Ann Pediatr Endocrinol Metab.  2021 Dec;26(4):227-236. 10.6065/apem.2142164.082.

Prader-Willi syndrome: an update on obesity and endocrine problems

Affiliations
  • 1Department of Pediatrics, Inha University Hospital, Inha University College of Medicine, Incheon, Korea
  • 2Northwest Gyeonggi Regional Center for Rare Disease, Inha University Hospital, Incheon, Korea
  • 3Department of Pediatrics, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea

Abstract

Prader-Willi syndrome (PWS) is a rare complex genetic disorder that results from a lack of expression of the paternally inherited chromosome 15q11-q13. PWS is characterized by hypotonia and feeding difficulty in early infancy and development of morbid obesity aggravated by uncontrolled hyperphagia after childhood and adolescent. Dysmorphic facial features, delayed motor and language development, various degrees of cognitive impairment, and behavioral problems are common in PWS. Without early, intensive nutritional therapy along with behavioral modification, PWS patients develop severe obesity associated with type 2 diabetes, obstructive sleep apnea, right-side heart failure, and other obesity-related metabolic complications. Hypothalamic dysfunction in PWS can lead to several endocrine disorders, including short stature with growth hormone deficiency, hypothyroidism, central adrenal insufficiency, and hypogonadism. In this review, we discuss the natural history of PWS and the mechanisms of hyperphagia and obesity. We also provide an update on obesity treatments and recommendations for screening and monitoring of various endocrine problems that can occur in PWS.

Keyword

Prader-Willi syndrome; obesity; endocrine system disease; hypothalamic dysfunction

Figure

  • Fig. 1. The nutritional stages of Prader-Willi syndrome.


