HDR syndrome with a novel mutation in GATA3 mimicking a congenital X-linked stapes gusher: a case report

BMC Med Genet. 2017 Oct 26;18(1):121. doi: 10.1186/s12881-017-0484-6.


Background: Hypoparathyroidism, sensorineural hearing loss, and renal disease (HDR) syndrome, also known as Barakat syndrome, is a rare genetic disorder with high phenotypic heterogeneity caused by haploinsufficiency of the GATA3 gene on chromosome 10p14-p15. For these reasons, the diagnosis of HDR syndrome is challenging and requires a high index of suspicion as well as genetic analysis.

Case presentation: A 14-month-old boy, with sensorineural hearing loss in both ears, showed typical radiological features of X-linked stapes gusher on preoperative temporal bone computed tomography (CT) for cochlear implantations. Then after his discharge from hospital, he suffered a hypocalcemic seizure and we discovered a renal cyst during investigation of hypocalcemia. He was finally diagnosed with HDR syndrome by clinical findings, which were confirmed by molecular genetic testing. Direct sequencing of the GATA3 gene showed a heterozygous 2-bp deletion (c.1201_1202delAT), which is predicted to cause a frameshift of the reading frame (p.Met401Valfs*106).

Conclusions: To our knowledge, this is the first case of HDR syndrome with a novel de novo variant mimicking a congenital X-linked stapes gusher syndrome. Novel mutations and the diversity of clinical manifestations expand the genotypic and phenotypic spectrum of HDR syndrome. Diagnosis of HDR syndrome is still challenging, but clinicians should consider it in their differential diagnosis for children with a wide range of clinical manifestations including hypocalcemia induced seizures and deafness. We hope that this case will contribute to further understanding and studies of HDR-associated GATA3 mutations.

Keywords: Case report; DFNX2; GATA3 gene; HDR syndrome; Hearing loss; Hypoparathyroidism; Renal anomalies; Sensorineural.

Publication types

  • Case Reports
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Chromosomes, Human, Pair 10 / chemistry*
  • Cochlear Implantation*
  • Diagnosis, Differential
  • Frameshift Mutation*
  • GATA3 Transcription Factor / genetics*
  • Gene Expression
  • Genetic Diseases, X-Linked / diagnosis
  • Genetic Diseases, X-Linked / genetics
  • Genetic Diseases, X-Linked / physiopathology
  • Haploinsufficiency
  • Hearing Loss, Conductive / diagnosis
  • Hearing Loss, Conductive / genetics
  • Hearing Loss, Conductive / physiopathology
  • Hearing Loss, Sensorineural / diagnosis*
  • Hearing Loss, Sensorineural / genetics
  • Hearing Loss, Sensorineural / physiopathology
  • Hearing Loss, Sensorineural / surgery
  • Heterozygote
  • Humans
  • Hypoparathyroidism / diagnosis*
  • Hypoparathyroidism / genetics
  • Hypoparathyroidism / physiopathology
  • Hypoparathyroidism / surgery
  • Infant
  • Male
  • Nephrosis / diagnosis*
  • Nephrosis / genetics
  • Nephrosis / physiopathology
  • Nephrosis / surgery
  • Tomography, X-Ray Computed


  • GATA3 Transcription Factor
  • GATA3 protein, human

Supplementary concepts

  • Barakat syndrome
  • Progressive hearing loss stapes fixation