Exp Clin Endocrinol Diabetes 2025; 133(02): 83-91
DOI: 10.1055/a-2444-4320
Article

Endocrine Complications in Hepatic Glycogen Storage Diseases: A Long-term Perspective

Ja Hye Kim
1   Department of Pediatrics, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea (the Republic of) (Ringgold ID: RIN65526)
,
Yena Lee
2   Department of Pediatrics, Hallym University Sacred Heart Hospital, Hallym University College of Medicine, Anyang, Korea (the Republic of)
,
Soojin Hwang
1   Department of Pediatrics, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea (the Republic of) (Ringgold ID: RIN65526)
,
Dohyung Kim
1   Department of Pediatrics, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea (the Republic of) (Ringgold ID: RIN65526)
,
Beom Hee Lee
1   Department of Pediatrics, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea (the Republic of) (Ringgold ID: RIN65526)
3   Medical Genetics Center, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea (the Republic of) (Ringgold ID: RIN368760)
,
Gu-Hwan Kim
3   Medical Genetics Center, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea (the Republic of) (Ringgold ID: RIN368760)
,
Han-Wook Yoo
1   Department of Pediatrics, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea (the Republic of) (Ringgold ID: RIN65526)
,
1   Department of Pediatrics, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea (the Republic of) (Ringgold ID: RIN65526)
› Author Affiliations
Supported by: National Research Foundation of Korea (NRF) NRF2021R1F1A104593011

Abstract

Objective

Patients with a hepatic type of glycogen storage diseases (GSDs) can manifest endocrine features such as hypoglycemia, dyslipidemia, or osteoporosis. This study aimed to investigate the long-term endocrine consequences in patients with hepatic GSDs.

Methods

This study included 64 patients from 52 families with hepatic GSDs including GSD type Ia (41 patients from 37 families), Ib (3 unrelated), III (8 from 6 families), IV (1 patient), and IX (11 from 5 families). All patients were genetically confirmed. Clinical and endocrine findings were retrospectively analyzed.

Results

The median age at diagnosis and current age were 2.4 years (range, 0.1−42.4 years) and 17.6 years (range, 1.0−47.8 years), respectively. The mean height SDS at diagnosis was –3.5±1.4, and short stature was observed in 35.6% of patients. Patients diagnosed after the age of 3.4 years exhibited a high risk of short stature (OR=36.1; P-value<0.001). Among 33 patients who reached the final height, 23 (69.7%) showed delayed puberty. Hypertriglyceridemia was observed in 46 patients (71.9%), whereas 25 patients (39%) had elevated low-density lipoprotein cholesterol levels during the follow-up period. Among 24 patients who underwent dual-energy X-ray absorptiometry, 22 showed a low bone mineral density Z-score of –3.0±1.3 at the L-spine.

Conclusions

This study described the long-term endocrine consequences in patients with hepatic GSDs. Pediatric endocrinologists should be aware of the presenting features and long-term endocrine sequelae of GSDs to provide proper management and decrease its morbidities.

Supplementary Material



Publication History

Received: 09 May 2024

Accepted after revision: 17 October 2024

Accepted Manuscript online:
17 October 2024

Article published online:
13 January 2025

© 2025. Thieme. All rights reserved.

