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At a glance

An extremely rare bronzed hyperpigmentation, endocrine anomalies, and mental retardation syndrome.

Incidence

Limited case descriptions. No further reports since 1981.

Diagnosis

Patterson and Watkins originally described a 10-month-old boy who they thought had leprechaunism. However, in view of the normal birth weight (rather than the usual severe intrauterine growth retardation in leprechaunism) and marked cutis gyrata of hands and feet, as well as a generalized skeletal disorder, they suggested the disorder is distinct from leprechaunism. Since then the syndrome is characterized by skeletal dysplasia, hyperpigmentation, cutis laxa, endocrine abnormalities, and mental impairment. The boy also had hyperadrenocorticism and diabetes mellitus. There is no insight as to the genetics or other etiology of this disorder.

Clinical aspects

Children are usually of normal birth weight. They may have generalized skeletal abnormalities, hyperadrenocorticism, and diabetes mellitus. In addition, they have cutis gyrata of the hands and feet. Case reports have noted bladder diverticula and marked enlargement of the adrenal glands, especially of the zona fasciculata.

Anesthetic considerations

Obtain full history and examination. Recent blood glucose and evaluation of sodium, potassium, and water balance in view of possible hyperadrenocorticism. May have undiagnosed hypertension.

Other condition to be considered

  • Donohue Syndrome: Rare condition characterized by severe insulin resistance, hyperinsulinemia, intrauterine and postnatal growth retardation, and dysmorphic (“gnome-like”) features.

References

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David  TJ, Webb  BW, Gordon  IRS: The Patterson syndrome, leprechaunism, and pseudoleprechaunism. J Med Genet 18:294, 1981.  [PubMed: 7277424]
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Patterson  JH, Watkins  WL: Leprechaunism in a male infant. J Pediat 60:730, 1962.  [PubMed: 14484402]

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