Adiposogenital dystrophy differential diagnosis: Difference between revisions

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==Overview==
==Overview==
Adiposogenital dystrophy must be differentiated from other diseases that cause [[polyphagia]], [[obesity]], and a [[delayed puberty]] such as [[Prader-Willi syndrome]], [[Bardet-Biedl syndrome]], [[Borjeson syndrome]] and [[Klinefelter's syndrome]].
Adiposogenital dystrophy must be differentiated from other diseases that cause [[polyphagia]], [[obesity]], and a [[delayed puberty]] such as [[Prader-Willi syndrome]], [[Bardet-Biedl syndrome]], [[Klinefelter's syndrome]] and [[Borjeson syndrome]].


==Differentiating Adiposogenital Dystrophy from Other Diseases==
==Differentiating Adiposogenital Dystrophy from Other Diseases==
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* [[Congenital heart disease]]  
* [[Congenital heart disease]]  
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* It is a rare autosomal recessive genetic disorder. <ref name="pmid27385962">{{cite journal| author=Suspitsin EN, Imyanitov EN| title=Bardet-Biedl Syndrome. | journal=Mol Syndromol | year= 2016 | volume= 7 | issue= 2 | pages= 62-71 | pmid=27385962 | doi=10.1159/000445491 | pmc=4906432 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=27385962  }} </ref>. Males and females are affected equally
* It is a rare autosomal recessive genetic disorder. <ref name="pmid27385962">{{cite journal| author=Suspitsin EN, Imyanitov EN| title=Bardet-Biedl Syndrome. | journal=Mol Syndromol | year= 2016 | volume= 7 | issue= 2 | pages= 62-71 | pmid=27385962 | doi=10.1159/000445491 | pmc=4906432 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=27385962  }} </ref>. Males and females are affected equally<ref>Bardet-biedl syndrome. Bissonnette B, & Luginbuehl I, & Marciniak B, & Dalens B.J.(Eds.), (2006). Syndromes: Rapid Recognition and Perioperative Implications. McGraw Hill. https://accessanesthesiology.mhmedical.com/content.aspx?bookid=852&sectionid=49517256</ref>.
* Increased in the Arab population of Kuwait at a prevalence of approximately 1:13,500<ref>Bardet-biedl syndrome. Bissonnette B, & Luginbuehl I, & Marciniak B, & Dalens B.J.(Eds.), (2006). Syndromes: Rapid Recognition and Perioperative Implications. McGraw Hill. https://accessanesthesiology.mhmedical.com/content.aspx?bookid=852&sectionid=49517256</ref>
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* [[Hair pull test]] followed by [[trichogram]] reveals numerous clubbed-shaped hairs; telogen count must exceed 20% for diagnosis.  
* [[Bardet–Biedl syndrome]] mutations can be diagnosed by genomic sequencing which would show the coding regions of the genes implicated in causing the disease<ref>Bardet-biedl syndrome. Bissonnette B, & Luginbuehl I, & Marciniak B, & Dalens B.J.(Eds.), (2006). Syndromes: Rapid Recognition and Perioperative Implications. McGraw Hill. https://accessanesthesiology.mhmedical.com/content.aspx?bookid=852&sectionid=49517256</ref>.  
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* It could be an acute self-limiting form triggered by stressors such as crash diets, childbirth, febrile illness, or psychological stress.
* Treatment is symptomatic with focus on managing co=morbidities especially diabetes, hypertension, and obesity <ref name="pmid29487844">{{cite journal| author=Forsythe E, Kenny J, Bacchelli C, Beales PL| title=Managing Bardet-Biedl Syndrome-Now and in the Future. | journal=Front Pediatr | year= 2018 | volume= 6 | issue=  | pages= 23 | pmid=29487844 | doi=10.3389/fped.2018.00023 | pmc=5816783 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=29487844  }} </ref>.
* It may be chronic and present in association with female pattern hair loss.
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| style="padding: 5px 5px; background: #DCDCDC; font-weight: bold; text-align:center;" |[[Borjeson Syndrome]] <ref>Otberg N, Shapiro J 2012. Hair growth disorders. In Fitzpatrick’s dermatology in general medicine, 8th ed (ed. Goldsmith LA, et al.). McGraw-Hill, New York [Google Scholar]</ref> <ref name="pmid24591533">{{cite journal| author=Qi J, Garza LA| title=An overview of alopecias. | journal=Cold Spring Harb Perspect Med | year= 2014 | volume= 4 | issue= 3 | pages=  | pmid=24591533 | doi=10.1101/cshperspect.a013615 | pmc=3935391 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=24591533  }} </ref> <ref name="pmid15113284">{{cite journal| author=Callender VD, McMichael AJ, Cohen GF| title=Medical and surgical therapies for alopecias in black women. | journal=Dermatol Ther | year= 2004 | volume= 17 | issue= 2 | pages= 164-76 | pmid=15113284 | doi=10.1111/j.1396-0296.2004.04017.x | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=15113284  }} </ref> <ref name="pmid29265342">{{cite journal| author=Aguado Lobo M, Jiménez-Reyes J| title=Traction alopecia. | journal=Int J Dermatol | year= 2018 | volume= 57 | issue= 2 | pages= 231-232 | pmid=29265342 | doi=10.1111/ijd.13846 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi? dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=29265342  }} </ref> <ref name="pmid15113284">{{cite journal| author=Callender VD, McMichael AJ, Cohen GF| title=Medical and surgical therapies for alopecias in black women. | journal=Dermatol Ther | year= 2004 | volume= 17 | issue= 2 | pages= 164-76 | pmid=15113284 | doi=10.1111/j.1396-0296.2004.04017.x | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=15113284  }} </ref>
