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PHACE syndrome

MedGen UID:
376231
Concept ID:
C1847874
Disease or Syndrome
Synonyms: Aortic aneurysm, giant congenital; PHACES association; Posterior fossa brain malformations, hemangiomas of the face, arterial anomalies, cardiac anomalies, and eye abnormalities
Modes of inheritance:
X-linked dominant inheritance
MedGen UID:
376232
Concept ID:
C1847879
Finding
Source: Orphanet
A mode of inheritance that is observed for dominant traits related to a gene encoded on the X chromosome. In the context of medical genetics, X-linked dominant disorders tend to manifest very severely in affected males. The severity of manifestation in females may depend on the degree of skewed X inactivation.
 
Monarch Initiative: MONDO:0011676
OMIM®: 606519
Orphanet: ORPHA42775

Definition

PHACE is an acronym for a neurocutaneous syndrome encompassing the following features: posterior fossa brain malformations, hemangiomas of the face (large or complex), arterial anomalies, cardiac anomalies, and eye abnormalities. The association is referred to as PHACES when ventral developmental defects, such as sternal clefting or supraumbilical raphe, are present (summary by Bracken et al., 2011). [from OMIM]

Clinical features

From HPO
Cavernous hemangioma of the face
MedGen UID:
234097
Concept ID:
C1332863
Neoplastic Process
A cavernous hemangioma arising from the face.
Subglottic hemangioma
MedGen UID:
234907
Concept ID:
C1336518
Neoplastic Process
A hemangioma, a benign tumor of the vascular endothelial cells, located in the airway, typically below the vocal chords, that can cause severe obstruction of the airway.
Vascular dilatation
MedGen UID:
8076
Concept ID:
C0002940
Pathologic Function
Abnormal outpouching or sac-like dilatation in the wall of an atery, vein or the heart.
Aortic aneurysm
MedGen UID:
362
Concept ID:
C0003486
Disease or Syndrome
Aortic dilatation refers to a dimension that is greater than the 95th percentile for the normal person age, sex and body size. In contrast, an aneurysm is defined as a localized dilation of the aorta that is more than 150 percent of predicted (ratio of observed to expected diameter 1.5 or more). Aneurysm should be distinguished from ectasia, which represents a diffuse dilation of the aorta less than 50 percent of normal aorta diameter.
Coarctation of aorta
MedGen UID:
1617
Concept ID:
C0003492
Congenital Abnormality
Coarctation of the aorta is a narrowing or constriction of a segment of the aorta.
Patent ductus arteriosus
MedGen UID:
4415
Concept ID:
C0013274
Congenital Abnormality
In utero, the ductus arteriosus (DA) serves to divert ventricular output away from the lungs and toward the placenta by connecting the main pulmonary artery to the descending aorta. A patent ductus arteriosus (PDA) in the first 3 days of life is a physiologic shunt in healthy term and preterm newborn infants, and normally is substantially closed within about 24 hours after bith and completely closed after about three weeks. Failure of physiologcal closure is referred to a persistent or patent ductus arteriosus (PDA). Depending on the degree of left-to-right shunting, PDA can have clinical consequences.
Ventricular septal defect
MedGen UID:
42366
Concept ID:
C0018818
Congenital Abnormality
A hole between the two bottom chambers (ventricles) of the heart. The defect is centered around the most superior aspect of the ventricular septum.
Arterial stenosis
MedGen UID:
11612
Concept ID:
C0038449
Pathologic Function
Narrowing or constriction of the inner surface (lumen) of an artery.
Anomalous branches of internal carotid artery
MedGen UID:
338339
Concept ID:
C1847886
Finding
Horner syndrome
MedGen UID:
5616
Concept ID:
C0019937
Disease or Syndrome
An abnormality resulting from a lesion of the sympathetic nervous system characterized by a combination of unilateral ptosis, miosis, and often ipsilateral hypohidrosis and conjunctival injection.
Seizure
MedGen UID:
20693
Concept ID:
C0036572
Sign or Symptom
A seizure is an intermittent abnormality of nervous system physiology characterized by a transient occurrence of signs and/or symptoms due to abnormal excessive or synchronous neuronal activity in the brain.
Migraine
MedGen UID:
57451
Concept ID:
C0149931
Disease or Syndrome
Migraine is a chronic neurological disorder characterized by episodic attacks of headache and associated symptoms.
Cerebellar hypoplasia
MedGen UID:
120578
Concept ID:
C0266470
Congenital Abnormality
Cerebellar hypoplasia is a descriptive term implying a cerebellum with a reduced volume, but a normal shape and is stable over time.
Global developmental delay
MedGen UID:
107838
Concept ID:
C0557874
Finding
A delay in the achievement of motor or mental milestones in the domains of development of a child, including motor skills, speech and language, cognitive skills, and social and emotional skills. This term should only be used to describe children younger than five years of age.
Dandy-Walker syndrome
MedGen UID:
4150
Concept ID:
C0010964
Disease or Syndrome
Dandy-Walker malformation is defined by hypoplasia and upward rotation of the cerebellar vermis and cystic dilation of the fourth ventricle. Affected individuals often have motor deficits such as delayed motor development, hypotonia, and ataxia; about half have mental retardation and some have hydrocephalus. DWM is a heterogeneous disorder. The low empiric recurrence risk of approximately 1 to 2% for nonsyndromic DWM suggests that mendelian inheritance is unlikely (summary by Murray et al., 1985).
Plaque-like facial hemangioma
