed hypogonadotropic hypogonadism. To distinguish it from other forms of hypogonadotropic hypogonadism, Kallmann syndrome has the additional symptom of a total lack of sense of smell (anosmia) or a reduced sense of smell. If left untreated, people will have poorly defined secondary sexual characteristics, show signs of hypogonadism, almost invariably are infertile and are at increased risk of developing osteoporosis. A range of other physical symptoms affecting the face, hands and skeletal system can also occur.
Agenesis of the corpus callosum (ACC) is a rare birth defect in which there is a complete or partial absence of the corpus callosum. It occurs when the development of the corpus callosum, the band of white matter connecting the two hemispheres in the brain, in the embryo is disrupted. The result of this is that the fibers that would otherwise form the corpus callosum are instead longitudinally oriented along the ipsilateral ventricular wall and form structures called Probst bundles.
Kleine–Levin syndrome (KLS) is a rare neurological disorder characterized by persistent episodic hypersomnia accompanied by cognitive and behavioral changes. These changes may include disinhibition, sometimes manifested through hypersexuality, hyperphagia or emotional lability, and other symptoms, such as derealization. Patients generally experience recurrent episodes of the condition for more than a decade, which may return at a later age. Individual episodes generally last more than a week, sometimes lasting for months. The condition greatly affects the personal, professional, and social lives of those with KLS. The severity of symptoms and the course of the syndrome vary between those with KLS. Patients commonly have about 20 episodes over about a decade. Several months may elapse between episodes.
Young–Simpson syndrome (YSS) is a rare congenital disorder with symptoms including hypothyroidism, heart defects, facial dysmorphism, cryptorchidism in males, hypotonia, intellectual disability, and postnatal growth retardation.
Vici syndrome, also called immunodeficiency with cleft lip/palate, cataract, hypopigmentation and absent corpus callosum, is a rare autosomal recessive congenital disorder characterized by albinism, agenesis of the corpus callosum, cataracts, cardiomyopathy, severe psychomotor retardation, seizures, immunodeficiency and recurrent severe infections. To date, about 50 cases have been reported.
Acrocallosal syndrome is an extremely rare autosomal recessive syndrome characterized by corpus callosum agenesis, polydactyly, multiple dysmorphic features, motor and intellectual disabilities, and other symptoms. The syndrome was first described by Albert Schinzel in 1979. Mutations in KIF7 are causative for ACLS, and mutations in GLI3 are associated with a similar syndrome.
Marden–Walker syndrome (MWS) is a rare autosomal recessive congenital disorder. It is characterized by blepharophimosis, microcephaly, micrognathia, multiple joint contractures, arachnodactyly, camptodactyly, kyphoscoliosis and delayed motor development and is often associated with cystic dysplastic kidneys, dextrocardia, Dandy–Walker malformation and agenesis of corpus callosum.
FG syndrome (FGS) is a rare genetic syndrome caused by one or more recessive genes located on the X chromosome and causing physical anomalies and developmental delays. FG syndrome was named after the first letters of the surnames of the first patients noted with the disease. First reported by American geneticists John M. Opitz and Elisabeth G. Kaveggia in 1974, its major clinical features include intellectual disability, hyperactivity, hypotonia, and a characteristic facial appearance including macrocephaly.
Rapid-onset obesity with hypothalamic dysregulation, hypoventilation, and autonomic dysregulation (ROHHAD) is a rare condition whose etiology is currently unknown. ROHHAD mainly affects the endocrine system and autonomic nervous system, but patients can exhibit a variety of signs. Patients present with both alveolar hypoventilation along with hypothalamic dysfunction, which distinguishes ROHHAD from congenital central hypoventilation syndrome (CCHS). ROHHAD is a rare disease, with only 100 reported cases worldwide thus far.
Lujan–Fryns syndrome (LFS) is an X-linked genetic disorder that causes mild to moderate intellectual disability and features described as Marfanoid habitus, referring to a group of physical characteristics similar to those found in Marfan syndrome. These features include a tall, thin stature and long, slender limbs. LFS is also associated with psychopathology and behavioral abnormalities, and it exhibits a number of malformations affecting the brain and heart. The disorder is inherited in an X-linked dominant manner, and is attributed to a missense mutation in the MED12 gene. There is currently no treatment or therapy for the underlying MED12 malfunction, and the exact cause of the disorder remains unclear.
Adipsia, also known as hypodipsia, is a symptom of inappropriately decreased or absent feelings of thirst. It involves an increased osmolality or concentration of solute in the urine, which stimulates secretion of antidiuretic hormone (ADH) from the hypothalamus to the kidneys. This causes the person to retain water and ultimately become unable to feel thirst. Due to its rarity, the disorder has not been the subject of many research studies.
Andermann syndrome, also known as agenesis of corpus callosum with neuronopathy (ACCPN), Charlevoix disease and KCC3 axonopathy among other names, is a very rare neurodegenerative genetic disorder that damages the nerves used to control muscles and related to sensation and is often associated with agenesis of the corpus callosum.
Proud syndrome is a very rare genetic disorder which is characterized by severe intellectual disabilities, corpus callosum agenesis, epilepsy, and spasticity. It is a type of syndromic X-linked intellectual disability.
X-linked complicated corpus callosum dysgenesis is a genetic disorder characterized by dysplasia, hypoplasia or agenesis of the corpus callosum alongside variable intellectual disability and spastic paraplegia. Only 13 cases have been described in medical literature. Transmission is X-linked recessive. It is the mildest subtype of L1 syndrome.