| style="padding: 5px 5px; background: #DCDCDC; font-weight: bold; text-align:center;" |[[Klinefelter Syndrome]]  
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* Hair loss at regions of the scalp exposed to tension on hair follicles for a prolonged period of time in people who make tight hairstyles.
* Visual impairment
* [[Polydactyly]], [[brachydactyly]] or [[syndactyly]]
* [[Obesity]]
* Renal and genital abnormalities
* Neurological and mental deficits such as learning difficulties developmental delay, speech deficit, [[ataxia]]
* [[Diabetes mellitus]]
* [[Congenital heart disease]]
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* [[Traction alopecia]] is more commonly seen among black populations with females being affected more often than males at a rate of about 31,000-32,000 per 100,000 women compared to about 2,300 per 100,000 men.
* It is a rare autosomal recessive genetic disorder. <ref name="pmid27385962">{{cite journal| author=Suspitsin EN, Imyanitov EN| title=Bardet-Biedl Syndrome. | journal=Mol Syndromol | year= 2016 | volume= 7 | issue= 2 | pages= 62-71 | pmid=27385962 | doi=10.1159/000445491 | pmc=4906432 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=27385962  }} </ref>. Males and females are affected equally<ref>Bardet-biedl syndrome. Bissonnette B, & Luginbuehl I, & Marciniak B, & Dalens B.J.(Eds.), (2006). Syndromes: Rapid Recognition and Perioperative Implications. McGraw Hill. https://accessanesthesiology.mhmedical.com/content.aspx?bookid=852&sectionid=49517256</ref>.
* [[Traction alopecia]] is seen in about 18,000 per 100,000 girls between the ages of 5.4 to 14.3 years based on a study of African-American girls.  
* Increased in the Arab population of Kuwait at a prevalence of approximately 1:13,500<ref>Bardet-biedl syndrome. Bissonnette B, & Luginbuehl I, & Marciniak B, & Dalens B.J.(Eds.), (2006). Syndromes: Rapid Recognition and Perioperative Implications. McGraw Hill. https://accessanesthesiology.mhmedical.com/content.aspx?bookid=852&sectionid=49517256</ref>
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* Mostly a clinical diagnosis based on hair loss at areas of the scalp where tension on the hair is highest.
* [[Bardet–Biedl syndrome]] mutations can be diagnosed by genomic sequencing which would show the coding regions of the genes implicated in causing the disease<ref>Bardet-biedl syndrome. Bissonnette B, & Luginbuehl I, & Marciniak B, & Dalens B.J.(Eds.), (2006). Syndromes: Rapid Recognition and Perioperative Implications. McGraw Hill. https://accessanesthesiology.mhmedical.com/content.aspx?bookid=852&sectionid=49517256</ref>.  
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* Early detection and switching to more loose hairstyles may reverse the condition, however, with prolonged tension on the scalp destruction of the hair follicles will occur, causing the condition to become irreversible.  
* Treatment is symptomatic with focus on managing co=morbidities especially diabetes, hypertension, and obesity <ref name="pmid29487844">{{cite journal| author=Forsythe E, Kenny J, Bacchelli C, Beales PL| title=Managing Bardet-Biedl Syndrome-Now and in the Future. | journal=Front Pediatr | year= 2018 | volume= 6 | issue=  | pages= 23 | pmid=29487844 | doi=10.3389/fped.2018.00023 | pmc=5816783 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=29487844  }} </ref>.
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| style="padding: 5px 5px; background: #DCDCDC; font-weight: bold; text-align:center;" |[[Klinefelter Syndrome]] <ref name="pmid30725594">{{cite journal| author=| title=StatPearls | journal= | year= 2020 | volume=  | issue=  | pages=  | pmid=30725594 | doi= | pmc= | url= }} </ref> <ref name="pmid12431130">{{cite journal| author=Pomeranz AJ, Sabnis SS| title=Tinea capitis: epidemiology, diagnosis and management strategies. | journal=Paediatr Drugs | year= 2002 | volume= 4 | issue= 12 | pages= 779-83 | pmid=12431130 | doi=10.2165/00128072-200204120-00002 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=12431130  }} </ref> <ref name="pmid19502982">{{cite journal| author=Kos L, Conlon J| title=An update on alopecia areata. | journal=Curr Opin Pediatr | year= 2009 | volume= 21 | issue= 4 | pages= 475-80 | pmid=19502982 | doi=10.1097/MOP.0b013e32832db986 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=19502982  }} </ref> <ref>Sperling LC, Cowper SE, Knopp EA. An atlas of hair pathology with clinical correlations. 