MedGen UID:
376233
Concept ID:
C1847884
Neoplastic Process
Hemangioma is a benign tumor of the vascular endothelial cells. This term refers to facial hemangiomas that have a plaque-like morphology.
Facial hemangioma
MedGen UID:
348361
Concept ID:
C1861443
Finding
Hemangioma, a benign tumor of the vascular endothelial cells, occurring in the face.
Congenital hypothyroidism
MedGen UID:
41344
Concept ID:
C0010308
Disease or Syndrome
Congenital hypothyroidism is a partial or complete loss of function of the thyroid gland (hypothyroidism) that affects infants from birth (congenital). The thyroid gland is a butterfly-shaped tissue in the lower neck. It makes iodine-containing hormones that play an important role in regulating growth, brain development, and the rate of chemical reactions in the body (metabolism). People with congenital hypothyroidism have lower-than-normal levels of these important hormones.\n\nCongenital hypothyroidism occurs when the thyroid gland fails to develop or function properly. In 80 to 85 percent of cases, the thyroid gland is absent, severely reduced in size (hypoplastic), or abnormally located. These cases are classified as thyroid dysgenesis. In the remainder of cases, a normal-sized or enlarged thyroid gland (goiter) is present, but production of thyroid hormones is decreased or absent. Most of these cases occur when one of several steps in the hormone synthesis process is impaired; these cases are classified as thyroid dyshormonogenesis. Less commonly, reduction or absence of thyroid hormone production is caused by impaired stimulation of the production process (which is normally done by a structure at the base of the brain called the pituitary gland), even though the process itself is unimpaired. These cases are classified as central (or pituitary) hypothyroidism.\n\nSigns and symptoms of congenital hypothyroidism result from the shortage of thyroid hormones. Affected babies may show no features of the condition, although some babies with congenital hypothyroidism are less active and sleep more than normal. They may have difficulty feeding and experience constipation. If untreated, congenital hypothyroidism can lead to intellectual disability and slow growth. In the United States and many other countries, all hospitals test newborns for congenital hypothyroidism. If treatment begins in the first two weeks after birth, infants usually develop normally.\n\nCongenital hypothyroidism can also occur as part of syndromes that affect other organs and tissues in the body. These forms of the condition are described as syndromic. Some common forms of syndromic hypothyroidism include Pendred syndrome, Bamforth-Lazarus syndrome, and brain-lung-thyroid syndrome.
Lingual thyroid
MedGen UID:
78592
Concept ID:
C0266284
Congenital Abnormality
An aberrant thyroid gland or Ectopic thyroid located at the base of the tongue, just posterior to the foramen cecum as a result of a failure of the thyroid to descend.
Developmental cataract
MedGen UID:
3202
Concept ID:
C0009691
Congenital Abnormality
A cataract that occurs congenitally as the result of a developmental defect, in contrast to the majority of cataracts that occur in adulthood as the result of degenerative changes of the lens.
Microphthalmia
MedGen UID:
10033
Concept ID:
C0026010
Congenital Abnormality
Microphthalmia is an eye abnormality that arises before birth. In this condition, one or both eyeballs are abnormally small. In some affected individuals, the eyeball may appear to be completely missing; however, even in these cases some remaining eye tissue is generally present. Such severe microphthalmia should be distinguished from another condition called anophthalmia, in which no eyeball forms at all. However, the terms anophthalmia and severe microphthalmia are often used interchangeably. Microphthalmia may or may not result in significant vision loss.\n\nPeople with microphthalmia may also have a condition called coloboma. Colobomas are missing pieces of tissue in structures that form the eye. They may appear as notches or gaps in the colored part of the eye called the iris; the retina, which is the specialized light-sensitive tissue that lines the back of the eye; the blood vessel layer under the retina called the choroid; or in the optic nerves, which carry information from the eyes to the brain. Colobomas may be present in one or both eyes and, depending on their size and location, can affect a person's vision.\n\nPeople with microphthalmia may also have other eye abnormalities, including clouding of the lens of the eye (cataract) and a narrowed opening of the eye (narrowed palpebral fissure). Additionally, affected individuals may have an abnormality called microcornea, in which the clear front covering of the eye (cornea) is small and abnormally curved.\n\nBetween one-third and one-half of affected individuals have microphthalmia as part of a syndrome that affects other organs and tissues in the body. These forms of the condition are described as syndromic. When microphthalmia occurs by itself, it is described as nonsyndromic or isolated.
Optic atrophy
MedGen UID:
18180
Concept ID:
C0029124
Disease or Syndrome
Atrophy of the optic nerve. Optic atrophy results from the death of the retinal ganglion cell axons that comprise the optic nerve and manifesting as a pale optic nerve on fundoscopy.
Optic nerve hypoplasia
MedGen UID:
137901
Concept ID:
C0338502
Disease or Syndrome
Underdevelopment of the optic nerve.
Increased retinal vascularity
MedGen UID:
336208
Concept ID:
C1847882
Finding