Georg Thieme Verlag KG
Oswald-Hesse-Straße 50, 70469 Stuttgart, Germany

 
  • References

  • 1 Massese M, Tagliaferri F, Dionisi-Vici C. et al. Glycogen storage diseases with liver involvement: A literature review of GSD type 0, IV, VI, IX and XI. Orphanet J Rare Dis 2022; 17: 241
  • 2 Rich LR, Harris W, Brown AM. The role of brain glycogen in supporting physiological function. Front Neurosci 2019; 13: 1176
  • 3 Beyzaei Z, Geramizadeh B, Karimzadeh S. Diagnosis of hepatic glycogen storage disease patients with overlapping clinical symptoms by massively parallel sequencing: A systematic review of literature. Orphanet J Rare Dis 2020; 15: 286
  • 4 Bhattacharya K. Investigation and management of the hepatic glycogen storage diseases. Transl Pediatr 2015; 4: 240-248
  • 5 Kido J, Nakamura K, Matsumoto S. et al. Current status of hepatic glycogen storage disease in Japan: Clinical manifestations, treatments and long-term outcomes. J Hum Genet 2013; 58: 285-292
  • 6 Rake J, Visser G, Labrune P. et al. Glycogen storage disease type I: Diagnosis, management, clinical course and outcome. Results of the European Study on Glycogen Storage Disease Type I (ESGSD I). Eur J Pediatr 2002; 161: S20-S34
  • 7 Liang Y, Du C, Wei H. et al. Genotypic and clinical analysis of 49 Chinese children with hepatic glycogen storage diseases. Mol Genet Genomic Med 2020; 8: e1444
  • 8 Melis D, Rossi A, Pivonello R. et al. Reduced bone mineral density in glycogen storage disease type III: Evidence for a possible connection between metabolic imbalance and bone homeostasis. Bone 2016; 86: 79-85
  • 9 Melis D, Carbone F, Minopoli G. et al. Cutting edge: Increased autoimmunity risk in glycogen storage disease type 1b is associated with a reduced engagement of glycolysis in T cells and an impaired regulatory T cell function. J Immun 2017; 198: 3803-3808
  • 10 Kishnani PS, Austin SL, Abdenur JE. et al. Diagnosis and management of glycogen storage disease type I: A practice guideline of the American College of Medical Genetics and Genomics. Genet Med 2014; 16: e1-e29
  • 11 Kim YM, Choi JH, Lee BH. et al. Predominance of the c.648G > T G6PC gene mutation and late complications in Korean patients with glycogen storage disease type Ia. Orphanet J Rare Dis 2020; 15: 45
  • 12 Wong EM, Lehman A, Acott P. et al. Hypogonadotropic hypogonadism in males with glycogen storage disease type 1. JIMD Reports 2017; 36: 79-84
  • 13 Bernier AV, Sentner CP, Correia CE. et al. Hyperlipidemia in glycogen storage disease type III: effect of age and metabolic control. J Inherit Metab Dis 2008; 31: 729-732
  • 14 Sechi A, Deroma L, Lapolla A. et al. Fertility and pregnancy in women affected by glycogen storage disease type I, results of a multicenter Italian study. J Inherit Metab Dis 2013; 36: 83-89
  • 15 Kim JH, Yun S, Hwang SS. et al. The 2017 Korean national growth charts for children and adolescents: Development, improvement, and prospects. Korean J Pediatr 2018; 61: 135-149
  • 16 Bozzola M, Bozzola E, Montalbano C. et al. Delayed puberty versus hypogonadism: A challenge for the pediatrician. Ann Pediatr Endocrinol Metab 2018; 23: 57-61
  • 17 Hyun SE, Lee BC, Suh BK. et al. Reference values for serum levels of insulin-like growth factor-I and insulin-like growth factor binding protein-3 in Korean children and adolescents. Clin Biochem 2012; 45: 16-21
  • 18 Lim JS, Kim EY, Kim JH. et al. 2017 Clinical practice guidelines for dyslipidemia of Korean children and adolescents. Clin Exp Pediatr 2020; 63: 454-462
  • 19 Grundy SM, Stone NJ, Bailey AL. et al. 2018 AHA/ACC/AACVPR/AAPA/ABC/ACPM/ADA/AGS/APhA/ASPC/NLA/PCNA Guideline on the management of blood cholesterol: A report of the American College of Cardiology/American Heart Association task force on clinical practice guidelines. Circulation 2019; 139: e1082-e1143
  • 20 Valsaraj R, Singh AK, Gangopadhyay KK. et al. Management of asymptomatic hyperuricemia: Integrated Diabetes & Endocrine Academy (IDEA) consensus statement. Diabetes Metab Syndr 2020; 14: 93-100
  • 21 Wilcox WD. Abnormal serum uric acid levels in children. J Pediatr 1996; 128: 731-741
  • 22 Lim JS, Hwang JS, Lee JA. et al. Bone mineral density according to age, bone age, and pubertal stages in Korean children and adolescents. J Clin Densitom 2010; 13: 68-76
  • 23 Kang MJ, Hong HS, Chung SJ. et al. Body composition and bone density reference data for Korean children, adolescents, and young adults according to age and sex: Results of the 2009–2010 Korean National Health and Nutrition Examination Survey (KNHANES). J Bone Metab 2016; 34: 429-439
  • 24 Bishop N, Arundel P, Clark E. et al. Fracture prediction and the definition of osteoporosis in children and adolescents: The ISCD 2013 Pediatric Official Positions. J Clin Densitom 2014; 17: 275-280
  • 25 Haj-Ahmad LM, Mahmoud MM, Sweis NWG. et al. Serum IGF-1 to IGFBP-3 molar ratio: A promising diagnostic tool for growth hormone deficiency in children. J Clin Endocrinol Metab 2023; 108: 986-994
