Donohue syndrome

Facial features indicative of Donohue syndrome include protuberant and low-set ears, flaring nostrils, unusually large mouth, thick lips, and widely spaced eyes. Physical features include stunted growth (including during gestation), lack of subcutaneous adipose tissue, muscle atrophy, hirsutism (excessive body hair growth), and dysplasia (nail malformation). Additionally, a condition known as acanthosis nigricans is present in affected individuals, involving patches of skin that darken and thicken to gain a velvet-like appearance. Gender specific features also include enlarged clitoris and breasts, as well as ovarian cysts in affected females, and enlarged penis in affected males. Very early death (or spontaneous abortion) is typical, although affected individuals sometimes live longer than a decade. It is caused by a less severe mutation of the same gene. ==Cause==

Donohue syndrome is an autosomal recessive genetic disorder. The mutations responsible for the disorder are found on the short arm chromosome 19 (19p13.2) within the coding sequence of the INSR gene (insulin receptor) causing the production of inactive receptor molecules. There are several mutations that can be responsible for the disease, as any mutation that severely impairs the functionality of the insulin receptor will have similar effects. The INSR gene spans over one hundred and twenty thousand base pairs, which contain twenty-two exons coding for a protein that consists of 1382 amino acids. Some of the introns may or may not be spliced out depending on the kind of cell. Known mutations to the gene which can cause Donohue syndrome include a nonsense mutation that resulted in early termination of the protein, an addition or deletion mutation that resulted in a frame shift, a single missense mutation A heterozygous individual (i.e. one who is a carrier for the disease, having only one normal allele for the insulin receptor) will not be affected. Two heterozygous parents have, in theory, a one in four chance of having a child with the disease, and two thirds of their unaffected children will be carriers. However, because spontaneous abortion (miscarriage) often results when the fetus has the disease, in actuality the proportion of children born alive with Donohue syndrome will be lower than 25%. It is possible to do a genetic test to identify carriers, but because it is so rare, this is not usually done unless there is reason to suspect that the individual being tested is a carrier, for instance having an affected sibling or cousin. As expected for a genetic disease that can be caused by many different mutations, it is not limited to a specific ethnic group, and has been seen in people of various ethnicities. ==Pathophysiology==

The cause of the disease is the lack of a fully functional insulin receptor, which has a profound effect during fetal development and thereafter. In one case, it was found (by culturing pancreatic cells) that the receptor produced by the mutant allele is only about 15% as effective as the normal receptor. ==Diagnosis==

There are a few ways to diagnose Donohue syndrome. Due to the nature of the disorder, Donohue syndrome can be diagnosed either genetically, symptomatically, or both. Because Donohue syndrome is a genetic disorder, genetic testing can be performed to diagnose the disease. These genetic tests include diagnostic testing, carrier testing, predictive and pre-symptomatic testing, as well as forensic testing. Prenatally, amniocentesis can be performed to determine if the child will have Donohue syndrome. Additionally, the disorder can be diagnosed through laboratory testing to measure blood insulin levels and defective insulin receptors. ==Treatment==

While there currently is no cure for Donohue syndrome, treatments for those with the disease are tailored specifically to the symptoms present in each individual. It is often that a team of medical professionals will come together to treat a patient with this condition in their specific realm of practice such as pediatrics, endocrinology, and dermatology. Treatment will often address specific dysfunctions in the patient, such as skin defects, hormonal imbalances, and normal progression of child growth. ==Prognosis==

The prognosis is quite dire, with early death usual. In fact, most patients die in their first year except in milder forms of the disease, but few are known to have lived longer. The variation is unsurprising given the diversity of mutations causing the disease. ==Epidemiology==

Donohue syndrome is an extremely rare disorder that occurs in one of every million births worldwide. Several dozen cases have been reported in the medical community, and in the reported cases of the disorder, it has been found that the females are twice as likely to have the disorder as men. ==Eponym==

Donohue syndrome was first identified in 1948 by Canadian pathologist William L. Donohue (1906–1985). The name leprechaunism has been largely abandoned because of the perception of the name by some parents of patients as insulting. ==Future research==

The National Institute of Diabetes and Digestive Kidney Diseases sponsored a phase 2 clinical study in 2001 that would look at the effectiveness of leptin to treat severe insulin resistance. In the study, two children with severe insulin resistance of ages 11 and 13 with known a known defect in the insulin receptor. The goal for the study was to see if leptin could overcome insulin receptor defects by initiating molecules in the insulin-signal cascade. While no outcomes have yet been reported to date, the direction in which this clinical trial is heading is promising. ==See also==