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Case Reports
. 2023 Jul 31;26(1):63-68.
doi: 10.2478/bjmg-2023-0008. eCollection 2023 Jul.

Sensorineural Hearing Loss in a Child with Succinic Semialdehyde Dehydrogenase Deficiency

M Parezanović  1 , N Ilić  2 , S Ostojić  3   4 , G Stevanović  5 , J Ječmenica  6 , A Maver  7 , A Sarajlija  2   4   8
Affiliations
Case Reports

Sensorineural Hearing Loss in a Child with Succinic Semialdehyde Dehydrogenase Deficiency

M Parezanović et al. Balkan J Med Genet. .

Abstract

Succinic semialdehyde dehydrogenase (SSADH) deficiency is a rare autosomal-recessive disorder of gamma-aminobutyric acid (GABA) metabolism, resulting in accumulation of GABA and gamma-hydroxybutyric acid (GHB) in physiological fluids. Approximately 450 patients have been diagnosed worldwide with this inherited neurotransmitter disorder. We report on a five-year-old male patient, homozygous for the pathogenic variant (NM_170740:c.1265G>A) in ALDH5A1 presenting with an unexpected association of typical SSADH deficiency manifestations with bilateral sensorineural hearing loss (SNHL). Brainstem evoked response audiometry (BERA) testing showed mid-frequency sensorineural hearing damage that suggested a hereditary component to SNHL. Whole exome sequencing (WES) failed to discern other genetic causes of deafness. Several variants of uncertain significance (VUS) detected in genes known for their role in hearing physiology could not be verified as the cause for the SNHL. It is known that central auditory processing depends on a delicate balance between excitatory and inhibitory neurotransmission, and GABA is known to play a significant role in this process. Additionally, excessive concentrations of accumulated GABA and GBH are known to cause a down-regulation of GABA receptors, which could have an adverse influence on hearing function. However, these mechanisms are very speculative in context of SNHL in a patient with inherited disorder of GABA metabolism. Injury of the globi pallidi, one of hallmarks of SSADH deficiency, could also be a contributory factor to SNHL, as was suspected in some other inborn errors in metabolism. We hope that this case will contribute to the understanding of phenotypic complexity of SSADH deficiency.

Keywords: ALDH5A1; cookie-bite audiogram; gamma-aminobutyric acid; sensorineural hearing loss; succinic semialdehyde dehydrogenase deficiency.

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Figures

Figure 1.
Figure 1.
Brain MRI scan at the age of 15 months in a boy with SSADH deficiency revealing incomplete myelination and signal hyperintensity in globi pallidi
Figure 2.
Figure 2.
Audiogram approximation showing “cookie bite” type of symmetric sensorineural hearing impairment
See this image and copyright information in PMC

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