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Jedraszak G, Jobic F, Receveur A, Bilan F, Gilbert-Dussardier B, Tiffany B, Missirian C, Willems M, Odent S, Lucas J, Dubourg C, Schaefer E, Scheidecker S, Lespinasse J, Goldenberg A, Guerrot AM, Joly-Helas G, Chambon P, Le Caignec C, David A, Coutton C, Satre V, Vieville G, Amblard F, Harbuz R, Sanlaville D, Till M, Vincent-Delorme C, Colson C, Andrieux J, Naudion S, Toutain J, Rooryck C, de Fréminville B, Prieur F, Daire VC, Amram D, Kleinfinger P, Raabe-Meyer G, Courage C, Lemke J, Stefanou EG, Loretta T, Emmanouil M, Tzeli SK, Sodowska H, Anderson J, Nandini A, Copin H, Garçon L, Liehr T, Morin G. Cat eye syndrome: Clinical, cytogenetics and familial findings in a large cohort of 43 patients highlighting the importance of congenital heart disease and inherited cases. Am J Med Genet A 2024; 194:e63476. [PMID: 37974505 DOI: 10.1002/ajmg.a.63476] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2023] [Revised: 10/13/2023] [Accepted: 11/05/2023] [Indexed: 11/19/2023]
Abstract
Cat Eye Syndrome (CES) is a rare genetic disease caused by the presence of a small supernumerary marker chromosome derived from chromosome 22, which results in a partial tetrasomy of 22p-22q11.21. CES is classically defined by association of iris coloboma, anal atresia, and preauricular tags or pits, with high clinical and genetic heterogeneity. We conducted an international retrospective study of patients carrying genomic gain in the 22q11.21 chromosomal region upstream from LCR22-A identified using FISH, MLPA, and/or array-CGH. We report a cohort of 43 CES cases. We highlight that the clinical triad represents no more than 50% of cases. However, only 16% of CES patients presented with the three signs of the triad and 9% not present any of these three signs. We also highlight the importance of other impairments: cardiac anomalies are one of the major signs of CES (51% of cases), and high frequency of intellectual disability (47%). Ocular motility defects (45%), abdominal malformations (44%), ophthalmologic malformations (35%), and genitourinary tract defects (32%) are other frequent clinical features. We observed that sSMC is the most frequent chromosomal anomaly (91%) and we highlight the high prevalence of mosaic cases (40%) and the unexpectedly high prevalence of parental transmission of sSMC (23%). Most often, the transmitting parent has mild or absent features and carries the mosaic marker at a very low rate (<10%). These data allow us to better delineate the clinical phenotype associated with CES, which must be taken into account in the cytogenetic testing for this syndrome. These findings draw attention to the need for genetic counseling and the risk of recurrence.
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Affiliation(s)
- Guillaume Jedraszak
- Constitutional Genetics Laboratory, University Hospital of Amiens, Amiens, France
- UR4666, University of Picardy Jules Verne, Amiens, France
| | - Florence Jobic
- Clinical Genetics Unit, University Hospital of Amiens, Amiens, France
| | - Aline Receveur
- Constitutional Genetics Laboratory, University Hospital of Amiens, Amiens, France
| | - Frédéric Bilan
- Genetics Laboratory, University Hospital of Poitiers, Poitiers, France
| | | | - Busa Tiffany
- Medical Genetics Unit, University Hospital of Marseille, Marseille, France
| | - Chantal Missirian
- Cytogenetics Laboratory, University Hospital of Marseille, Marseille, France
| | - Marjolaine Willems
- Medical Genetics Laboratory, University Hospital of Montpellier, Montpellier, France
| | - Sylvie Odent
- Medical Genetics Unit, University Hospital of Rennes, Rennes, France
| | - Josette Lucas
- Genetics Laboratory, University Hospital of Rennes, Rennes, France
| | | | - Elise Schaefer
- Clinical Genetics Unit, University Hospital of Strasbourg, Strasbourg, France
| | | | | | - Alice Goldenberg
- Clinical Genetics Unit, University Hospital of Rouen, Rouen, France
| | | | | | - Pascal Chambon
- Cytogenetics Laboratory, University Hospital of Rouen, Rouen, France
| | - Cédric Le Caignec
- Medical Gentics Unit, University Hospital of Toulouse, Toulouse, France
| | - Albert David
- Clinical Genetics Unit, University Hospital of Nantes, Nantes, France
| | - Charles Coutton
- Cytogenetics Laboratory, University Hospital of Grenoble & INSERM U1209 Institute for Advanced Biosciences, University of Grenoble Alpes, Grenoble, France
| | - Véronique Satre
- Cytogenetics Laboratory, University Hospital of Grenoble & INSERM U1209 Institute for Advanced Biosciences, University of Grenoble Alpes, Grenoble, France
| | - Gaëlle Vieville
- Cytogenetics Laboratory, University Hospital of Grenoble, Grenoble, France
| | - Florence Amblard
- Cytogenetics Laboratory, University Hospital of Grenoble, Grenoble, France
| | - Radu Harbuz
- Cytogenetics Laboratory, University Hospital of Grenoble, Grenoble, France
| | | | - Marianne Till
- Cytogenetics Laboratory, University Hospital of Lyon, Bron, France
| | - Catherine Vincent-Delorme