2. Informa Healthcare; 2014. [Google Scholar]</ref> <ref name="pmid22972730">{{cite journal| author=Ponka D, Baddar F| title=Wood lamp examination. | journal=Can Fam Physician | year= 2012 | volume= 58 | issue= 9 | pages= 976 | pmid=22972730 | doi= | pmc=3440273 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=22972730  }} </ref> <ref name="pmid26455063">{{cite journal| author=Vidal CI| title=Overview of Alopecia: A Dermatopathologist's Perspective. | journal=Mo Med | year= 2015 | volume= 112 | issue= 4 | pages= 308-12 | pmid=26455063 | doi= | pmc=6170065 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=26455063  }} </ref>
| style="padding: 5px 5px; background: #DCDCDC; font-weight: bold; text-align:center;" |[[Borjeson Syndrome]]  
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* Presents in diverse ways such as ordinary scaling without any obvious hair loss which is considered to be a seborrheic form, a crusted or [[pustular]] form that may be localized or diffuse, a ‘black dot’ type that is characterized by tiny black dots within regions of [[alopecia]], an inflammatory mass called [[kerion]], and a round, bald, scaly patch where the follicular ostia are filled with keratinous debris.
* Visual impairment
* A unique feature of [[tinea capita]]s is the presence of post-auricular and cervical [[lymphadenopathy]].
* [[Polydactyly]], [[brachydactyly]] or [[syndactyly]]
* [[Obesity]]
* Renal and genital abnormalities
* Neurological and mental deficits such as learning difficulties developmental delay, speech deficit, [[ataxia]]
* [[Diabetes mellitus]]
* [[Congenital heart disease]]  
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* It is more common in the pediatric population.  
* It is a rare autosomal recessive genetic disorder. <ref name="pmid27385962">{{cite journal| author=Suspitsin EN, Imyanitov EN| title=Bardet-Biedl Syndrome. | journal=Mol Syndromol | year= 2016 | volume= 7 | issue= 2 | pages= 62-71 | pmid=27385962 | doi=10.1159/000445491 | pmc=4906432 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=27385962  }} </ref>. Males and females are affected equally<ref>Bardet-biedl syndrome. Bissonnette B, & Luginbuehl I, & Marciniak B, & Dalens B.J.(Eds.), (2006). Syndromes: Rapid Recognition and Perioperative Implications. McGraw Hill. https://accessanesthesiology.mhmedical.com/content.aspx?bookid=852&sectionid=49517256</ref>.
* Increased in the Arab population of Kuwait at a prevalence of approximately 1:13,500<ref>Bardet-biedl syndrome. Bissonnette B, & Luginbuehl I, & Marciniak B, & Dalens B.J.(Eds.), (2006). Syndromes: Rapid Recognition and Perioperative Implications. McGraw Hill. https://accessanesthesiology.mhmedical.com/content.aspx?bookid=852&sectionid=49517256</ref>
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* [[Potassium hydroxide]] preparation can be added to skin scrapings of affected areas in order to diagnose the condition. <ref name="pmid24591533">{{cite journal| author=Qi J, Garza LA| title=An overview of alopecias. | journal=Cold Spring Harb Perspect Med | year= 2014 | volume= 4 | issue= 3 | pages=  | pmid=24591533 | doi=10.1101/cshperspect.a013615 | pmc=3935391 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=24591533  }} </ref>
* [[Bardet–Biedl syndrome]] mutations can be diagnosed by genomic sequencing which would show the coding regions of the genes implicated in causing the disease<ref>Bardet-biedl syndrome. Bissonnette B, & Luginbuehl I, & Marciniak B, & Dalens B.J.(Eds.), (2006). Syndromes: Rapid Recognition and Perioperative Implications. McGraw Hill. https://accessanesthesiology.mhmedical.com/content.aspx?bookid=852&sectionid=49517256</ref>.  
* Wood's light can also be used in diagnosis as majority of [[Microsporum]] spp will appear bluish-green, occasionally dull yellow (Microsporum gypseum) and dull blue ([[Trichophyton]] schoenleinii).
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* In the U.S., under 5% of cases will show [[fluorescence]].
* Treatment is symptomatic with focus on managing co=morbidities especially diabetes, hypertension, and obesity <ref name="pmid29487844">{{cite journal| author=Forsythe E, Kenny J, Bacchelli C, Beales PL| title=Managing Bardet-Biedl Syndrome-Now and in the Future. | journal=Front Pediatr | year= 2018 | volume= 6 | issue=  | pages= 23 | pmid=29487844 | doi=10.3389/fped.2018.00023 | pmc=5816783 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=29487844 }} </ref>.
* Possible complications of [[tinea capita]]s are [[kerion]], an [[abscess]] in the scalp, or [[favus]], another inflammatory form in which there is honeycomb destruction of the hair shaft.  Both are severe forms of the disease and can cause permanent scarring.
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1] Ogechukwu Hannah Nnabude, MD

