Diabetes Mellitus and Optic Atrophy: A Study of Wolfram Syndrome in the Lebanese Population

• Published in: The journal of clinical endocrinology and metabolism Vol. 89; no. 4; pp. 1656 - 1661
• Main Authors: Medlej, R., Wasson, J., Baz, P., Azar, S., Salti, I., Loiselet, J., Permutt, A., Halaby, G.
• Format: Journal Article
• Language: English
• Published: Bethesda, MD Endocrine Society 01-04-2004; Copyright by The Endocrine Society
• Subjects: Adolescent; Adult; Biological and medical sciences; Child; Diabetes Insipidus - complications; Diabetes Mellitus, Type 1 - complications; Endocrinopathies; Feeding. Feeding behavior; Female; Fundamental and applied biological sciences. Psychology; Hearing Loss, Sensorineural - complications; Heart Defects, Congenital - complications; Humans; Hypogonadism - complications; Lebanon; Male; Medical sciences; Membrane Proteins - genetics; Mutation; Nervous System Diseases - complications; Optic Atrophy - complications; Pituitary Diseases - complications; Vertebrates: anatomy and physiology, studies on body, several organs or systems; Vertebrates: endocrinology; Wolfram Syndrome - complications; Wolfram Syndrome - genetics; Lebanon; Endocrinopathy; Human; Nervous system diseases; Optic nerve atrophy; Nutrition; Diabetes mellitus; Metabolic diseases; Genetic disease; Eye disease; Cranial nerve disease; Wolfram syndrome; Population; Complex syndrome; Endocrinology
• ISSN: 0021-972X; 1945-7197
• DOI: 10.1210/jc.2002-030015

Wolfram syndrome (WFS) is a rare hereditary neurodegenerative disorder also known as DIDMOAD (diabetes insipidus, diabetes mellitus, optic atrophy, and deafness). WFS seems to be a heterogeneous disease that has not yet been fully characterized in terms of clinical features and pathophysiological mechanisms because the number of patients in most series was small.
In this study we describe 31 Lebanese WFS patients belonging to 17 families; this, to our knowledge, is the largest number of patients reported in one series so far. Criteria for diagnosis of WFS were the presence of insulin-dependent diabetes mellitus and optic atrophy unexplained by any other disease. Central diabetes insipidus was found in 87% of the patients, and sensorineural deafness confirmed by audiograms was present in 64.5%. Other less frequent features included neurological and psychiatric abnormalities, urodynamic abnormalities, limited joint motility, cardiovascular and gastrointestinal autonomic neuropathy, hypergonadotropic hypogonadism in males, and diabetic microvascular disease. New features, not reported in previous descriptions, such as heart malformations and anterior pituitary dysfunction, were recognized in some of the patients and participated in the morbidity and mortality of the disease. Genetic analysis revealed WFS1 gene mutations in three families (23.5%), whereas no abnormalities were detected in mitochondrial DNA.
In conclusion, WFS is a devastating disease for the patients and their families. More information about WFS will lead to a better understanding of this disease and hopefully to improvement in means of its prevention and treatment.