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Cornelia de Lange syndrome (CdLS) is a rare genetic disorder that is apparent at birth (congenital). Associated symptoms and findings typically include delays in physical development before and after birth (prenatal and postnatal growth retardation); characteristic abnormalities of the head and facial (craniofacial) area, resulting in a distinctive facial appearance; malformations of the hands and arms (upper limbs); and mild to severe mental retardation. Many infants and children with the disorder have an unusually small, short head (microbrachycephaly); an abnormally long vertical groove between the upper lip and nose (philtrum); a depressed nasal bridge; upturned nostrils (anteverted nares); and a protruding upper jaw (maxillary prognathism). Additional, characteristic facial abnormalities may include thin, downturned lips; low-set ears; arched, well-defined eyebrows that grow together across the base of the nose (synophrys); an unusually low hairline on the forehead and the back of the neck; and abnormally curly, long eyelashes. Affected individuals may also have distinctive malformations of the limbs, such as unusually small hands and feet, inward deviation (clinodactyly) of the fifth fingers, or webbing (syndactyly) of certain toes. Less commonly, there may be absence of the forearms, hands, and fingers. Infants with Cornelia de Lange syndrome may also have feeding and breathing difficulties; an increased susceptibility to respiratory infections; a low-pitched "growling" cry; heart defects; delayed skeletal maturation; hearing loss; or other physical abnormalities. The range and severity of associated symptoms and findings may be extremely variable from case to case.
Cornelia de Lange syndrome can be inherited as an autosomal dominant condition or an X-linked condition. The only genes that have been found to be associated with Cornelia de Lange syndrome are the NIPBL gene on chromosome 5 and the SMC1L1 gene on the X chromosome. Most affected individuals have an abnormal gene as a result of a new gene mutation and do not have an affected parent. Other genes may be found to be associated with Cornelia de Lange syndrome in the future.
Cornelia de Lange syndrome (CdLS) is a very rare disorder characterized by growth delays; distinctive facial features; malformations of the hands, feet, arms, and/or legs (limb anomalies); other physical abnormalities; mental retardation; and/or developmental delays. The range and severity of symptoms and physical characteristics may vary greatly from case to case.
Individuals with CdLS exhibit abnormal growth delays that affect both weight and linear growth before and after birth (prenatal and postnatal growth retardation). Most affected infants may have a low birth weight and may fail to gain weight or grow at the expected rate (failure to thrive). CdLS growth charts are available to compare growth to other affected individuals. Individuals may experience feeding, chewing, and swallowing difficulties during the first several months/years of life.
Many affected infants may frequently "spit up" food that has already been swallowed (regurgitation) and experience episodes of severe, forceful vomiting (projectile vomiting). Infants with CdLS may also demonstrate abnormally increased muscle tone (hypertonicity) and have an unusual, low-pitched, growling cry.
Individuals with Cornelia de Lange syndrome also have distinctive features of the head and facial (craniofacial) area including an abnormally small head (microcephaly) that may also be unusually short and wide (brachycephaly); a short, thick neck; a low hairline; a small, broad, upturned nose with nostrils that tilt forward (anteverted nares); neat, arched eyebrows that grow together (synophrys); long, curly eyelashes; and/or excessive hair growth on various areas of the body (hypertrichosis). Additional features may include thin, downturned lips; an abnormally long vertical gap between the upper lip (philtrum) and the nose; an abnormally small, underdeveloped jaw (micrognathia); late-erupting, widely-spaced, unusually small teeth; and low-set ears. In some cases, affected infants may also exhibit incomplete closure of the roof of the mouth (cleft palate) and/or a highly arched palate.