- Catherine Vincent Delorme, Clinical Genetics Unit Guy Fontaine, University Hospital of Lille, Lille, France
| | - Cindy Colson
- Catherine Vincent Delorme, Clinical Genetics Unit Guy Fontaine, University Hospital of Lille, Lille, France
| | - Joris Andrieux
- Molecular Genetics Institute, University hospital of Lille, Lille, France
| | - Sophie Naudion
- Clinical Genetics Unit, University Hospital of Bordeaux, Bordeaux, France
| | - Jérome Toutain
- Clinical Genetics Unit, University Hospital of Bordeaux, Bordeaux, France
| | - Caroline Rooryck
- Medical Genetics Laboratory, University Hospital of Bordeaux, Bordeaux, France
| | | | - Fabienne Prieur
- Medical Genetics Unit, University Hospital of Saint-Etienne, Saint Etienne, France
| | | | - Daniel Amram
- Clinicial Genetics Unit, University Hospital of Creteil, Creteil, France
| | | | | | | | - Johannes Lemke
- Institute of Human Genetics, University of Leipzig Medical Center, Leipzig, Germany
| | - Eunice G Stefanou
- Cytogenetics Unit, Laboratory of Medical Genetics, University General Hospital of Patras, Patras, Greece
| | - Thomaidis Loretta
- Developmental Assessment Unit, National and Kapodistrian University of Athens, Athens, Greece
| | | | - Sophia Kitsiou Tzeli
- Department of Medical Genetics, National and Kapodistrian University of Athens, Athens, Greece
| | - Henryka Sodowska
- Niepubliczny Zakład Opieki Zdrowotne "Genom", Ruda Slaska, Poland
| | - Jasen Anderson
- Cytogenetics Department, Sullivan and Nicolaides Pathology, Taringa, Queensland, Australia
| | - Adayapalam Nandini
- Department of Cytogenetics, Royal Brisbane and Women's Hospital, Brisbane, Australia
| | - Henri Copin
- Constitutional Genetics Laboratory, University Hospital of Amiens, Amiens, France
| | - Loïc Garçon
- Constitutional Genetics Laboratory, University Hospital of Amiens, Amiens, France
- UR4666, University of Picardy Jules Verne, Amiens, France
| | - Thomas Liehr
- Jena University Hospital, Friedrich Schiller University, Institute of Human Genetics, Jena, Germany
| | - Gilles Morin
- Clinical Genetics Unit, University Hospital of Amiens, Amiens, France
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Kodytková A, Amaratunga SA, Zemková D, Maratová K, Dušátková P, Plachý L, Průhová Š, Koloušková S, Lebl J. SALL4 Phenotype in Four Generations of One Family: An Interplay of the Upper Limb, Kidneys, and the Pituitary. Horm Res Paediatr 2023; 97:203-210. [PMID: 37611564 DOI: 10.1159/000531996] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/29/2022] [Accepted: 07/01/2023] [Indexed: 08/25/2023] Open
Abstract
INTRODUCTION The SALL4 gene encodes a transcription factor that is essential for early embryonic cellular differentiation of the epiblast and primitive endoderm. It is required for the development of neural tissue, kidney, heart, and limbs. Pathogenic SALL4 variants cause Duane-radial ray syndrome (Okihiro syndrome), acro-renal-ocular syndrome, and Holt-Oram syndrome. We report a family with vertical transmission of a SALL4 pathogenic variant leading to radial hypoplasia and kidney dystopia in several generations with additional growth hormone deficiency (GHD) in the proband. CASE PRESENTATION Our male proband was born at the 39th week of gestation. He was born small for gestational age (SGA; birth weight 2,550 g, -2.2 SDS; length 47 cm, -2.0 SDS). He had bilateral asymmetrical radial ray malformation (consisting of radial hypoplasia, ulnar flexure, and bilateral aplasia of the thumb) and pelvic kidney dystopia, but no cardiac malformations, clubfoot, ocular coloboma, or Duane anomaly. He was examined for progressive short stature at the age of 3.9 years, where his IGF-1 was 68 μg/L (-1.0 SD), and growth hormone (GH) after stimulation 6.2 μg/L. Other pituitary hormones were normal. A brain CT revealed normal morphology of the cerebral midline and the pituitary. He had a dental anomaly - a central mandibular ectopic canine. MRI could not be done due to the presence of metal after multiple corrective plastic surgeries of his hands. His mother's and father's heights are 152.3 cm (-2.4 SD) and 177.8 cm (-0.4 SD), respectively. His father has a milder malformation of the forearm. The affected paternal grandfather (height 164 cm; -2.3 SD) has a radial ray defect with missing opposition of the thumb. The family reports a similar phenotype of radial dysplasia in the paternal grandfather's mother. The proband started GH therapy at age 6.5 years when his height was 109 cm (-2.8 SDS) and he experienced catch-up growth as expected in GHD. Puberty started spontaneously at the age of 12.5 years. At age 13, his height was 158.7 cm (-0.2 SDS). Whole-exome sequencing revealed a nonsense variant in the SALL4 gene c.1717C>T (p.Arg573Ter) in the proband, his father, and paternal grandfather. CONCLUSION This is the first observation of a patient with a congenital upper limb defect due to a pathogenic SALL4 variant who has isolated GHD with no apparent cerebral or facial midline anomaly and has been successfully treated with growth hormone.