Overview

Adiposogenital dystrophy must be differentiated from other diseases that cause polyphagia, obesity, and a delayed puberty such as Prader-Willi syndrome, Bardet-Biedl syndrome, Klinefelter's syndrome and Borjeson syndrome.

Differentiating Adiposogenital Dystrophy from Other Diseases
Disease/Condition Clinical presentation Demographics/History Diagnosis Treatment
Adiposogenital Dystrophy

Partial destruction of hypothalamic nuclei resulting in hormonal dysfunction with obesity, growth retardation, and hypogonadism. Deep brain stimulation may also cause symptoms similar to adiposogenital syndrome [1] [2].

Prevalence is unknown, but it is more common in males [3] [4]

Diagnosis is based on visual field tests, hormonal assays, CT, MRI, autoimmune assays [5]

  • Diet and exercise
  • Radiation
  • Surgery, thermoablation, radiosurgery
  • Hormone replacement[6]
Prader-Willi Syndrome

It presents with hyperphagia, hypogonadism, truncal obesity, intellectual disability, growth delay, hypotonia, almond-shaped palpebral fissures, narrow frontal diameter, thin upper vermilion with downturned corners of the mouth behavioral problems such as anxiety and temper outbursts [7]

Prader Willi Syndrome has a prevalence of 1 in every 1 in 20000 to 1 in 30000 births[8]. Females and males can be equally affected, and there is no difference between races and ethnicities[9]. Most cases of Prader Willi syndrome are sporadic, but familial cases can present when the paternal genes carry a microdeletion in the imprinting center inherited from his mother[10].