In most infants with Cornelia de Lange syndrome, the hands and feet are small for their size. In addition, affected individuals may have short fingers that become smaller and thinner toward the ends (tapered fingers), fifth fingers that are permanently curved toward the ring finger (clinodactyly), and/or, in some cases, absence of one or more fingers (oligodactyly). The thumbs may be abnormally positioned (i.e., proximally placed) and the arms may be permanently bent or flexed at the elbows due to bone fusions. In addition, in many cases, affected individuals may demonstrate underdevelopment (hypoplasia) of some of the bones of the fingers and toes, and the second and third toes are often abnormally fused or webbed (syndactyly). Some affected infants may also have abnormally small or short bones in the arms and/or legs (micromelia) or, in rare cases, fingers, hands, and forearms may be missing. In individuals with CdLS, upper limb abnormalities may involve one side (unilateral) or both sides (bilateral) of the body. If bilateral limb malformations are present, the abnormalities on one side of the body may be completely different from those on the other side (asymmetrical). Although the feet are small, only in extremely rare cases are there absent bones in the feet or lower legs.
Individuals with Cornelia de Lange syndrome also demonstrate delayed bone age (retarded osseous maturation). In addition, affected individuals may remain low in weight and exhibit abnormally short stature (prenatal and postnatal growth retardation), failure to thrive during infancy, delayed bone age, and/or other abnormalities. Many individuals with CdLS also exhibit additional skeletal abnormalities. These may include a deformity of the hip (coxa valga), a short breastbone (sternum), and/or abnormally thin ribs.
Many infants and children with CdLS may exhibit delays in the acquisition of skills requiring the coordination of mental and muscular activity (psychomotor retardation), have mild to severe mental retardation, and/or demonstrate behavioral problems (e.g., episodes of biting, screaming, hitting, etc.). In addition, although affected children often lack facial expression based on emotion, they appear to respond positively to certain stimuli (e.g., fast movements). A CdLS developmental chart is available to compare milestones.
In many cases, children with Cornelia de Lange syndrome also demonstrate hearing impairment as well as abnormal speech development. Middle ear infections (otitis media), which sometimes occur chronically with an accumulation of sticky fluid (otitis media with effusion or glue ear), are common. Younger children may have difficulty speaking (dysphonia), while older children may have abnormally hoarse speech.
Many individuals with CdLS also exhibit additional physicial abnormalities. In many cases, the skin may appear "marbled" (cutis marmorata), and the skin above the eyes, mouth, and nose may have an unusual bluish tone. In addition, many affected individuals demonstrate irregularities in the skin ridge patterns on the palms of the hands (dermatoglyphics). As mentioned earlier, most affected individuals may exhibit excessive hair growth (hypertrichosis) on various areas of the body including the ears. Hair may also tend to appear on the lower back, limbs, and/or other areas of the body.
Many individuals with Cornelia de Lange syndrome may also have various abnormalities of the gastrointestinal system including gastroesophageal reflux, a condition in which the acidic contents of the stomach flow upward into the lower esophagus; inflammation of the lining of the esophagus (esophagitis); and/or narrowing of the esophagus (esophageal stenosis). (For more information on this condition, choose "Gastroesophageal Reflux" as your search term in the Rare Disease Database.) In addition, affected individuals may demonstrate abnormal twisting (malrotation) of the intestines, potentially causing intestinal obstruction (volvulus). In some cases, the bands of muscle fibers (pyloric sphincter) at the junction between the stomach and small intestine (pyloric stenosis) may become abnormally narrowed (stenosis), resulting in obstruction of the normal flow of stomach contents into the small intestine. In addition, some individuals with CdLS may also exhibit protrusion of portions of the large intestine through an abnormal opening in musculature lining the abdominal cavity in the area of the groin (inguinal hernia) and/or part of the stomach through an abnormal opening where the esophagus passes through the diaphragm (hiatal hernia). In some individuals with CdLS, certain gastrointestinal abnormalities may lead to intestinal obstruction, potentially causing serious or life-threatening complications if left untreated.
