Galaz-Montoya Carolina Isabel, García-Delgado Constanza, Cervantes-Peredo Alicia, García-Morales Leticia, Morán-Barroso Verónica Fabiola
Departamento de Genética, Hospital Infantil de México Federico Gómez, México D.F., México.
Servicio de Genética, Hospital General de México Dr. Eduardo Liceaga, México D.F., México; Facultad de Medicina, Universidad Nacional Autónoma de México, México D.F., México.
Bol Med Hosp Infant Mex. 2014 Jul-Aug;71(4):218-226. doi: 10.1016/j.bmhimx.2014.08.001. Epub 2015 May 19.
Patients with Silver-Russell syndrome suffer from severe intrauterine and postnatal growth retardation, relative macrocephaly and body asymmetry, among other characteristics. It is caused by several genetic and epigenetic mechanisms in 11p15.5 in 40% of the cases and maternal uniparental disomy of chromosome 7 in 10%.
Twenty patients with a diagnosis of Silver-Russell syndrome who were seen at the HIMFG from 1998 to 2012, were evaluated according to international clinical criteria confirming the diagnosis in nine of the subjects.
All patients showed intrauterine and postnatal growth retardation and short stature, both considered as major criteria of Silver-Russell syndrome. Relative macrocephaly was present in 78% of the patients and asymmetry in 33%. Other characteristics such as renal tubular acidosis were present > 50% of the cases.
The clinical diagnosis of Silver-Russell syndrome is complex. Short stature is the main reason for seeking medical attention and is helpful in the identification of a differential diagnosis. This situation underlines the importance of growth and development evaluation of all patients and particularly in those with short stature to identify those cases that may require molecular studies, with implications in management, prognosis and genetic counseling.
Silver-Russell综合征患者存在严重的宫内和出生后生长发育迟缓、相对巨头畸形和身体不对称等特征。40%的病例是由11p15.5的几种遗传和表观遗传机制引起的,10%是由母源7号染色体单亲二体所致。
对1998年至2012年在HIMFG就诊的20例诊断为Silver-Russell综合征的患者,根据国际临床标准进行评估,其中9例确诊。
所有患者均表现出宫内和出生后生长发育迟缓及身材矮小,这两者均被视为Silver-Russell综合征的主要标准。78%的患者存在相对巨头畸形,33%存在不对称。其他特征如肾小管酸中毒在超过50%的病例中出现。
Silver-Russell综合征的临床诊断较为复杂。身材矮小是就医的主要原因,有助于鉴别诊断。这种情况凸显了对所有患者,尤其是身材矮小患者进行生长发育评估的重要性,以便识别那些可能需要分子研究的病例,这对管理、预后和遗传咨询具有重要意义。