Background:Hypoparathyroidism-deafness-renal dysplasia (HDR) syndrome is an autosomal dominant disorder primarily caused by haploinsufficiency of GATA binding protein 3 (GATA3) gene mutations,and hearing loss is the most frequent phenotypic feature.This study aimed at identifying the causative gene mutation for a three-generation Chinese family with HDR syndrome and analyzing auditory phenotypes in all familial HDR syndrome cases.Methods:Three affected family members underwent otologic examinations,biochemistry tests,and other clinical evaluations.Targeted genes capture combining next-generation sequencing was performed within the family.Sanger sequencing was used to confirm the causative mutation.The auditory phenotypes of all reported familial HDR syndrome cases analyzed were provided.Results:In Chinese family 7121,a heterozygous nonsense mutation c.826C＞T (p.R276*) was identified in GATA3.All the three affected members suffered from sensorineural deafness and hypocalcemia;however,renal dysplasia only appeared in the youngest patient.Furthermore,an overview of thirty HDR syndrome families with corresponding GATA3 mutations revealed that hearing impairment occurred earlier in the younger generation in at least nine familial cases (30％) and two thirds of them were found to carry premature stop mutations.Conclusions:This study highlights the phenotypic heterogeneity of HDR and points to a possible genetic anticipation in patients with HDR,which needs to be further investigated.