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Leri-Weill Dyschondrosteosis

LWD

Leri-Weill dyschondrosteosis is a rare genetic disease that induces short stature and limb abnormalities primarily due to to SHOX gene mutations. The diagnosis can be made by observing typical clinical findings and identification of specific genetic mutations. Growth hormone therapy may be an option, but there is no cure for this disorder and long-term symptomatic care is necessary.


Presentation

The clinical presentation includes a triad of symptoms [1] [2] [5]:

  • Short stature - Growth failure and reduced height in early childhood is an essential feature of LWD.
  • Madelung deformity - Defined as deformity of the wrist and abnormal placement of radius and ulna, this anatomical malformation is most evident in later childhood and can cause significant movement restriction, limiting supination and pronation.
  • Mesomelia - Disproportionately shorter segments of the middle limb portion induces overall shortening of the extremities, leading to evidently abnormal limb anatomy.
Virilization
  • Despite having almost the same genetic constitution as 47,XXY Klinefelter syndrome, he was normally virilized, although slight elevation of serum gonadotropins indicated gonadal dysfunction.[ncbi.nlm.nih.gov]
Short Disproportionate Stature
  • Methods and Results: We report a unique case of an 8-year-old girl who was successfully treated for acute lymphoblastic leukemia (pre-B ALL, intermediate risk) and was subsequently diagnosed with LWS due to characteristic clinical appearance (short disproportionate[biomed.papers.upol.cz]
Pediatric Disorder
  • Pediatric Hand and Upper Limb Surgery guides you to the present indications for intervention and care in upper limb pediatric disorders.[books.google.com]
High Arched Palate
  • In comparing the LWD and TS populations in the GeNeSIS sample, Madelung deformity, increased carrying angle, and scoliosis were more prevalent in the LWD population, whereas high arched palate was similarly prevalent in the two populations.[ncbi.nlm.nih.gov]
  • His mother had LWD plus additional findings of Turner syndrome (TS): high arched palate, bicuspid aortic valve, aortic stenosis, and premature ovarian failure. The proband's karyotype was 46,X,dic(X;Y)(p22.3;p11.32).[ncbi.nlm.nih.gov]
  • Other features of Leri Weill dyschondrosteosis can include increased muscle size, elbow abnormalities, scoliosis , high-arched palate, and exostoses . Intelligence is not affected by this condition.[globalgenes.org]
  • Short stature Shortening of lower limbs Abnormality of wrist Sometimes underdevelopment of jaw Increased muscle mass Bowing of lower leg Greater angling of elbow from body High arched palate *Please be aware, not all of the characteristics may be present[littlepeopleuk.org]
  • Other features of Leri Weill dyschondrosteosis can include increased muscle size, elbow abnormalities, scoliosis, high-arched palate, and exostoses. Intelligence is not affected by this condition.[resourcerepository.org]
Dermatitis
  • Página 54 - Pedigree demonstrating a sex-linked recessive condition characterized by draining ears, eczematoid dermatitis and bloody diarrhea. ‎ Página 51 - Selective IgA deficiency: presentation of 30 cases and a review of the literature. ‎[books.google.es]
Ptosis
  • Findings included growth retardation/short stature, congenital ptosis, abnormal tarsal bones, metatarsal duplication/hypoplasia, nail/phalangeal hypoplasia of fingers and toes, Madelung deformity, syndactyly of toes, and hallux valgus.[cags.org.ae]
  • […] hand Cubitus valgus, genu valgum Short stature, scoliosis Clinical clues to the diagnosis of SHOX haploinsufficiency in childhood include short stature, short limbs, wrist changes, and tibial bowing. 22 Noonan's syndrome Craniofacial anomalies, i.e. ptosis[powershow.com]
Short Neck
  • The physical examination showed dysmorphic aspect with shortening of arms and legs, small hands and feet, and short neck. Hypertension was not confirmed.[revistaseletronicas.pucrs.br]

Workup

A presumptive diagnosis can be made based on clinical findings during physical examination, but X-rays of the affected extremities can support clinical suspicion. Decreased length of ulna and radius, early fusion of the ulnar half of the distal epiphysis and dorsal subluxaton of the ulna are some of the most common radiological findings [1]. To confirm LWD, however, genetic testing for SHOX gene mutations should be performed [2].

Treatment

Recombinant human growth hormone (rhGH) can be used in the attempt to promote growth, although symptomatic care of patients is the main form of therapy, as there is no cure for LWD [1] [6].