  • Hormone replacement[11]
  • Cognitive and behavioral therapy[12]
Bardet-Biedl Syndrome
  • It is a rare autosomal recessive genetic disorder. [13]. Males and females are affected equally[14].
  • Increased in the Arab population of Kuwait at a prevalence of approximately 1:13,500[15]
  • Bardet–Biedl syndrome mutations can be diagnosed by genomic sequencing which would show the coding regions of the genes implicated in causing the disease[16].
  • Treatment is symptomatic with focus on managing co=morbidities especially diabetes, hypertension, and obesity [17].
Klinefelter Syndrome
  • It is a rare autosomal recessive genetic disorder. [13]. Males and females are affected equally[18].
  • Increased in the Arab population of Kuwait at a prevalence of approximately 1:13,500[19]
  • Bardet–Biedl syndrome mutations can be diagnosed by genomic sequencing which would show the coding regions of the genes implicated in causing the disease[20].
  • Treatment is symptomatic with focus on managing co=morbidities especially diabetes, hypertension, and obesity [17].
Borjeson Syndrome
  • It is a rare autosomal recessive genetic disorder. [13]. Males and females are affected equally[21].
  • Increased in the Arab population of Kuwait at a prevalence of approximately 1:13,500[22]
  • Bardet–Biedl syndrome mutations can be diagnosed by genomic sequencing which would show the coding regions of the genes implicated in causing the disease[23].
  • Treatment is symptomatic with focus on managing co=morbidities especially diabetes, hypertension, and obesity [17].


