{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,25]],"date-time":"2026-09-25T17:51:46Z","timestamp":1790358706447,"version":"4.1.0"},"reference-count":23,"publisher":"Wiley","issue":"7","license":[{"start":{"date-parts":[[2019,5,1]],"date-time":"2019-05-01T00:00:00Z","timestamp":1556668800000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["American J of Med Genetics Pt A"],"published-print":{"date-parts":[[2019,7]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:p>Albright hereditary osteodystrophy (AHO) is a complex disorder defined by the presence of a short adult stature relative to the height of an unaffected parent and brachydactyly type E, as well as a stocky build, round face, and ectopic calcifications. AHO and pseudohypoparathyroidism (PHP) have been used interchangeably in the past. The term PHP describes end\u2010organ resistance to parathyroid hormone (PTH), occurring with or without the physical features of AHO. Conversely, pseudopseudohypoparathyroidism (PPHP) describes individuals with AHO features in the absence of PTH resistance. PHP and PPHP are etiologically linked and caused by genetic and\/or epigenetic alterations in the guanine nucleotide\u2010binding protein alpha\u2010stimulating (G<jats:sub>s<\/jats:sub>\u03b1) locus (<jats:italic>GNAS<\/jats:italic>) in chromosome 20q13. Another less\u2010recognized group of skeletal dysplasias, termed acrodysostosis, partially overlap with skeletal, endocrine, and neurodevelopmental features of AHO\/PHP and can be overlooked in clinical practice, causing confusion in the literature. Acrodysostosis is caused by defects in two genes, <jats:italic>PRKAR1A<\/jats:italic> and <jats:italic>PDE4D<\/jats:italic>, both encoding important components of the G<jats:sub>s<\/jats:sub>\u03b1\u2010cyclic adenosine monophosphate\u2010protein kinase A signaling pathway. We describe the clinical course and genotype of two adult patients with overlapping AHO features who harbored novel pathogenic variants in <jats:italic>GNAS<\/jats:italic> (c.2273C\u2009&gt;\u2009G, p.Pro758Arg, NM_080425.2) and <jats:italic>PRKAR1A<\/jats:italic> (c.803C\u2009&gt;\u2009T, p.Ala268Val, NM_002734.4), respectively. We highlight the value of expert radiological opinion and molecular testing in establishing correct diagnoses and discuss phenotypic features of our patients, including the first description of subcutaneous ossification and spina bifida occulta in <jats:italic>PRKAR1A<\/jats:italic>\u2010related acrodysostosis, in the context of the novel inactivating PTH\/PTH related peptide signaling disorder classification system.<\/jats:p>","DOI":"10.1002\/ajmg.a.61163","type":"journal-article","created":{"date-parts":[[2019,5,1]],"date-time":"2019-05-01T07:49:42Z","timestamp":1556696982000},"page":"1330-1337","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":5,"title":["Identification of novel pathogenic variants and features in patients with pseudohypoparathyroidism and acrodysostosis, subtypes of the newly classified inactivating PTH\/PTHrP signaling disorders"],"prefix":"10.1002","volume":"179","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-2941-2052","authenticated-orcid":false,"given":"Adam","family":"Truelove","sequence":"first","affiliation":[{"name":"School of Clinical Medicine University of Cambridge  Cambridge UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-5340-5867","authenticated-orcid":false,"given":"Akhilesh","family":"Mulay","sequence":"additional","affiliation":[{"name":"School of Clinical Medicine University of Cambridge  Cambridge UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Matina","family":"Prapa","sequence":"additional","affiliation":[{"name":"East Anglian Medical Genetics Service Cambridge University Hospitals NHS Foundation Trust, Cambridge Biomedical Campus  Cambridge UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ruth T.","family":"Casey","sequence":"additional","affiliation":[{"name":"Wolfson Diabetes and Endocrine Clinic, Department of Endocrinology Cambridge University Hospitals NHS Foundation Trust, Cambridge Biomedical Campus  Cambridge UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Amanda I.","family":"Adler","sequence":"additional","affiliation":[{"name":"Wolfson Diabetes and Endocrine Clinic, Department of Endocrinology Cambridge University Hospitals NHS Foundation Trust, Cambridge Biomedical Campus  Cambridge UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Amaka C.","family":"Offiah","sequence":"additional","affiliation":[{"name":"Paediatric Musculoskeletal Imaging, Academic Unit of Child Health, University of Sheffield, Sheffield Children's NHS Foundation Trust  Sheffield UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kenneth E. S.","family":"Poole","sequence":"additional","affiliation":[{"name":"Department of Rheumatology Cambridge University Hospitals NHS Foundation Trust, Cambridge Biomedical Campus  Cambridge UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jamie","family":"Trotman","sequence":"additional","affiliation":[{"name":"East Anglian Medical Genetics Service Cambridge University Hospitals NHS Foundation Trust, Cambridge Biomedical Campus  Cambridge UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Namir","family":"Al Hasso","sequence":"additional","affiliation":[{"name":"East Anglian Medical Genetics Service Cambridge University Hospitals NHS Foundation Trust, Cambridge Biomedical Campus  Cambridge UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Soo\u2010Mi","family":"Park","sequence":"additional","affiliation":[{"name":"East Anglian Medical Genetics Service Cambridge University Hospitals NHS Foundation Trust, Cambridge Biomedical Campus  Cambridge UK"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2019,5]]},"reference":[{"issue":"4","key":"e_1_2_8_2_1","doi-asserted-by":"crossref","first-page":"525","DOI":"10.1046\/j.1365-2265.1997.1100922.x-i1","article-title":"GNAS1 mutational analysis in pseudohypoparathyroidism","volume":"49","author":"Ahmed S. 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