Transienter neonataler Diabetes und Hypomethylierungssyndrome

Transient neonatal diabetes (TNDM) is manifested before the age of 6 weeks and typically resolves within 18 months. Main clinical features include intrauterine growth retardation, hyperglycemia and dehydration with absent ketoacidosis. Causes of TNDM are heterogeneous but 70% are due to a chromosomal aberration in the region 6q24 which contains the imprinted genes PLAGL1/ZAC and HYMAI. Paternal uniparental disomy 6 (upd(6)pat) or paternal duplications of the imprinted region as well as imprinting defects of the maternal allele all result in an overexpression of the paternally expressed gene PLAGL1. Imprinting defects in 6q24 can occur as isolated events or can affect more than one locus (hypomethylation syndrome). Hypomethylation at multiple loci has so far been observed in patients with TNDM, Silver-Russell syndrome (SRS) and Beckwith-Wiedemann syndrome (BWS).The risk of recurrence depends on the underlying cause of TNDM. Chromosomal aberrations in the parents affecting chromosome 6 increase the risk for UPD or duplication of the imprinted locus in 6q24. Nevertheless, UPD and duplication 6q24 are mostly de novo occurrences.