Some individuals with Cornelia de Lange syndrome may also have malformations of the genitourinary tract. In affected males, such abnormalities may include underdevelopment (hypoplasia) of the genitals, failure of one or both of the testes to descend into the scrotum (cryptorchidism), and/or abnormal placement of the urinary opening (urinary meatus) on the underside of the penis (hypospadias). Affected females may demonstrate abnormal development of the uterus (e.g., bicornate or septate uterus), and menstruation may be irregular.
In many cases, individuals with CdLS may have additional physical abnormalities. Some affected infants and children may have various heart (cardiac) abnormalities, and many may demonstrate an increased suspectibility to repeated respiratory infections. In some cases, affected individuals may also have eye abnormalities such as nearsightedness (myopia), rapid, involuntary eye movements (nystagmus), and/or abnormal drooping of the upper eyelid(s) (ptosis). Some infants and children with CdLS may also experience episodes of uncontrolled electrical disturbances in the brain (seizures); and/or exhibit additional physical abnormalities.
Cornelia de Lange syndrome can be inherited as an autosomal dominant condition or an X-linked condition, but most affected individuals have an abnormal gene as a result of a new gene mutation. The only genes that have been found to be associated with Cornelia de Lange syndrome are the NIPBL gene on chromosome 5 and the SMC1L1 gene on the X chromosome. Approximately 50% of those affected have a NIPBL gene mutation and a small percentage have a SMC1L1 gene mutation. Other genes may be found to be associated with Cornelia de Lange syndrome in the future.
Dominant genetic disorders occur when only a single copy of an abnormal gene is necessary to cause a particular disease. The abnormal gene can be inherited from either parent or can be the result of a new mutation (gene change) in the affected individual. The risk of passing the abnormal gene from affected parent to offspring is 50% for each pregnancy. The risk is the same for males and females.
X-linked genetic disorders are conditions caused by an abnormal gene on the X chromosome and occur mostly in males. Females that have a disease gene present on one of their X chromosomes are carriers for that disorder. Carrier females usually do not display symptoms because females have two X chromosomes and one is inactivated so that the genes on that chromosome are nonfunctioning. It is usually the X chromosome with the abnormal gene that is inactivated. Males have one X chromosome that is inherited from their mother and if a male inherits an X chromosome that contains a disease gene he will develop the disease. Female carriers of an X-linked disorder have a 25% chance with each pregnancy to have a carrier daughter like themselves, a 25% chance to have a non-carrier daughter, a 25% chance to have a son affected with the disease and a 25% chance to have an unaffected son.
Males with X-linked disorders pass the disease gene to all of their daughters who will be carriers. A male cannot pass an X-linked gene to his sons because males always pass their Y chromosome instead of their X chromosome to male offspring.
Cornelia de Lange syndrome is a very rare disorder that is apparent at birth (congenital). Males and females appear to be affected in equal numbers. It has been estimated that Cornelia de Lange syndrome occurs in approximately one in every 10,000 live births in the United States. More than 400 cases have been reported in the medical literature, including affected individuals within several families (kindreds). In some reported cases, affected family members have been siblings. It is estimated that there is a one to two percent rate of recurrence within affected families.
Symptoms of the following disorders can be similar to those of Cornelia de Lange syndrome. Comparisons may be useful for a differential diagnosis:
Coffin-Siris syndrome is an extremely rare genetic disorder that is present at birth (congenital). Infants with this disorder typically have underdeveloped (hypoplastic) or missing fifth fingers on both hands. The toenails may be underdeveloped or absent. Affected individuals may also exhibit characteristic abnormalities of the head and facial (craniofacial) area including an abnormally small head (microcephaly), a broad nose, a wide mouth with thick lips, a low nasal bridge, widely-spaced eyes (ocular hypertelorism), droopy upper eyelids (ptosis), thick eyelashes, dental abnormalities, and/or sparse scalp hair. During infancy, many affected individuals may experience feeding difficulties, vomiting, slow growth, and/or frequent respiratory infections. During the first two years of life, developmental delays, unusually short stature, and varying degrees of mental retardation may become apparent. Some children with Coffin-Siris syndrome may also exhibit additional physical abnormalities including abnormally loose joints (laxity) that may result in frequent dislocations, particularly of the elbows; mild to severe muscle weakness (hypotonia); motor delays; sideways curvature of the spine (scoliosis); and/or other skeletal, gastrointestinal, genitourinary, and/or cardiac malformations. In some cases, Coffin-Siris syndrome may occur randomly, for no apparent reason (sporadically); in other cases, the disorder may be inherited as an autosomal recessive genetic trait. (For more information on this disorder, choose "Coffin Siris" as your search term in the Rare Disease Database.)