Prognosis

Deformities associated with LWD can significantly impact the quality of life of children and the degree of impairment depends on the severity of symptoms.

Etiology

Mutations and deletions of one copy of the SHOX gene from the short arms of either X or Y chromosomes is presumed to be the underlying mechanism of LWD development [4] [5]. The disorder is transferred through a pseudoautosomal dominant pattern of inheritance, but in 40% of cases, SHOX mutations have not been confirmed and the underlying cause remains unknown [5].

Epidemiology

Incidence and prevalence rates of LWD are unknown. Numerous reports have addressed its more frequent occurrence females, as well as its more severe clinical presentation, possibly due to the effects of estrogen on skeletal tissue [2] [5].

Sex distribution
Age distribution

Pathophysiology

Alterations in SHOX genes have shown to be important constituents of many conditions that result in short stature, including LWD. The pathogenesis model is still not completely understood, but normal chondrocyte differentiation and maturation is shown to be impaired, leading to premature fusion of the physis and earlier cessation of longitudinal bone growth [1].

Prevention

Current prevention strategies do not exist, as the exact event that leads to SHOX mutations is yet to be revealed.

Summary

Leri-Weill dyschondrosteosis (LWD) is a pseudoautosomal dominant genetic disease that presents with a clinical triad of short stature, mesomelia (shortening of the middle portion of the limb in relation to the proximal portion) and abnormal anatomy of the radius, ulna and the carpal bones, known as Madelung deformity [1]. Mutations in the short stature homeobox containing gene (SHOX) located on X and Y chromosomes is thought to be the underlying cause [2], but in up to 40% of cases, SHOX mutations are not encountered and the etiology remains unknown [3]. LWD is considered to be a rare disease with unknown incidence and prevalence rates and symptoms become evident in school-aged children [1]. The diagnosis can be made based on clinical findings that are supported by radiographic and genetic studies [2]. Recombinant human growth hormone (rhGH) may be used to promote growth [2].

Patient Information

Leri-Weill dyschondrosteosis (LWD) is a rare genetic disease that causes short stature and limb abnormalities. In about 60% of cases, the disorder stems from mutations of short stature homeobox containing gene (SHOX) located on chromosomes X and Y (known as sex chromosomes). LWD is transmitted by an autosomal dominant pattern of inheritance, meaning that children have a 50% of contracting the disease if one parent carries a mutation. A triad of shot stature, reduced limb length (mesomelia) and displacement of bones in the forearm (Madelung deformity) appearing in school-aged children (more commonly female) is the hallmark of LWD and the initial diagnosis can be made based on identifying these findings. To confirm this rare inherited condition, however, genetic testing is necessary. Current therapy includes administration of recombinant human growth hormone to stimulate growth and symptomatic care, as LWD may have an impact on the quality of life in terms of limited mobility of the affected extremities and basic daily functions.

References

Article

  1. Binder G, Rappold GA. SHOX Deficiency Disorders. In: Pagon RA, Adam MP, Ardinger HH, et al., editors. GeneReviews® [Internet]. Seattle (WA): University of Washington, Seattle; 1993-2016.
  2. Choi WB, Seo SH, Yoo WH, Kim SY, Kwak MJ. A Leri-Weill dyschondrosteosis patient confirmed by mutation analysis of SHOX gene. Ann Pediatr Endocrinol Metab. 2015;20(3):162-165.
  3. Benito-Sanz S, Thomas NS, Huber C, et al. A Novel Class of Pseudoautosomal Region 1 Deletions Downstream of SHOX Is Associated with Léri-Weill Dyschondrosteosis. Am J Hum Genet. 2005;77(4):533-544.
  4. Munns CF, Glass IA, LaBrom R, et al. Histopathological analysis of Leri-Weill dyschondrosteosis: disordered growth plate. Hand Surg. 2001;6(1):13-23.
  5. Binder G, Renz A, Martinez A, et al. SHOX haploinsufficiency and Leri-Weill dyschondrosteosis: prevalence and growth failure in relation to mutation, sex, and degree of wrist deformity. J Clin Endocrinol Metab. 2004;89(9):4403-4408.
  6. Salmon-Musial AS, Rosilio M, David M, et al. Clinical and radiological characteristics of 22 children with SHOX anomalies and familial short stature suggestive of Léri-Weill Dyschondrosteosis. Horm Res Paediatr. 2011;76(3):178-85.

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Last updated: 2019-07-11 20:18