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To the Editor:
Machigashira et al.1 reported the occurrence of human T-cell lymphotorophic virus type 1 (HTLV-I)-associated myelopathy/tropical spastic paraparesis (HAM/TSP) in patients with pseudohypoparathyroidism type Ia (PHP) or pseudopseudohypoparathyroidism (PPHP). They make the intriguing proposal that PHP/PPHP may be a risk factor for developing HAM/TSP in the course of HTLV-I infection.
PHP/PPHP is caused by mutations within the α subunit of the stimulatory guanine nucleotide binding protein (Gs-α) gene, which leads to reduced activity of the protein and thereby impairs the function of the Gs-α coupled parathyroid hormone (PTH) receptor, but many other Gs-α coupled receptors can also be affected. In a clinical setting, PHP is diagnosed in patients presenting either with signs of Albright’s hereditary osteodystrophy, symptomatic hypocalcemia, a positive family history, …
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