Reference

References

1. Cassidy SB, Schwartz S, Miller JL, Driscoll DJ. Prader-Willi syndrome. Genet Med. 2012; 14:10–26.
Article
2. Cheon CK. Genetics of Prader-Willi syndrome and PraderWill-Like syndrome. Ann Pediatr Endocrinol Metab. 2016; 21:126–35.
Article
3. Butler MG, Miller JL, Forster JL. Prader-Willi syndrome - clinical genetics, diagnosis and treatment approaches: an update. Curr Pediatr Rev. 2019; 15:207–44.
Article
4. Irizarry KA, Miller M, Freemark M, Haqq AM. Prader Willi syndrome: genetics, metabolomics, hormonal function, and new approaches to therapy. Adv Pediatr. 2016; 63:47–77.
5. Rocha CF, Paiva CL. Prader-Willi-like phenotypes: a systematic review of their chromosomal abnormalities. Genet Mol Res. 2014; 13:2290–8.
6. Angulo MA, Butler MG, Cataletto ME. Prader-Willi syndrome: a review of clinical, genetic, and endocrine findings. J Endocrinol Invest. 2015; 38:1249–63.
Article
7. Driscoll DJ, Miller JL, Schwartz S, Cassidy SB. Prader-Willi syndrome. Adam MP, Ardinger HH, Pagon RA, Wallace SE, Bean LJH, Mirzaa G, editors. GeneReviews® [Internet]. Seattle (WA): University of Washington, Seattle;1993–2021.
8. Bar C, Diene G, Molinas C, Bieth E, Casper C, Tauber M. Early diagnosis and care is achieved but should be improved in infants with Prader-Willi syndrome. Orphanet J Rare Dis. 2017; 12:118.
Article
9. Harris RM, Stafford DEJ. Prader Willi syndrome: endocrine updates and new medical therapies. Curr Opin Endocrinol Diabetes Obes. 2020; 27:56–62.
Article
10. Heksch R, Kamboj M, Anglin K, Obrynba K. Review of Prader-Willi syndrome: the endocrine approach. Transl Pediatr. 2017; 6:274–85.
Article
11. Miller JL, Lynn CH, Driscoll DC, Goldstone AP, Gold JA, Kimonis V, et al. Nutritional phases in Prader-Willi syndrome. Am J Med Genet A. 2011; 155A:1040–9.
Article
12. Gross N, Rabinowitz R, Gross-Tsur V, Hirsch HJ, Eldar-Geva T. Prader-Willi syndrome can be diagnosed prenatally. Am J Med Genet A. 2015; 167A:80–5.
Article
13. Lee J, Isojima T, Chang MS, Kwun YH, Huh R, Cho SY, et al. Disease-specific growth charts for Korean infants with Prader-Willi syndrome. Am J Med Genet A. 2015; 167A:86–94.
Article
14. Rosenbloom ST, Butler MG. Development and implementation of electronic growth charts for infants wit h Prader-Willi syndrome. Am J Med Genet A. 2012; 158A:2743–9.
15. Goldstone AP, Holland AJ, Hauffa BP, Hokken-Koelega AC, Tauber M; speakers contributors at the Second Expert Meeting of the Comprehensive Care of Patients with PWS. Recommendations for the diagnosis and management of Prader-Willi syndrome. J Clin Endocrinol Metab. 2008; 93:4183–97.
Article
16. Cassidy SB, Driscoll DJ. Prader-Willi syndrome. Eur J Hum Genet. 2009; 17:3–13.
Article
17. McCandless SE; Committee on G. Clinical report-health supervision for children with Prader-Willi syndrome. Pediatrics. 2011; 127:195–204.
18. Whittington JE, Holland AJ, Webb T, Butler J, Clarke D, Boer H. Population prevalence and estimated birth incidence and mortality rate for people with Prader-Willi syndrome in one UK Health Region. J Med Genet. 2001; 38:792–8.
Article
19. Butler MG, Manzardo AM, Heinemann J, Loker C, Loker J. Causes of death in Prader-Willi syndrome: Prader-Willi Syndrome Association (USA) 40-year mortality survey. Genet Med. 2017; 19:635–42.
Article
20. Pacoricona Alfaro DL, Lemoine P, Ehlinger V, Molinas C, Diene G, Valette M, et al. Causes of death in Prader-Willi syndrome: lessons from 11 years' experience of a national reference center. Orphanet J Rare Dis. 2019; 14:238.
Article
21. Lionti T, Reid SM, Rowell MM. Prader-Willi syndrome in Victoria: mortality and causes of death. J Paediatr Child Health. 2012; 48:506–11.
Article
22. Butler MG, Theodoro MF, Bittel DC, Donnelly JE. Energy expenditure and physical activity in Prader-Willi syndrome: comparison with obese subjects. Am J Med Genet A. 2007; 143A:449–59.
Article
