Dubowitz syndrome

Last updated
Dubowitz syndrome
Autosomal recessive - en.svg
This condition is inherited via autosomal recessive manner
Specialty Medical genetics   OOjs UI icon edit-ltr-progressive.svg
Symptoms Intrauterine growth retardation, short stature, microcephaly, mild mental retardation with behavior problems, eczema, and unusual and distinctive faci [1]
Diagnostic method <rarediseases.org>The diagnosis is usually based upon clinical determination made by a geneticist (dysmorphologist) or physician.
TreatmentDue to this rare syndrome and no known cures or treatments take into consideration that these people may develop slower than others and may need more specialized attention and personal care. One on one care may be appropriate in some cases to best fit their personal needs.

Dubowitz syndrome is a rare genetic disorder characterized by microcephaly, stunted growth, and a receding chin. Symptoms vary among patients, but other characteristics include a soft, high-pitched voice, partial webbing of the fingers and toes, palate deformations, genital abnormalities, language difficulties, and an aversion to crowds. [2] The pathogenesis of the disease is yet to be identified, and no medical tests can definitively diagnose the disease. [3] The primary method of diagnosis is to identify facial phenotypes. Since it was first described in 1965 by English physician Victor Dubowitz, over 140 cases have been reported worldwide. Although the majority of cases have been reported from the United States, Germany, and Russia, the disorder appears to affect both genders and all ethnicities equally. [2]

Contents

Signs and symptoms

Microcephaly is a characteristic in which the circumference of the head is smaller than normal due to improper development of the brain. It is caused by genetic disorders, infections, radiation, medications or alcohol use during pregnancy. Defects in the growth of the cerebral cortex lead to many of the features associated with microcephaly. [4]

Microcephaly has a vast range of prognoses: some patients experience little to very intellectual disability and can reach regular age-appropriate milestones. Others may experience severe intellectual disability and neuromuscular side effects. [4]

Genetics

Dubowitz syndrome patient.png
Dubowitz syndrome patient, frontal view
Dubowitz syndrome patient lateral view.png
Dubowitz syndrome patient, lateral view

Although the pathology of Dubowitz syndrome is unknown, it is a heritable autosomal recessive disorder. Parents of people with Dubowitz syndrome are sometimes related, and there have been several cases of it occurring in monozygotic twins, siblings, and cousins. [5] There is great variability in symptoms between cases, especially in intelligence. [6] Although there is much evidence that Dubowitz syndrome is genetic, the symptoms are similar to fetal alcohol syndrome. Further studies are needed to determine whether alcohol influences whether Dubowitz syndrome manifests in people who are genetically vulnerable. [7] Breakdown of chromosomes is known to occur. [5]

Growth hormone

Dubowitz syndrome is accompanied by a deficiency in growth hormone. [8] People with Dubowitz syndrome have stunted growth, and growth hormones are secreted by the anterior pituitary of the brain. The main function of the anterior pituitary is to increase height during development. Other functions include regulating the immune system, increasing calcium retention, increasing muscle mass and stimulating gluconeogenesis. A deficiency in growth hormone may be caused by genetic mutations, malformations of the hypothalamus or pituitary gland during development, or damage to the pituitary. [9] In Dubowitz syndrome, the cause is likely the underlying mutations or disruption of brain structures during development. Growth hormone deficiency also correlates with low levels of IgG antibodies, a condition found in Dubowitz patients. [5]

DNA repair defect

A fibroblast cell line developed from a patient with Dubowitz syndrome was found to be hypersensitive to ionizing radiation and several other DNA damaging agents due to a defect in the repair of DNA double strand breaks. [10] The DNA repair defect was traced to mutations in the DNA ligase IV LIG4 gene. [10] This finding suggests that the molecular basis for at least a subset of Dubowitz syndrome cases is a DNA ligase IV defect.[ citation needed ]

Relationship to Smith–Lemli–Opitz syndrome

Researchers are investigating the genetic similarities between Dubowitz syndrome and Smith–Lemli–Opitz syndrome (SLOS). Patients with SLOS and Dubowitz syndromes have many of the same abnormalities, and the two disorders are hypothesized to be linked. Two characteristics of SLOS are a low cholesterol level and a high 7-Dehydrocholesterol level. Cholesterol is essential for several bodily functions, including maintaining cell membrane structure, embryogenesis, and synthesis of steroid and sex hormones. Impaired cholesterol synthesis or transport may account for most of the symptoms of both SLOS and Dubowitz syndrome. Although only a few patients with Dubowitz syndrome have been identified with altered cholesterol levels, researchers are exploring whether Dubowitz syndrome, like SLOS, is linked to a defect in the cholesterol biosynthetic pathway. [11]