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Affiliation(s)
- Aneta Kodytková
- Department of Paediatrics, 2nd Faculty of Medicine, Charles University and University Hospital Motol, Prague, Czechia
| | - Shenali Anne Amaratunga
- Department of Paediatrics, 2nd Faculty of Medicine, Charles University and University Hospital Motol, Prague, Czechia
| | - Daniela Zemková
- Department of Paediatrics, 2nd Faculty of Medicine, Charles University and University Hospital Motol, Prague, Czechia
| | - Klára Maratová
- Department of Paediatrics, 2nd Faculty of Medicine, Charles University and University Hospital Motol, Prague, Czechia
| | - Petra Dušátková
- Department of Paediatrics, 2nd Faculty of Medicine, Charles University and University Hospital Motol, Prague, Czechia
| | - Lukáš Plachý
- Department of Paediatrics, 2nd Faculty of Medicine, Charles University and University Hospital Motol, Prague, Czechia
| | - Štěpánka Průhová
- Department of Paediatrics, 2nd Faculty of Medicine, Charles University and University Hospital Motol, Prague, Czechia
| | - Stanislava Koloušková
- Department of Paediatrics, 2nd Faculty of Medicine, Charles University and University Hospital Motol, Prague, Czechia
| | - Jan Lebl
- Department of Paediatrics, 2nd Faculty of Medicine, Charles University and University Hospital Motol, Prague, Czechia,
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Serra G, Giambrone C, Antona V, Cardella F, Carta M, Cimador M, Corsello G, Giuffrè M, Insinga V, Maggio MC, Pensabene M, Schierz IAM, Piro E. Congenital hypopituitarism and multiple midline defects in a newborn with non-familial Cat Eye syndrome. Ital J Pediatr 2022; 48:170. [PMID: 36076277 PMCID: PMC9461219 DOI: 10.1186/s13052-022-01365-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/14/2022] [Accepted: 09/02/2022] [Indexed: 11/17/2022] Open
Abstract
Background Cat eye syndrome (CES) is a rare chromosomal disease, with estimated incidence of about 1 in 100,000 live newborns. The classic triad of iris coloboma, anorectal malformations, and auricular abnormalities is present in 40% of patients, and other congenital defects may also be observed. The typical associated cytogenetic anomaly relies on an extra chromosome, derived from an inverted duplication of short arm and proximal long arm of chromosome 22, resulting in partial trisomy or tetrasomy of such regions (inv dup 22pter-22q11.2). Case presentation We report on a full-term newborn, referred to us soon after birth. Physical examination showed facial dysmorphisms, including hypertelorism, down slanted palpebral fissures, and dysplastic ears with tragus hypoplasia and pre-auricular pit. Ophthalmologic evaluation and heart ultrasound identified left chorioretinal and iris coloboma and ostium secundum type atrial septal defect, respectively. Based on the suspicion of cat eye syndrome, a standard karyotype analysis was performed, and detected an extra small marker chromosome confirming the CES diagnosis. The chromosomal abnormality was then defined by array comparative genome hybridization (a-CGH, performed also in the parents), which identified the size of the rearrangement (3 Mb), and its de novo occurrence. Postnatally, our newborn presented with persistent hypoglycemia and cholestatic jaundice. Endocrine tests revealed congenital hypothyroidism, cortisol and growth hormone (GH) deficiencies, which were treated with replacement therapies (levotiroxine and hydrocortisone). Brain magnetic resonance imaging, later performed, showed aplasia of the anterior pituitary gland, agenesis of the stalk and ectopic neurohypophysis, confirming the congenital hypopituitarism diagnosis. She was discharged at 2 months of age, and included in a multidisciplinary follow-up. She currently is 7 months old and shows a severe global growth failure, and developmental delay. She started GH replacement treatment, and continues oral hydrocortisone, along with ursodeoxycholic acid and levothyroxine, allowing an adequate control of glycemic and thyroid profiles as well as of cholestasis. Conclusions CES phenotypic spectrum is wide and highly variable. Our report highlights how among the possible associated endocrine disorders, congenital hypopituitarism may occur, leading to persistent hypoglycemia and cholestasis. These patients should be promptly assessed for complete hormonal evaluations, in addition to major malformations and midline anomalies. Early recognition of such defects is necessary to decrease fatal events, as well as short and long-term related adverse outcomes.