23. Burman P, Ritzen EM, Lindgren AC. Endocrine dysfunction in Prader-Willi syndrome: a review with special reference to GH. Endocr Rev. 2001; 22:787–99.
Article
24. Khan MJ, Gerasimidis K, Edwards CA, Shaikh MG. Mechanisms of obesity in Prader-Willi syndrome. Pediatr Obes. 2018; 13:3–13.
Article
25. Holsen LM, Savage CR, Martin LE, Bruce AS, Lepping RJ, Ko E, et al. Importance of reward and prefrontal circuitry in hunger and satiety: Prader-Willi syndrome vs simple obesity. Int J Obes (Lond). 2012; 36:638–47.
Article
26. Blanco-Hinojo L, Pujol J, Esteba-Castillo S, MartinezVilavella G, Gimenez-Palop O, Gabau E, et al. Lack of response to disgusting food in the hypothalamus and related structures in Prader Willi syndrome. Neuroimage Clin. 2019; 21:101662.
Article
27. Dimitropoulos A, Schultz RT. Food-related neural circuitry in Prader-Willi syndrome: response to high- versus low-calorie foods. J Autism Dev Disord. 2008; 38:1642–53.
Article
28. DelParigi A, Tschop M, Heiman ML, Salbe AD, Vozarova B, Sell SM, et al. High circulating ghrelin: a potential cause for hyperphagia and obesity in prader-willi syndrome. J Clin Endocrinol Metab. 2002; 87:5461–4.
Article
29. Haqq AM, Farooqi IS, O'Rahilly S, Stadler DD, Rosenfeld RG, Pratt KL, et al. Serum ghrelin levels are inversely correlated with body mass index, age, and insulin concentrations in normal children and are markedly increased in Prader-Willi syndrome. J Clin Endocrinol Metab. 2003; 88:174–8.
Article
30. Kweh FA, Miller JL, Sulsona CR, Wasserfall C, Atkinson M, Shuster JJ, et al. Hyperghrelinemia in Prader-Willi syndrome begins in early infancy long before the onset of hyperphagia. Am J Med Genet A. 2015; 167A:69–79.
Article
31. Beauloye V, Diene G, Kuppens R, Zech F, Winandy C, Molinas C, et al. High unacylated ghrelin levels support the concept of anorexia in infants with prader-willi syndrome. Orphanet J Rare Dis. 2016; 11:56.
Article
32. Lawson EA, Olszewski PK, Weller A, Blevins JE. The role of oxytocin in regulation of appetitive behaviour, body weight and glucose homeostasis. J Neuroendocrinol. 2020; 32:e12805.
Article
33. Swaab DF, Purba JS, Hofman MA. Alterations in the hypothalamic paraventricular nucleus and its oxytocin neurons (putative satiety cells) in Prader-Willi syndrome: a study of five cases. J Clin Endocrinol Metab. 1995; 80:573–9.
Article
34. Martin A, State M, Anderson GM, Kaye WM, Hanchett JM, McConaha CW, et al. Cerebrospinal fluid levels of oxytocin in Prader-Willi syndrome: a preliminary report. Biol Psychiatry. 1998; 44:1349–52.
Article
35. Johnson L, Manzardo AM, Miller JL, Driscoll DJ, Butler MG. Elevated plasma oxytocin levels in children with Prader-Willi syndrome compared with healthy unrelated siblings. Am J Med Genet A. 2016; 170:594–601.
Article
36. Xue Q, Bai B, Ji B, Chen X, Wang C, Wang P, et al. Ghrelin through GHSR1a and OX1R heterodimers reveals a Galphas-cAMP-cAMP response element binding protein signaling pathway in vitro. Front Mol Neurosci. 2018; 11:245.
37. Wallace Fitzsimons SE, Chruscicka B, Druelle C, Stamou P, Nally K, Dinan TG, et al. A ghrelin receptor and oxytocin receptor heterocomplex impairs oxytocin mediated signalling. Neuropharmacology. 2019; 152:90–101.
Article
38. Kuppens RJ, Donze SH, Hokken-Koelega AC. Promising effects of oxytocin on social and food-related behaviour in young children with Prader-Willi syndrome: a randomized, double-blind, controlled crossover trial. Clin Endocrinol (Oxf). 2016; 85:979–87.
Article
39. Miller JL, Tamura R, Butler MG, Kimonis V, Sulsona C, Gold JA, et al. Oxytocin treatment in children with Prader-Willi syndrome: a double-blind, placebo-controlled, crossover study. Am J Med Genet A. 2017; 173:1243–50.
Article
40. Allas S, Caixas A, Poitou C, Coupaye M, Thuilleaux D, Lorenzini F, et al. AZP-531, an unacylated ghrelin analog, improves food-related behavior in patients with Prader-Willi syndrome: a randomized placebo-controlled trial. PLoS One. 2018; 13:e0190849.
Article