The pathology of Dubowitz syndrome is still unclear because of its rarity and the wide array of associated symptoms. Several studies have focused on different aspects of the disorder to try to find its exact cause and expression. One study examined the specific oral features in one patient. [12] Another found abnormalities in the brain, such as corpus callosum dysgenesis, an underdeveloped anterior pituitary and a brain stalk with an ectopic (misplaced) posterior pituitary. [13]

Diagnosis

There is no definitive test available for this condition. The diagnosis is based on the constellation of typical clinical features.[ citation needed ]

Management

There is currently no specific treatment for this condition. Management is supportive.[ citation needed ]

In particular there is currently no known method of correcting microcephaly. However, there are a variety of symptomatic treatments that help to counter some of its adverse effects, such as speech and occupational therapies, as well as medication to control seizures and hyperactivity. [14]

Epidemiology

This condition is rare with ~200 cases reported between 1965 and 2018. [15]

History

This condition was first reported in 1965.[ citation needed ]

Related Research Articles

<span class="mw-page-title-main">Microcephaly</span> Condition in which the head is small due to an underdeveloped brain

Microcephaly is a medical condition involving a smaller-than-normal head. Microcephaly may be present at birth or it may develop in the first few years of life. Brain development is often affected; people with this disorder often have an intellectual disability, poor motor function, poor speech, abnormal facial features, seizures and dwarfism.

<span class="mw-page-title-main">Gigantism</span> Human growth disorder

Gigantism, also known as giantism, is a condition characterized by excessive growth and height significantly above average. In humans, this condition is caused by over-production of growth hormone in childhood.

<span class="mw-page-title-main">Septo-optic dysplasia</span> Medical condition

Septo-optic dysplasia (SOD), known also as de Morsier syndrome, is a rare congenital malformation syndrome that features a combination of the underdevelopment of the optic nerve, pituitary gland dysfunction, and absence of the septum pellucidum . Two or more of these features need to be present for a clinical diagnosis—only 30% of patients have all three. French-Swiss doctor Georges de Morsier first recognized the relation of a rudimentary or absent septum pellucidum with hypoplasia of the optic nerves and chiasm in 1956.

<span class="mw-page-title-main">Adrenal insufficiency</span> Medical condition

Adrenal insufficiency is a condition in which the adrenal glands do not produce adequate amounts of steroid hormones. The adrenal glands—also referred to as the adrenal cortex—normally secrete glucocorticoids, mineralocorticoids, and androgens. These hormones are important in regulating blood pressure, electrolytes, and metabolism as a whole. Deficiency of these hormones leads to symptoms ranging from abdominal pain, vomiting, muscle weakness and fatigue, low blood pressure, depression, mood and personality changes to organ failure and shock. Adrenal crisis may occur if a person having adrenal insufficiency experiences stresses, such as an accident, injury, surgery, or severe infection; this is a life-threatening medical condition resulting from severe deficiency of cortisol in the body. Death may quickly follow.

<span class="mw-page-title-main">Growth hormone deficiency</span> Medical condition

Growth hormone deficiency (GHD), or human growth hormone deficiency, is a medical condition resulting from not enough growth hormone (GH). Generally the most noticeable symptom is that an individual attains a short height. Newborns may also present low blood sugar or a small penis size. In adults there may be decreased muscle mass, high cholesterol levels, or poor bone density.

<span class="mw-page-title-main">Hypopituitarism</span> Medical condition

Hypopituitarism is the decreased (hypo) secretion of one or more of the eight hormones normally produced by the pituitary gland at the base of the brain. If there is decreased secretion of one specific pituitary hormone, the condition is known as selective hypopituitarism. If there is decreased secretion of most or all pituitary hormones, the term panhypopituitarism is used.

<span class="mw-page-title-main">Noonan syndrome</span> Genetic condition involving facial, heart, blood and skeletal features

Noonan syndrome (NS) is a genetic disorder that may present with mildly unusual facial features, short height, congenital heart disease, bleeding problems, and skeletal malformations. Facial features include widely spaced eyes, light-colored eyes, low-set ears, a short neck, and a small lower jaw. Heart problems may include pulmonary valve stenosis. The breast bone may either protrude or be sunken, while the spine may be abnormally curved. Intelligence is often normal. Complications of NS can include leukemia.

<span class="mw-page-title-main">Pituitary adenoma</span> Human disease

Pituitary adenomas are tumors that occur in the pituitary gland. Most pituitary tumors are benign, approximately 35% are invasive and just 0.1% to 0.2% are carcinomas. Pituitary adenomas represent from 10% to 25% of all intracranial neoplasms and the estimated prevalence rate in the general population is approximately 17%.