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Affiliation(s)
- Gregorio Serra
- Department of Health Promotion, Mother and Child Care, Internal Medicine and Medical Specialties "G. D'Alessandro", University of Palermo, Palermo, Italy.
| | - Clara Giambrone
- Department of Health Promotion, Mother and Child Care, Internal Medicine and Medical Specialties "G. D'Alessandro", University of Palermo, Palermo, Italy
| | - Vincenzo Antona
- Department of Health Promotion, Mother and Child Care, Internal Medicine and Medical Specialties "G. D'Alessandro", University of Palermo, Palermo, Italy
| | - Francesca Cardella
- Pediatric Unit, Children's Hospital "G. Di Cristina", University of Palermo, Palermo, Italy
| | - Maurizio Carta
- Department of Health Promotion, Mother and Child Care, Internal Medicine and Medical Specialties "G. D'Alessandro", University of Palermo, Palermo, Italy
| | - Marcello Cimador
- Department of Health Promotion, Mother and Child Care, Internal Medicine and Medical Specialties "G. D'Alessandro", University of Palermo, Palermo, Italy
| | - Giovanni Corsello
- Department of Health Promotion, Mother and Child Care, Internal Medicine and Medical Specialties "G. D'Alessandro", University of Palermo, Palermo, Italy
| | - Mario Giuffrè
- Department of Health Promotion, Mother and Child Care, Internal Medicine and Medical Specialties "G. D'Alessandro", University of Palermo, Palermo, Italy
| | - Vincenzo Insinga
- Department of Health Promotion, Mother and Child Care, Internal Medicine and Medical Specialties "G. D'Alessandro", University of Palermo, Palermo, Italy
| | - Maria Cristina Maggio
- Pediatric Unit, Children's Hospital "G. Di Cristina", University of Palermo, Palermo, Italy
| | - Marco Pensabene
- Department of Health Promotion, Mother and Child Care, Internal Medicine and Medical Specialties "G. D'Alessandro", University of Palermo, Palermo, Italy
| | - Ingrid Anne Mandy Schierz
- Department of Health Promotion, Mother and Child Care, Internal Medicine and Medical Specialties "G. D'Alessandro", University of Palermo, Palermo, Italy
| | - Ettore Piro
- Department of Health Promotion, Mother and Child Care, Internal Medicine and Medical Specialties "G. D'Alessandro", University of Palermo, Palermo, Italy
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Chen Y, Liu Z, Lin Z, Shi X. Eye Signs in Pituitary Disorders. Neurol India 2019; 67:979-982. [PMID: 31512618 DOI: 10.4103/0028-3886.266265] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
The eye is a vital sense organ and plays a vital role in conveying the underlying physical and mental state of wellbeing of an individual. A comprehensive examination of the eye is often required in patients presenting with systemic complaints. Many endocrine disorders have characteristic manifestations pertaining to the eye, the classical being the exophthalmos in thyrotoxicosis. However, a cursory eye evaluation may lead to the identification of early features that can help in the diagnosis of other endocrine disorders. This is more common in cases of pituitary mass lesions, who often present with the functional hormonal alterations rather than the visual symptoms. The definitive therapy during the late stages of the disease leads to persisting visual disabilities and affects the quality of life. Hence, the endocrinologists and ophthalmologists need to be aware of various ophthalmic features in the pituitary disorders. In this review, we highlight the eye signs in pituitary disorders, along with a brief description of uncommon ocular-pituitary syndromes.
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Affiliation(s)
- Yan Chen
- Department of Ophthalmology, The Affiiated Hospital to Changchun University of Chinese Medicine, Changchun, Jilin, China
| | - Zhihong Liu
- Department of Ophthalmology, The Affiiated Hospital to Changchun University of Chinese Medicine, Changchun, Jilin, China
| | - Zhihui Lin
- Department of Ophthalmology, The Affiiated Hospital to Changchun University of Chinese Medicine, Changchun, Jilin, China
| | - Xiaozhe Shi
- Department of Ophthalmology, The Affiiated Hospital to Changchun University of Chinese Medicine, Changchun, Jilin, China
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