Rubinstein-Taybi Syndrome is a rare genetic disorder associated with multiple abnormalities that include characteristic facial features and abnormally wide fingers and toes. Vision and hearing problems along with mental retardation may also occur. (For more information on this disorder, choose "Rubinstein-Taybi" as your search term in the Rare Disease Database.)
Fetal Alcohol syndrome (FAS) is a syndrome of altered fetal growth resulting in certain birth defects due to maternal consumption of alcohol during pregnancy. When a pregnant woman drinks alcoholic beverages, a pattern of defects in the fetus may occur at different stages of pregnancy. In many cases, affected infants are unusually small at birth, have an abnormally small head (microcephaly), and may fail to gain weight and grow at the expected rate (failure to thrive). Affected infants and children may exhibit delays in intellectual development as well as in the acquisition of fine and gross motor skills. In addition, affected individuals may have characteristic craniofacial abnormalities including a protruding forehead, a sunken nasal bridge and an abnormally short, upturned nose, an abnormally short opening between the upper and lower eyelids (palpebral fissures), the presence of vertical skin folds on the inner corners of the eyes (epicanthal folds), an incompletely developed, abnormally small upper jaw (maxillary hypoplasia), and/or incomplete closure of the roof of the mouth (cleft palate). Affected infants may also have other physical abnormalities including joint abnormalities, heart (cardiac) defects, and/or genital malformations. Infants with FAS often experience alcohol addiction withdrawal symptoms within 24 hours after birth. These may include tremors and/or convulsions, irritability, increased muscle tone, muscle and/or whole body spasms, increased respiratory rate, abdominal swelling (distention), and/or vomiting. (For more information on this disorder, choose "Fetal Alcohol" as your search term in the Rare Disease Database.)
Ruvalcaba syndrome is a very rare disorder thought to be inherited as an autosomal dominant genetic trait. The symptoms vary greatly among individuals with the disorder. Characteristic facial features are among the most distinguishable symptoms of this disorder. Affected individuals may have an abnormally small head (microcephaly) with an oval face; downslanting eyelid folds; abnormalities of the nose; a small, downturned mouth; a narrow, pointed jaw; and/or low-set ears. Additional features may include short stature; a narrow chest; protruding breastbone (pectus carinatum); abnormal sideways and/or front-to-back curvature of the spine (scoliosis and/or kyphosis); short fingers, toes, arms, and/or legs; abnormally small hands and feet; and/or abnormal bending of the fingers (clinodactyly). Affected individuals may also have certain skin abnormalities, underdevelopment (hypoplasia) of the reproductive organs, delayed puberty, and/or other physical abnormalities. Many individuals with Ruvalcaba syndrome may also have varying degrees of mental retardation. (For more information on this disorder, choose "Ruvalcaba" as your search term in the Rare Disease Database.)
