Department of Clinical Genetics, The Churchill Hospital, Oxford, UK.
Am J Med Genet A. 2009 Dec;149A(12):2809-12. doi: 10.1002/ajmg.a.33096.
We present a patient with features of Ulnar Mammary syndrome (UMS) consisting of bilateral ulnar defects, inverted nipples, short stature with associated growth hormone deficiency, and cryptorchidism. Our patient also had a hypoplastic anterior pituitary and an ectopic posterior pituitary gland, ventricular septal defect (VSD), and cardiac conduction defects consistent with Wolff-Parkinson-White (WPW) syndrome. Although TBX3 is known to be expressed in both the developing heart and the pituitary gland, conduction defects and anatomical pituitary abnormalities have not been previously described in UMS. This may, in part, be due to the fact that these features are not actively sought in individuals with UMS. Because these new findings have important clinical implications, we suggest that clinicians caring for individuals with UMS offer brain imaging, growth hormone testing, and cardiac arrhythmia screening. The diagnosis of UMS was confirmed on mutation analysis of TBX3. The mother of the propositus was also found to carry the same mutation, although she did not show the classical features of UMS. Therefore, our report also supports the variable expressivity of UMS within the same family.
我们报告了 1 例具有 Ulnar Mammary 综合征(UMS)特征的患者,其特征包括双侧尺骨缺陷、乳头内陷、身材矮小伴生长激素缺乏症和隐睾。我们的患者还存在垂体前叶发育不良和垂体后叶异位,室间隔缺损(VSD)和符合 Wolff-Parkinson-White(WPW)综合征的心脏传导缺陷。尽管 TBX3 已知在发育中的心脏和垂体中均有表达,但 UMS 中以前未描述过传导缺陷和解剖垂体异常。这可能部分是因为在 UMS 患者中并未积极寻求这些特征。由于这些新发现具有重要的临床意义,因此我们建议照顾 UMS 患者的临床医生提供脑部成像、生长激素检测和心律失常筛查。通过对 TBX3 的突变分析,确认了 UMS 的诊断。先证者的母亲也发现携带相同的突变,尽管她没有表现出典型的 UMS 特征。因此,我们的报告还支持了同一家庭中 UMS 的可变表达性。