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. 2023 Sep 25:11:1272177.
doi: 10.3389/fped.2023.1272177. eCollection 2023.

The frequency of Duchenne muscular dystrophy/Becker muscular dystrophy and Pompe disease in children with isolated transaminase elevation: results from the observational VICTORIA study

Aydan Kansu  1 , Zarife Kuloglu  1 , Gökhan Tümgör  2 , Didem Gülcü Taşkın  3 , Buket Dalgıç  4 , Gönül Çaltepe  5 , Kaan Demirören  6 , Güzide Doğan  7 , Ceyda Tuna Kırsaçlıoğlu  1 , Duran Arslan  8 , İshak Abdurrahman Işık  9 , Hülya Demir  10 , Özlem Bekem  11 , Yasin Şahin  12 , Nevzat Aykut Bayrak  13 , Mukadder Ayşe Selimoğlu  14 , Sibel Yavuz  2 , İbrahim Ethem Taşkaya  5 , Derya Altay  8 ; VICTORIA Study Group
Collaborators, Affiliations

The frequency of Duchenne muscular dystrophy/Becker muscular dystrophy and Pompe disease in children with isolated transaminase elevation: results from the observational VICTORIA study

Aydan Kansu et al. Front Pediatr. .

Abstract

Introduction: Elevated transaminases and/or creatine phosphokinase can indicate underlying muscle disease. Therefore, this study aims to determine the frequency of Duchenne muscular dystrophy/Becker muscular dystrophy (DMD/BMD) in male children and Pompe disease (PD) in male and female children with isolated hypertransaminasemia.

Methods: This multi-center, prospective study enrolled patients aged 3-216 months with serum alanine transaminase (ALT) and/or aspartate transaminase (AST) levels >2× the upper limit of normal (ULN) for ≥3 months. Patients with a known history of liver or muscle disease or physical examination findings suggestive of liver disease were excluded. Patients were screened for creatinine phosphokinase (CPK) levels, and molecular genetic tests for DMD/BMD in male patients and enzyme analysis for PD in male and female patients with elevated CPK levels were performed. Genetic analyses confirmed PD. Demographic, clinical, and laboratory characteristics of the patients were analyzed.

Results: Overall, 589 patients [66.8% male, mean age of 63.4 months (standard deviation: 60.5)] were included. In total, 251 patients (188 male and 63 female) had CPK levels above the ULN. Of the patients assessed, 47% (85/182) of male patients were diagnosed with DMD/BMD and 1% (3/228) of male and female patients were diagnosed with PD. The median ALT, AST, and CPK levels were statistically significantly higher, and the questioned neurological symptoms and previously unnoticed examination findings were more common in DMD/BMD patients than those without DMD/BMD or PD (p < 0.001).

Discussion: Questioning neurological symptoms, conducting a complete physical examination, and testing for CPK levels in patients with isolated hypertransaminasemia will prevent costly and time-consuming investigations for liver diseases and will lead to the diagnosis of occult neuromuscular diseases.

Trial registration: Clinicaltrials.gov NCT04120168.

Keywords: Becker muscular dystrophy; Duchenne muscular dystrophy; Pompe disease; elevated transaminase; hypertransaminasemia; neuromuscular disease.

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Conflict of interest statement

The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.

Figures

Figure 1
Figure 1
Study disposition. ALT, alanine aminotransferase; AST, aspartate aminotransferase; CPK, creatinine phosphokinase; DMD, Duchenne muscular dystrophy; GAA, acid alpha glucosidase.
Figure 2
Figure 2
Evaluation of symptoms in groups 1 and 2.
See this image and copyright information in PMC

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