Scott craniodigital syndrome with mental retardation is an extremely rare disorder that is thought to be inherited as an X-linked recessive genetic trait. This disorder is characterized by mental retardation and various physical abnormalities affecting the head and facial (craniofacial) area and the fingers and/or toes (digits). Characteristic craniofacial features may include a short, wide head (brachycephaly); a small, narrow nose; widely-spaced eyes (ocular hypertelorism); and/or an abnormally small lower jaw (mandible). In addition, some children may have a "startled" expression to their faces. Other characteristic features may include webbing of some of the fingers and toes (syndactyly); uncommmon skin ridge patterns (dermatoglyphic patterns) on the palms of the hands; and/or abnormal inward turning of the heel of the foot (talipes varus). In addition, individuals with this disorder may have scalp hair that is very thick with hair growing down onto the temples and in front of the ears; long, dark eyelashes; abnormally thick eyebrows; and/or excessive hair growth (hirsutism) on other areas of the body. (For more information on this disorder, choose "Scott Craniodigital" as your search term in the Rare Disease Database.)
Chromosome 3, Trisomy 3q2 is an extremely rare chromosomal disorder in which the end (distal) portion of the long arm (q) of the 3rd chromosome (3q) is present three times (trisomy) rather than twice in cells of the body. This disorder is characterized by abnormalities of the head and facial (craniofacial) area, other physical malformations, moderate to severe developmental delays, and/or mental retardation. Many of the craniofacial abnormalities and/or other physical malformations associated with Chromosome 3, Trisomy 3q2 are very similar to those often associated with Cornelia de Lange syndrome. For example, many infants and children with Trisomy 3q2 may have an abnormally small head (microcephaly) that also appears unusually short and wide (brachycephaly); a low hairline; a small, broad nose; thick, well-defined, bushy eyebrows that grow together (synophyrys); long eyelashes; and/or thin, downturned lips. Affected infants and children may also have excessive hair growth (hirsutism) on various areas of the body; abnormalities of the hands, feet, arms, and/or legs; hearing loss and speech impairment; and/or eye (ocular) abnormalities including crossing of the eyes (strabismus), rapid, involuntary eye movements (nystagmus), clouding of the lenses of the eyes (cataracts), and/or other ocular abnormalities. Individuals with Trisomy 3q2 may also have seizure episodes and/or genital, heart (cardiac), gastrointestinal, and/or kidney (renal) malformations. In most cases, Chromosome 3, Trisomy 3q2 is due to a balanced translocation in one of the parents. (For more information on this disorder, choose "Trisomy 3q2" as your search term in the Rare Disease Database.)
There may be other chromosomal disorders that may be characterized by symptoms similar to those of Cornelia de Lange syndrome. The only way to determine which chromosomal disorder an individual has is through chromosomal testing. Most individuals with CdLS have normal chromosomes. (For more information on such disorders, choose the exact disease name in question or "Chromosome" as your search term in the Rare Disease Database.)
In some cases, a diagnosis of Cornelia de Lange syndrome (CdLS) may be suspected before birth (prenatally) through the use of ultrasound imaging. During such testing, reflected sound waves create an image of the fetus that may reveal certain abnormalities characteristic of CdLS such as retarded growth, limb abnormalities, facial anomalies and/or organ malformations.
In most cases, CdLS is diagnosed and/or confirmed after birth based upon a thorough clinical evaluation and identification of characteristic physical findings. According to the medical literature, a diagnosis of Cornelia de Lange syndrome should be considered if affected individuals exhibit certain distinctive facial features in association with limb anomalies, prenatal and postnatal growth retardation, and mental retardation. Diagnosis may be more difficult if symptoms and physical characteristics associated with the disorder are very mild. Molecular genetic testing for the NIPBL and SMC1L1 gene mutations associated with CdLS is available to confirm the diagnosis and is particularly helpful when the physical features are mild or unusual. Prenatal diagnosis is available if a specific NIPBL or SMC1L1 gene mutation has been identified.
Molecular genetic testing for the NIPBL and SMC1L1 gene mutations associated with CdLS is available to confirm the diagnosis and is particularly helpful when the physical features are mild or unusual. Prenatal diagnosis is available if a specific NIPBL or SMC1L1 gene mutation has been identified.
