Published online February 1, 2008
PEDIATRICS Vol. 121 No. 2 February 2008, pp. e377-e386 (doi:10.1542/peds.2007-1350)
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REVIEW ARTICLE

Recognition and Diagnosis of Mucopolysaccharidosis II (Hunter Syndrome)

Rick Martin, MDa, Michael Beck, MDb, Christine Eng, MDc, Roberto Giugliani, MD, PhDd, Paul Harmatz, MDe, Verónica Muñoz, MDd and Joseph Muenzer, MD, PhDf

a Department of Pediatrics, St Louis University, St Louis, Missouri
b Children's Hospital, University of Mainz, Mainz, Germany
c Department of Molecular and Human Genetics, Baylor College of Medicine, Houston, Texas
d Hospital de Clinicas de Porto Alegre, Porto Alegre, Brazil
e Research Center, Children's Hospital of Oakland, Oakland, California
f Department of Pediatrics, University of North Carolina, Chapel Hill, North Carolina

Mucopolysaccharidosis II, also known as Hunter syndrome, is a rare, X-linked disorder caused by a deficiency of the lysosomal enzyme iduronate-2-sulfatase, which catalyzes a step in the catabolism of glycosaminoglycans. In patients with mucopolysaccharidosis II, glycosaminoglycans accumulate within tissues and organs, contributing to the signs and symptoms of the disease. Mucopolysaccharidosis II affects multiple organs and physiologic systems and has a variable age of onset and variable rate of progression. Common presenting features include excess urinary glycosaminoglycan excretion, facial dysmorphism, organomegaly, joint stiffness and contractures, pulmonary dysfunction, myocardial enlargement and valvular dysfunction, and neurologic involvement. In patients with neurologic involvement, intelligence is impaired, and death usually occurs in the second decade of life, whereas those patients with minimal or no neurologic involvement may survive into adulthood with normal intellectual development. Enzyme replacement therapy has emerged as a new treatment for mucopolysaccharidosis disorders, including Hunter syndrome. The purpose of this report is to provide a concise review of mucopolysaccharidosis II for practitioners with the hope that such information will help identify affected boys earlier in the course of their disease.

Key Words: lysosomal storage disease

Abbreviations: MPS—mucopolysaccharidosis • GAG—glycosaminoglycan • I2S—iduronate-2-sulfatase • EOW—every other week

Accepted Jul 5, 2007.