  • 26 Brooks ED, Little D, Arumugam R. et al. Pathogenesis of growth failure and partial reversal with gene therapy in murine and canine Glycogen Storage Disease type Ia. Mol Genet Metab 2013; 109: 161-170
  • 27 Melis D, Pivonello R, Parenti G. et al. The growth hormone-insulin-like growth factor axis in glycogen storage disease type 1: Evidence of different growth patterns and insulin-like growth factor levels in patients with glycogen storage disease type 1a and 1b. J Pediatr 2010; 156: 663-670
  • 28 Mundy HR, Hindmarsh PC, Matthews DR. et al. The regulation of growth in glycogen storage disease type 1. Clin Endocrinol 2003; 58: 332-339
  • 29 Hribal ML, Procopio T, Petta S. et al. Insulin-like growth factor-I, inflammatory proteins, and fibrosis in subjects with nonalcoholic fatty liver disease. J Clin Endocrinol Metab 2013; 98: E304-E308
  • 30 Menon RK, Sperling MA. Insulin as a growth factor. Endocrinol Metab Clin North Am 1996; 25: 633-647
  • 31 Lee PI, Patel A, Hindmarsh PC. et al. Polycystic ovaries and glucose tolerance in hepatic glycogen storage disease. Pediatr Res 1993; 33: S14
  • 32 Dambska M, Labrador EB, Kuo CL. et al. Prevention of complications in glycogen storage disease type Ia with optimization of metabolic control. Pediatr Diabetes 2017; 18: 327-331
  • 33 Simons PIHG ValkenburgO, Telgenkamp I. et al. Serum sex hormone-binding globulin levels are reduced and inversely associated with intrahepatic lipid content and saturated fatty acid fraction in adult patients with glycogen storage disease type 1a. J Endocrinol Invest 2022; 45: 1227-1234
  • 34 Lee PJ, Patel A, Hindmarsh PC. et al. The prevalence of polycystic ovaries in the hepatic glycogen storage diseases: Its association with hyperinsulinism. Clin Endocrinol (Oxf) 1995; 42: 601-606
  • 35 Ellingwood SS, Cheng A. Biochemical and clinical aspects of glycogen storage diseases. J Endocrinol 2018; 238: R131-R141
  • 36 Park MS, Youn JC, Kim EJ. et al. Efficacy and safety of fenofibrate-statin combination therapy in patients with inadequately controlled triglyceride levels despite previous statin monotherapy: A multicenter, randomized, double-blind, phase IV study. Clin Ther 2021; 43: 1735-1747
  • 37 Davidson MH, Armani A, McKenney JM. et al. Safety considerations with fibrate therapy. Am J Card 2007; 99: S3-S18
  • 38 Ballantyne CM, Houri J, Notarbartolo A. et al. Effect of ezetimibe coadministered with atorvastatin in 628 patients with primary hypercholesterolemia. Circulation 2003; 107: 2409-2415
  • 39 Hammersley D, Signy M. Ezetimibe: An update on its clinical usefulness in specific patient groups. Ther Adv Chronic Dis 2017; 8: 4-11
  • 40 Bays HE, Neff D, Tomassini JE. et al. Ezetimibe: cholesterol lowering and beyond. Expert Rev Cardiovasc Ther 2008; 6: 447-470
  • 41 Krieger NS, Sessler NE, Bushinsky DA. Acidosis inhibits osteoblastic and stimulates osteoclastic activity in vitro. Am J Physiol 1992; 262: F442-F448
  • 42 Minarich LA, Kirpich A, Fiske LM. et al. Bone mineral density in glycogen storage disease type Ia and Ib. Genet Med 2013; 14: 737-741
  • 43 Jacoby JT, Bento Dos Santos B, Nalin T. et al. Bone mineral density in patients with hepatic glycogen storage diseases. Nutrients 2021; 13: 2987
  • 44 Sullivan MA, Forbes JM. Glucose and glycogen in the diabetic kidney: Heroes or villains?. EBioMedicine 2019; 47: 590-597
  • 45 Melis D, Cozzolino M, Minopoli G. et al. Progression of renal damage in glycogen storage disease type I is associated to hyperlipidemia: A multicenter prospective Italian study. J Pediatr 2015; 166: 1079-1082
  • 46 Melis D, Parenti G, Gatti R. et al. Efficacy of ACE-inhibitor therapy on renal disease in glycogen storage disease type 1: A multicentre retrospective study. Clin Endocrinol 2005; 63: 19-25
  • 47 Lee P. Glycogen storage disease type I: Pathophysiology of liver adenomas. Eur J Pediatr 2002; 161: S46-S49
  • 48 Beegle RD, Brown LM, Weinstein DA. Regression of hepatocellular adenomas with strict dietary therapy in patients with glycogen storage disease type I. JIMD Reports 2015; 18: 23-32
  • 49 Dambska M, Labrador EB, Kuo CL. et al. Prevention of complications in glycogen storage disease type Ia with optimization of metabolic control. Pediatr Diabetes 2017; 18: 327-331
  • 50 Veiga-da-Cunha M, Chevalier N, Stephenne X. et al. Failure to eliminate a phosphorylated glucose analog leads to neutropenia in patients with G6PT and G6PC3 deficiency. Proc Natl Acad Sci USA 2019; 116: 1241-1250
  • 51 Tazawa S, Yamato T, Fujikura H. et al. SLC5A9/SGLT4, a new Na+-dependent glucose transporter, is an essential transporter for mannose, 1,5-anhydro-D-glucitol, and fructose. Life Sci 2005; 76: 1039-1050
  • 52 Maiorana A, Tagliaferri F, Dionisi-Vici C. Current understanding on pathogenesis and effective treatment of glycogen storage disease type Ib with empagliflozin: New insights coming from diabetes for its potential implications in other metabolic disorders. Front Endocrinol 2023; 14: 1145111