The treatment of Cornelia de Lange syndrome is directed toward the specific symptoms that are apparent in each individual. Treatment may require the efforts of a team of specialists who will work together to systematically and comprehensively plan an affected child's treatment. Such specialists may include pediatricians; geneticists; surgeons; specialists who diagnose and treat skeletal disorders (orthopedists); plastic surgeons; orthopedic surgeons; specialists who diagnose and treat abnormalities of the digestive system (gastroenterologists), disorders of the urinary tract (urologists), and abnormalities of the ears, nose, and throat (otolaryngologists); pediatric heart specialists (cardiologists); dental specialists; speech pathologists; specialists who assess and treat hearing problems (audiologists); eye specialists; physical and occupational therapists; and/or other health care professionals.
Affected infants and children may be closely monitored for certain abnormalities potentially associated with Cornelia de Lange syndrome (e.g., potential intestinal obstruction due to gastrointestinal abnormalities, cardiac defects, gastroesophageal reflux, glue ear, and/or susceptibility to respiratory infections) to ensure early detection and prompt treatment.
Specific therapies for the treatment of Cornelia de Lange syndrome are symptomatic and supportive. In some cases, surgery may be performed to help correct certain cleft palate. Plastic surgery may be helpful in reducing excessive hair. In some cases, other abnormalities potentially associated with CdLS (e.g., gastrointestinal, genitourinary, and/or cardiac malformations) may be treated with certain medications, surgical intervention, and/or other techniques. In such cases, the surgical procedures performed will depend upon the location and severity of the anatomical abnormalities and their associated symptoms. Respiratory infections may be treated with antibiotic drug therapy and/or other medications that may help fight infection.
In some individuals with Cornelia de Lange syndrome, various orthopedic techniques may be used to help treat limb deformities. In affected individuals with hearing impairment, hearing aids may be beneficial in some cases. In addition, for individuals with CdLS who experience seizure episodes, treatment with anticonvulsant medications may help prevent, reduce, or control seizures in some cases.
Early intervention is important in ensuring that children with Cornelia de Lange Syndrome reach their highest potential. Services that may be beneficial may include special remedial education, vocational training, speech therapy, and/or other medical and/or social services.
Genetic counseling is recommended for affected individuals and their families. Other treatment is symptomatic and supportive.
Information on current clinical trials is posted on the Internet at www.clinicaltrials.gov. All studies receiving U.S. government funding, and some supported by private industry, are posted on this web site.
For information about clinical trials being conducted at the NIH Clinical Center in Bethesda, MD, contact the NIH Patient Recruitment Office:
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The identification in May 2004 of the gene involved in Cornelia de Lange syndrome offers the opportunity to learn more about the disorder, perhaps ultimately leading to new ways of treating or caring for those affected. It is hoped that this discovery will speed the development of a prenatal genetic test for the syndrome. The discovery is also expected to be helpful in confirming the diagnosis in young children suspected of having the disorder.
(Please note that some of these organizations may provide information concerning certain conditions potentially associated with this disorder [e.g., craniofacial abnormalities, limb anomalies, hearing impairment, mental retardation, etc.)
(To become a member of NORD, an organization must meet established criteria and be approved by the NORD Board of Directors. If you're interested in becoming a member, please contact Susan Olivo, Membership Manager, at firstname.lastname@example.org.)
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FROM THE INTERNET
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Cornelia de Lange syndrome-Genetics Home Reference
eMedicine-Cornelai de Lange Syndrome: Article by Mustafa Tekin, MD
Deardorff MA, Yaeger DM and Krantz ID. (Updated 8/14/06) Cornelia de Lange Syndrome. In: GeneReviews at Genetests: Medical Genetics Information Resource (database online). Copyright, Universiity of Washington, Seattle. 1997-2008. Available at http://www.genetests.org. Accessed 1/08.
Report last updated: 2008/01/29 00:00:00 GMT+0