<span class="mw-page-title-main">Primrose syndrome</span> Medical condition

Primrose syndrome is a rare, slowly progressive genetic disorder that can vary symptomatically between individual cases, but is generally characterised by ossification of the external ears, learning difficulties, and facial abnormalities. It was first described in 1982 in Scotland's Royal National Larbert Institution by Dr D.A.A. Primrose.

<span class="mw-page-title-main">Smith–Lemli–Opitz syndrome</span> Medical condition

Smith–Lemli–Opitz syndrome is an inborn error of cholesterol synthesis. It is an autosomal recessive, multiple malformation syndrome caused by a mutation in the enzyme 7-Dehydrocholesterol reductase encoded by the DHCR7 gene. It causes a broad spectrum of effects, ranging from mild intellectual disability and behavioural problems to lethal malformations.

Macroorchidism is a disorder found in males, specifically in children, where a subject has abnormally large testes. The condition is commonly inherited in connection with fragile X syndrome (FXS), which is also the second most common genetic cause of intellectual disability. The condition is also a rare sign of the McCune-Albright syndrome. The opposite of macroorchidism is called microorchidism, which is the condition of abnormally small testes.

<span class="mw-page-title-main">Empty sella syndrome</span> Medical condition

Empty sella syndrome is the condition when the pituitary gland shrinks or becomes flattened, filling the sella turcica with cerebrospinal fluid instead of the normal pituitary. It can be discovered as part of the diagnostic workup of pituitary disorders, or as an incidental finding when imaging the brain.

<span class="mw-page-title-main">Laron syndrome</span> Medical condition

Laron syndrome (LS), also known as growth hormone insensitivity or growth hormone receptor deficiency (GHRD), is an autosomal recessive disorder characterized by a lack of insulin-like growth factor 1 production in response to growth hormone. It is usually caused by inherited growth hormone receptor (GHR) mutations.

<span class="mw-page-title-main">3C syndrome</span> Medical condition

3C syndrome is a rare condition whose symptoms include heart defects, cerebellar hypoplasia, and cranial dysmorphism. It was first described in the medical literature in 1987 by Ritscher and Schinzel, for whom the disorder is sometimes named.

<span class="mw-page-title-main">Floating–Harbor syndrome</span> Medical condition

Floating–Harbor syndrome, also known as Pelletier–Leisti syndrome, is a rare disease with fewer than 50 cases described in the literature. It is usually diagnosed in early childhood and is characterized by the triad of proportionate short stature with delayed bone age, characteristic facial appearance, and delayed speech development. Although its cause is unknown, it is thought to result from genetic mutation, and diagnosis is established by the presence of a heterozygous SRCAP mutation in those with clinical findings of FHS.

Gonadotropin-releasing hormone (GnRH) insensitivity also known as Isolated gonadotropin-releasing hormone (GnRH)deficiency (IGD) is a rare autosomal recessive genetic and endocrine syndrome which is characterized by inactivating mutations of the gonadotropin-releasing hormone receptor (GnRHR) and thus an insensitivity of the receptor to gonadotropin-releasing hormone (GnRH), resulting in a partial or complete loss of the ability of the gonads to synthesize the sex hormones. The condition manifests itself as isolated hypogonadotropic hypogonadism (IHH), presenting with symptoms such as delayed, reduced, or absent puberty, low or complete lack of libido, and infertility, and is the predominant cause of IHH when it does not present alongside anosmia.

Hypogonadotropic hypogonadism (HH), is due to problems with either the hypothalamus or pituitary gland affecting the hypothalamic-pituitary-gonadal axis. Hypothalamic disorders result from a deficiency in the release of gonadotropic releasing hormone (GnRH), while pituitary gland disorders are due to a deficiency in the release of gonadotropins from the anterior pituitary. GnRH is the central regulator in reproductive function and sexual development via the HPG axis. GnRH is released by GnRH neurons, which are hypothalamic neuroendocrine cells, into the hypophyseal portal system acting on gonadotrophs in the anterior pituitary. The release of gonadotropins, LH and FSH, act on the gonads for the development and maintenance of proper adult reproductive physiology. LH acts on Leydig cells in the male testes and theca cells in the female. FSH acts on Sertoli cells in the male and follicular cells in the female. Combined this causes the secretion of gonadal sex steroids and the initiation of folliculogenesis and spermatogenesis. The production of sex steroids forms a negative feedback loop acting on both the anterior pituitary and hypothalamus causing a pulsatile secretion of GnRH. GnRH neurons lack sex steroid receptors and mediators such as kisspeptin stimulate GnRH neurons for pulsatile secretion of GnRH.