41. Butler MG, Bittel DC, Talebizadeh Z. Plasma peptide YY and ghrelin levels in infants and children with Prader-Willi syndrome. J Pediatr Endocrinol Metab. 2004; 17:1177–84.
Article
42. Hoybye C, Bruun JM, Richelsen B, Flyvbjerg A, Frystyk J. Serum adiponectin levels in adults with Prader-Willi syndrome are independent of anthropometrical parameters and do not change with GH treatment. Eur J Endocrinol. 2004; 151:457–61.
Article
43. Butler MG, Bittel DC. Plasma obestatin and ghrelin levels in subjects with Prader-Willi syndrome. Am J Med Genet A. 2007; 143A:415–21.
Article
44. Haqq AM, Muehlbauer M, Svetkey LP, Newgard CB, Purnell JQ, Grambow SC, et al. Altered distribution of adiponectin isoforms in children with Prader-Willi syndrome (PWS): association with insulin sensitivity and circulating satiety peptide hormones. Clin Endocrinol (Oxf). 2007; 67:944–51.
Article
45. Park WH, Oh YJ, Kim GY, Kim SE, Paik KH, Han SJ, et al. Obestatin is not elevated or correlated with insulin in children with Prader-Willi syndrome. J Clin Endocrinol Metab. 2007; 92:229–34.
Article
46. Haqq AM, Muehlbauer MJ, Newgard CB, Grambow S, Freemark M. The metabolic phenotype of Prader-Willi syndrome (PWS) in childhood: heightened insulin sensitivity relative to body mass index. J Clin Endocrinol Metab. 2011; 96:E225–32.
Article
47. Goldstone AP, Holland AJ, Butler JV, Whittington JE. Appetite hormones and the transition to hyperphagia in children with Prader-Willi syndrome. Int J Obes (Lond). 2012; 36:1564–70.
Article
48. Orsso CE, Butler AA, Muehlbauer MJ, Cui HN, Rubin DA, Pakseresht M, et al. Obestatin and adropin in Prader-Willi syndrome and nonsyndromic obesity: associations with weight, BMI-z, and HOMA-IR. Pediatr Obes. 2019; 14:e12493.
Article
49. Butler MG, Moore J, Morawiecki A, Nicolson M. Comparison of leptin protein levels in Prader-Willi syndrome and control individuals. Am J Med Genet. 1998; 75:7–12.
Article
50. Bochukova EG. Transcriptomics of the Prader-Willi syndrome hypothalamus. Handb Clin Neurol. 2021; 181:369–79.
Article
51. Bochukova EG, Lawler K, Croizier S, Keogh JM, Patel N, Strohbehn G, et al. A transcriptomic signature of the hypothalamic response to fasting and BDNF deficiency in Prader-Willi syndrome. Cell Rep. 2018; 22:3401–8.
Article
52. Gray J, Yeo GS, Cox JJ, Morton J, Adlam AL, Keogh JM, et al. Hyperphagia, severe obesity, impaired cognitive function, and hyperactivity associated with functional loss of one copy of the brain-derived neurotrophic factor (BDNF) gene. Diabetes. 2006; 55:3366–71.
53. Han JC, Muehlbauer MJ, Cui HN, Newgard CB, Haqq AM. Lower brain-derived neurotrophic factor in patients with prader-willi syndrome compared to obese and lean control subjects. J Clin Endocrinol Metab. 2010; 95:3532–6.
Article
54. Lloret-Linares C, Faucher P, Coupaye M, Alili R, Green A, Basdevant A, et al. Comparison of body composition, basal metabolic rate and metabolic outcomes of adults with Prader Willi syndrome or lesional hypothalamic disease, with primary obesity. Int J Obes (Lond). 2013; 37:1198–203.
Article
55. Lacroix D, Moutel S, Coupaye M, Huvenne H, Faucher P, Pelloux V, et al. Metabolic and adipose tissue signatures in adults with Prader-Willi syndrome: a model of extreme adiposity. J Clin Endocrinol Metab. 2015; 100:850–9.
Article
56. Yazdi PG, Su H, Ghimbovschi S, Fan W, Coskun PE, Nalbandian A, et al. Differential gene expression reveals mitochondrial dysfunction in an imprinting center deletion mouse model of Prader-Willi syndrome. Clin Transl Sci. 2013; 6:347–55.
Article
57. Butler MG, Hossain WA, Tessman R, Krishnamurthy PC. Preliminary observations of mitochondrial dysfunction in Prader-Willi syndrome. Am J Med Genet A. 2018; 176:2587–94.
Article
58. Schmidt H, Pozza SB, Bonfig W, Schwarz HP, Dokoupil K. Successful early dietary intervention avoids obesity in patients with Prader-Willi syndrome: a ten-year follow-up. J Pediatr Endocrinol Metab. 2008; 21:651–5.