References

  1. ↑ Tuite PJ, Maxwell RE, Ikramuddin S, Kotz CM, Kotzd CM, Billington CJ; et al. (2005). "Weight and body mass index in Parkinson's disease patients after deep brain stimulation surgery". Parkinsonism Relat Disord. 11 (4): 247–52. doi:10.1016/j.parkreldis.2005.01.006. PMID 15878586.
  2. ↑ Romito LM, Scerrati M, Contarino MF, Iacoangeli M, Bentivoglio AR, Albanese A (2003) Bilateral high frequency subthalamic stimulation in Parkinson’s disease: long-term neurological follow-up. J Neurosurg Sci 47:119–128 Medline
  3. ↑ Babinski-fröhlich syndrome. Bissonnette B, & Luginbuehl I, & Marciniak B, & Dalens B.J.(Eds.), (2006). Syndromes: Rapid Recognition and Perioperative Implications. McGraw Hill. https://accessanesthesiology.mhmedical.com/content.aspx?bookid=852&sectionid=49517244
  4. ↑ Burfeind KG, Yadav V, Marks DL. Hypothalamic Dysfunction and Multiple Sclerosis: Implications for Fatigue and Weight Dysregulation. Curr Neurol Neurosci Rep. 2016 Nov;16(11):98.
  5. ↑ Sanchez Jimenez JG, De Jesus O. Hypothalamic Dysfunction. [Updated 2021 Aug 30]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2021 Jan-
  6. ↑ Sanchez Jimenez JG, De Jesus O. Hypothalamic Dysfunction. [Updated 2021 Aug 30]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2021 Jan-
  7. ↑ Fermin Gutierrez MA, Mendez MD. Prader-Willi Syndrome. [Updated 2021 Aug 11]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2021 Jan-.
  8. ↑ Pacoricona Alfaro DL, Lemoine P, Ehlinger V, Molinas C, Diene G, Valette M; et al. (2019). "Causes of death in Prader-Willi syndrome: lessons from 11 years' experience of a national reference center". Orphanet J Rare Dis. 14 (1): 238. doi:10.1186/s13023-019-1214-2. PMC 6829836 Check |pmc= value (help). PMID 31684997.
  9. ↑ Bohonowych J, Miller J, McCandless SE, Strong TV (2019). "The Global Prader-Willi Syndrome Registry: Development, Launch, and Early Demographics". Genes (Basel). 10 (9). doi:10.3390/genes10090713. PMC 6770999 Check |pmc= value (help). PMID 31540108.
  10. ↑ 10.0 10.1 Butler MG, Manzardo AM, Forster JL (2016). "Prader-Willi Syndrome: Clinical Genetics and Diagnostic Aspects with Treatment Approaches". Curr Pediatr Rev. 12 (2): 136–66. doi:10.2174/1573396312666151123115250. PMC 6742515 Check |pmc= value (help). PMID 26592417.
  11. ↑ Cassidy SB, Schwartz S, Miller JL, Driscoll DJ (2012) Prader-Willi syndrome. Genet Med 14 (1):10-26. DOI:10.1038/gim.0b013e31822bead0 PMID: 22237428
  12. ↑ Passone CBG, Pasqualucci PL, Franco RR, Ito SS, Mattar LBF, Koiffmann CP; et al. (2018). "PRADER-WILLI SYNDROME: WHAT IS THE GENERAL PEDIATRICIAN SUPPOSED TO DO? - A REVIEW". Rev Paul Pediatr. 36 (3): 345–352. doi:10.1590/1984-0462/;2018;36;3;00003. PMC 6202899. PMID 30365815.
  13. ↑ 13.0 13.1 13.2 Suspitsin EN, Imyanitov EN (2016). "Bardet-Biedl Syndrome". Mol Syndromol. 7 (2): 62–71. doi:10.1159/000445491. PMC 4906432. PMID 27385962.
  14. ↑ Bardet-biedl syndrome. Bissonnette B, & Luginbuehl I, & Marciniak B, & Dalens B.J.(Eds.), (2006). Syndromes: Rapid Recognition and Perioperative Implications. McGraw Hill. https://accessanesthesiology.mhmedical.com/content.aspx?bookid=852&sectionid=49517256
  15. ↑ Bardet-biedl syndrome. Bissonnette B, & Luginbuehl I, & Marciniak B, & Dalens B.J.(Eds.), (2006). Syndromes: Rapid Recognition and Perioperative Implications. McGraw Hill. https://accessanesthesiology.mhmedical.com/content.aspx?bookid=852&sectionid=49517256
  16. ↑ Bardet-biedl syndrome. Bissonnette B, & Luginbuehl I, & Marciniak B, & Dalens B.J.(Eds.), (2006). Syndromes: Rapid Recognition and Perioperative Implications. McGraw Hill. https://accessanesthesiology.mhmedical.com/content.aspx?bookid=852&sectionid=49517256
  17. ↑ 17.0 17.1 17.2 Forsythe E, Kenny J, Bacchelli C, Beales PL (2018). "Managing Bardet-Biedl Syndrome-Now and in the Future". Front Pediatr. 6: 23. doi:10.3389/fped.2018.00023. PMC 5816783. PMID 29487844.
  18. ↑ Bardet-biedl syndrome. Bissonnette B, & Luginbuehl I, & Marciniak B, & Dalens B.J.(Eds.), (2006). Syndromes: Rapid Recognition and Perioperative Implications. McGraw Hill. https://accessanesthesiology.mhmedical.com/content.aspx?bookid=852&sectionid=49517256
  19. ↑ Bardet-biedl syndrome. Bissonnette B, & Luginbuehl I, & Marciniak B, & Dalens B.J.(Eds.), (2006). Syndromes: Rapid Recognition and Perioperative Implications. McGraw Hill. https://accessanesthesiology.mhmedical.com/content.aspx?bookid=852&sectionid=49517256
  20. ↑ Bardet-biedl syndrome. Bissonnette B, & Luginbuehl I, & Marciniak B, & Dalens B.J.(Eds.), (2006). Syndromes: Rapid Recognition and Perioperative Implications. McGraw Hill. https://accessanesthesiology.mhmedical.com/content.aspx?bookid=852&sectionid=49517256
  21. ↑ Bardet-biedl syndrome. Bissonnette B, & Luginbuehl I, & Marciniak B, & Dalens B.J.(Eds.), (2006). Syndromes: Rapid Recognition and Perioperative Implications. McGraw Hill. https://accessanesthesiology.mhmedical.com/content.aspx?bookid=852&sectionid=49517256
  22. ↑ Bardet-biedl syndrome. Bissonnette B, & Luginbuehl I, & Marciniak B, & Dalens B.J.(Eds.), (2006). Syndromes: Rapid Recognition and Perioperative Implications. McGraw Hill. https://accessanesthesiology.mhmedical.com/content.aspx?bookid=852&sectionid=49517256
  23. ↑ Bardet-biedl syndrome. Bissonnette B, & Luginbuehl I, & Marciniak B, & Dalens B.J.(Eds.), (2006). Syndromes: Rapid Recognition and Perioperative Implications. McGraw Hill. https://accessanesthesiology.mhmedical.com/content.aspx?bookid=852&sectionid=49517256

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