<span class="mw-page-title-main">Strømme syndrome</span> Rare genetic condition involving intestinal atresia, eye abnormalities and microcephaly

Strømme syndrome is a very rare autosomal recessive genetic condition characterised by intestinal atresia, eye abnormalities and microcephaly. The intestinal atresia is of the "apple-peel" type, in which the remaining intestine is twisted around its main artery. The front third of the eye is typically underdeveloped, and there is usually moderate developmental delay. Less common features include an atrial septal defect, increased muscle tone or skeletal abnormalities. Physical features may include short stature, large, low-set ears, a small jaw, a large mouth, epicanthic folds, or fine, sparse hair.

XK aprosencephaly is an extremely rare congenital disorder characterized by the absence of the embryonic forebrain. Because the prosencephalon gives way to the cerebral cortex, survival with aprosencephaly is not possible outside utero. The external symptoms are similar to holoprosencephaly, a related disorder, including a smaller than normal head (microcephaly), small eyeballs (microphthalmia), a small mouth (microstomia), anal atresia, and abnormalities of the external genitalia, radius, nostrils, and pharynx (throat).

<span class="mw-page-title-main">Achalasia microcephaly</span> Medical condition

Achalasia microcephaly syndrome is a rare condition whereby achalasia in the oesophagus manifests alongside microcephaly and intellectual disability. This is a rare constellation of symptoms with a predicted familial trend.

References

  1. "Dubowitz syndrome | Genetic and Rare Diseases Information Center (GARD) – an NCATS Program". rarediseases.info.nih.gov. Archived from the original on 2017-10-20. Retrieved 2017-07-11.
  2. 1 2 "Dubowitz syndrome". Encyclopedia of Genetic Disorders. Archived from the original on 2007-04-18.
  3. "Dubowitz Syndrome Support Network". Archived from the original on 2008-05-09. Retrieved 2007-04-30.
  4. 1 2 Microcephaly Information Page at NINDS
  5. 1 2 3 Online Mendelian Inheritance in Man (OMIM): Rasmussen, Sonja A. Dubowitz Syndrome - 223370
  6. Ilyina HG, Lurie IW (1990). "Dubowitz syndrome: possible evidence for a clinical subtype". Am. J. Med. Genet. 35 (4): 561–5. doi:10.1002/ajmg.1320350423. PMID   2185633.
  7. Mathieu M, Berquin P, Epelbaum S, Lenaerts C, Piussan C (December 1991). "[Dubowitz syndrome. A diagnosis not to be missed]". Arch. Fr. Pediatr. (in French). 48 (10): 715–8. PMID   1793348.
  8. Hirano T, Izumi I, Tamura K (1996). "Growth hormone deficiency in Dubowitz syndrome". Acta Paediatr Jpn. 38 (3): 267–9. doi:10.1111/j.1442-200x.1996.tb03484.x. PMID   8741320. S2CID   26839351.
  9. Rieser, Patricia (1979). "Growth Hormone Deficiency". Archived from the original on 2007-04-24.
  10. 1 2 Yue, Jingyin; Lu, Huimei; Lan, Shijie; Liu, Jingmei; Stein, Mark N.; Haffty, Bruce G.; Shen, Zhiyuan (2013). "Identification of the DNA repair defects in a case of Dubowitz syndrome". PLOS ONE. 8 (1): e54389. Bibcode:2013PLoSO...854389Y. doi: 10.1371/journal.pone.0054389 . PMC   3556036 . PMID   23372718.
  11. Ahmad A, Amalfitano A, Chen YT, Kishnani PS, Miller C, Kelley R (1999). "Dubowitz syndrome: a defect in the cholesterol biosynthetic pathway?". Am. J. Med. Genet. 86 (5): 503–4. doi:10.1002/(SICI)1096-8628(19991029)86:5<503::AID-AJMG21>3.0.CO;2-Y. PMID   10508998.
  12. Chan KM, King NM (2005). "Dubowitz syndrome: report of a case with emphasis on the oral features". J Dent Child (Chic). 72 (3): 100–3. PMID   16568913.
  13. Oguz KK, Ozgen B, Erdem Z (2003). "Cranial midline abnormalities in Dubowitz syndrome: MR imaging findings". Eur Radiol. 13 (5): 1056–7. doi:10.1007/s00330-002-1580-2. PMID   12695828. S2CID   1703841.
  14. "Microcephaly – Symptoms, Treatment and Prevention". The HealthCentralNetwork. Archived from the original on 2007-05-13.
  15. Innes, A. Micheil; McInnes, Brenda L.; Dyment, David A. (December 2018). "Clinical and genetic heterogeneity in Dubowitz syndrome: Implications for diagnosis, management and further research". American Journal of Medical Genetics Part C: Seminars in Medical Genetics. 178 (4): 387–397. doi:10.1002/ajmg.c.31661. PMID   30580484. S2CID   58597474.