Article
59. Miller JL. Approach to the child with prader-willi syndrome. J Clin Endocrinol Metab. 2012; 97:3837–44.
Article
60. Crino A, Fintini D, Bocchini S, Grugni G. Obesity management in Prader- Willisy nd rome : current perspectives. Diabetes Metab Syndr Obes. 2018; 11:579–93.
61. Griggs JL, Sinnayah P, Mathai ML. Prader-Willi syndrome: From genetics to behaviour, with special focus on appetite treatments. Neurosci Biobehav Rev. 2015; 59:155–72.
Article
62. Sipila I, Sintonen H, Hietanen H, Apajasalo M, Alanne S, Viita AM, et al. Long-term effects of growth hormone therapy on patients with Prader-Willi syndrome. Acta Paediatr. 2010; 99:1712–8.
Article
63. Scheimann AO, Butler MG, Gourash L, Cuffari C, Klish W. Critical analysis of bariatric procedures in Prader-Willi syndrome. J Pediatr Gastroenterol Nutr. 2008; 46:80–3.
Article
64. Salehi P, Hsu I, Azen CG, Mittelman SD, Geffner ME, Jeandron D. Effects of exenatide on weight and appetite in overweight adolescents and young adults with Prader-Willi syndrome. Pediatr Obes. 2017; 12:221–8.
Article
65. Kim YM, Lee YJ, Kim SY, Cheon CK, Lim HH. Successful rapid weight reduction and the use of liraglutide for morbid obesity in adolescent Prader-Willi syndrome. Ann Pediatr Endocrinol Metab. 2020; 25:52–6.
Article
66. Senda M, Ogawa S, Nako K, Okamura M, Sakamoto T, Ito S. The glucagon-like peptide-1 analog liraglutide suppresses ghrelin and controls diabetes in a patient with Prader-Willi syndrome. Endocr J. 2012; 59:889–94.
Article
67. Fintini D, Grugni G, Brufani C, Bocchini S, Cappa M, Crino A. Use of GLP-1 receptor agonists in Prader-Willi Syndrome: report of six cases. Diabetes Care. 2014; 37:e76–7.
Article
68. Kimonis V, Surampalli A, Wencel M, Gold JA, Cowen NM. A randomized pilot efficacy and safety trial of diazoxide choline controlled-release in patients with Prader-Willi syndrome. PLoS One. 2019; 14:e0221615.
Article
69. Einfeld SL, Smith E, McGregor IS, Steinbeck K, Taffe J, Rice LJ, et al. A double-blind randomized controlled trial of oxytocin nasal spray in Prader Willi syndrome. Am J Med Genet A. 2014; 164A:2232–9.
Article
70. Hollander E, Levine KG, Ferretti CJ, Freeman K, Doernberg E, Desilva N, et al. Intranasal oxytocin versus placebo for hyperphagia and repetitive behaviors in children with Prader-Willi Syndrome: a randomized controlled pilot trial. J Psychiatr Res. 2021; 137:643–51.
Article
71. Tauber M, Boulanouar K, Diene G, Çabal-Berthoumieu S, Ehlinger V, Fichaux-Bourin P, et al. The use of oxytocin to improve feeding and social skills in infants with Prader-Willi syndrome. Pediatrics. 2017; 139:e20162976.
Article
72. Dykens EM, Miller J, Angulo M, Roof E, Reidy M, Hatoum HT, et al. Intranasal carbetocin reduces hyperphagia in individuals with Prader-Willi syndrome. JCI Insight. 2018; 3:e98333.
Article
73. Bridges N. What is the value of growth hormone therapy in Prader Willi syndrome? Arch Dis Child. 2014; 99:166–70.
Article
74. Cohen M, Harrington J, Narang I, Hamilton J. Growth hormone secretion decreases with age in paediatric PraderWilli syndrome. Clin Endocrinol (Oxf). 2015; 83:212–5.
75. Carrel AL, Myers SE, Whitman BY, Eickhoff J, Allen DB. Long-term growth hormone therapy changes the natural history of body composition and motor function in children with Prader-Willi syndrome. J Clin Endocrinol Metab. 2010; 95:1131–6.
Article
76. Myers SE, Whitman BY, Carrel AL, Moerchen V, Bekx MT, Allen DB. Two years of growth hormone therapy in young children with Prader-Willi syndrome: physical and neurodevelopmental benefits. Am J Med Genet A. 2007; 143A:443–8.
Article
77. Donze SH, Damen L, Mahabier EF, Hokken-Koelega ACS. Improved mental and motor development during 3 years of GH treatment in very young children with Prader-Willi syndrome. J Clin Endocrinol Metab. 2018; 103:3714–9.
Article
78. Grugni G, Marzullo P. Diagnosis and treatment of GH deficiency in Prader-Willi syndrome. Best Pract Res Clin Endocrinol Metab. 2016; 30:785–94.
Article
79. Koizumi M, Ida S, Shoji Y, Nishimoto Y, Etani Y, Kawai M. Visceral adipose tissue increases shortly after the cessation of GH therapy in adults with Prader-Willi syndrome. Endocr J. 2018; 65:1127–37.
Article
80. Hoybye C, Thoren M, Bohm B. Cognitive, emotional, physical and social effects of growth hormone treatment in adults with Prader-Willi syndrome. J Intellect Disabil Res. 2005; 49(Pt 4):245–52.
Article
81. Damen L, Donze SH, Kuppens RJ, Bakker NE, de Graaff LCG, van der Velden J, et al. Three years of growth hormone treatment in young adults with Prader-Willi syndrome: sustained positive effects on body composition. Orphanet J Rare Dis. 2020; 15:163.
Article
82. Grugni G, Marzullo P, Ragusa L, Sartorio A, Trifiro G, Liuzzi A, et al. Impairment of GH responsiveness to combined GH-releasing hormone and arginine administration in adult patients with Prader-Willi syndrome. Clin Endocrinol (Oxf). 2006; 65:492–9.
Article
83. Butler MG, Theodoro M, Skouse JD. Thyroid function studies in Prader-Willi syndrome. Am J Med Genet A. 2007; 143A:488–92.
Article
84. Diene G, Mimoun E, Feigerlova E, Caula S, Molinas C, Grandjean H, et al. Endocrine disorders in children with Prader-Willi syndrome--data from 142 children of the French database. Horm Res Paediatr. 2010; 74:121–8.
Article
85. Iughetti L, Vivi G, Balsamo A, Corrias A, Crino A, Delvecchio M, et al. Thyroid function in patients with Prader-Willi syndrome: an Italian multicenter study of 339 patients. J Pediatr Endocrinol Metab. 2019; 32:159–65.
Article
86. Vaiani E, Herzovich V, Chaler E, Chertkoff L, Rivarola MA, Torrado M, et al. Thyroid axis dysfunction in patients with Prader-Willi syndrome during the first 2 years of life. Clin Endocrinol (Oxf). 2010; 73:546–50.
87. de Lind van Wijngaarden RF, Otten BJ, Festen DA, Joosten KF, de Jong FH, Sweep FC, et al. High prevalence of central adrenal insufficiency in patients with Prader-Willi syndrome. J Clin Endocrinol Metab. 2008; 93:1649–54.
Article
88. Grugni G, Beccaria L, Corrias A, Crino A, Cappa M, De Medici C, et al. Central adrenal insufficiency in young adults with Prader-Willi syndrome. Clin Endocrinol (Oxf). 2013; 79:371–8.
Article
89. Farholt S, Sode-Carlsen R, Christiansen JS, Ostergaard JR, Hoybye C. Normal cortisol response to high-dose synacthen and insulin tolerance test in children and adults with Prader-Willi syndrome. J Clin Endocrinol Metab. 2011; 96:E173–80.
Article
90. Corrias A, Grugni G, Crino A, Di Candia S, Chiabotto P, Cogliardi A, et al. Assessment of central adrenal insufficiency in children and adolescents with Prader-Willi syndrome. Clin Endocrinol (Oxf). 2012; 76:843–50.
Article
91. Oto Y, Matsubara K, Ayabe T, Shiraishi M, Murakami N, Ihara H, et al. Delayed peak response of cortisol to insulin tolerance test in patients with Prader-Willi syndrome. Am J Med Genet A. 2018; 176:1369–74.
Article
92. Muscogiuri G, Formoso G, Pugliese G, Ruggeri RM, Scarano E, Colao A, et al. Prader- Willi syndrome: an uptodate on endocrine and metabolic complications. Rev Endocr Metab Disord. 2019; 20:239–50.
Article
93. Tauber M, Hoybye C. Endocrine disorders in Prader-Willi syndrome: a model to understand and treat hypothalamic dysfunction. Lancet Diabetes Endocrinol. 2021; 9:235–46.
Article
94. Crino A, Schiaffini R, Ciampalini P, Spera S, Beccaria L, Benzi F, et al. Hypogonadism and pubertal development in Prader-Willi syndrome. Eur J Pediatr. 2003; 162:327–33.
Article
95. Eldar-Geva T, Hirsch HJ, Rabinowitz R, Benarroch F, Rubinstein O, Gross-Tsur V. Primary ovarian dysfunction contributes to the hypogonadism in women with PraderWilli Syndrome. Horm Res. 2009; 72:153–9.
Article
96. Greco D, Vetri L, Ragusa L, Vinci M, Gloria A, Occhipinti P, et al. Prader-Willi syndrome with angelman syndrome in the offspring. Medicina (Kaunas). 2021; 57:460.
Article
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