Term Hierarchy

CClinical test,  RResearch test,  OOMIM,  GGeneReviews,  VClinVar  
  • CROGVPHACE syndrome

Professional guidelines

PubMed

Rotter A, Samorano LP, Rivitti-Machado MC, Oliveira ZNP, Gontijo B
An Bras Dermatol 2018 Jun;93(3):405-411. doi: 10.1590/abd1806-4841.20187693. PMID: 29924216Free PMC Article
Garzon MC, Epstein LG, Heyer GL, Frommelt PC, Orbach DB, Baylis AL, Blei F, Burrows PE, Chamlin SL, Chun RH, Hess CP, Joachim S, Johnson K, Kim W, Liang MG, Maheshwari M, McCoy GN, Metry DW, Monrad PA, Pope E, Powell J, Shwayder TA, Siegel DH, Tollefson MM, Vadivelu S, Lew SM, Frieden IJ, Drolet BA
J Pediatr 2016 Nov;178:24-33.e2. Epub 2016 Sep 19 doi: 10.1016/j.jpeds.2016.07.054. PMID: 27659028Free PMC Article
Winter PR, Itinteang T, Leadbitter P, Tan ST
Acta Paediatr 2016 Feb;105(2):145-53. Epub 2015 Nov 27 doi: 10.1111/apa.13242. PMID: 26469095

Recent clinical studies

Etiology

Valdebran M, Wine Lee L
Curr Opin Pediatr 2020 Aug;32(4):498-505. doi: 10.1097/MOP.0000000000000925. PMID: 32692048
Rotter A, Samorano LP, Rivitti-Machado MC, Oliveira ZNP, Gontijo B
An Bras Dermatol 2018 Jun;93(3):405-411. doi: 10.1590/abd1806-4841.20187693. PMID: 29924216Free PMC Article
Tortora D, Severino M, Accogli A, Martinetti C, Vercellino N, Capra V, Rossi A, Pavanello M
World Neurosurg 2017 Dec;108:291-302. Epub 2017 Sep 5 doi: 10.1016/j.wneu.2017.08.176. PMID: 28887276
Garzon MC, Epstein LG, Heyer GL, Frommelt PC, Orbach DB, Baylis AL, Blei F, Burrows PE, Chamlin SL, Chun RH, Hess CP, Joachim S, Johnson K, Kim W, Liang MG, Maheshwari M, McCoy GN, Metry DW, Monrad PA, Pope E, Powell J, Shwayder TA, Siegel DH, Tollefson MM, Vadivelu S, Lew SM, Frieden IJ, Drolet BA
J Pediatr 2016 Nov;178:24-33.e2. Epub 2016 Sep 19 doi: 10.1016/j.jpeds.2016.07.054. PMID: 27659028Free PMC Article
Spence-Shishido AA, Good WV, Baselga E, Frieden IJ
Clin Dermatol 2015 Mar-Apr;33(2):170-82. doi: 10.1016/j.clindermatol.2014.10.009. PMID: 25704937

Diagnosis

Rodríguez Bandera AI, Sebaratnam DF, Wargon O, Wong LF
J Am Acad Dermatol 2021 Dec;85(6):1379-1392. Epub 2021 Aug 19 doi: 10.1016/j.jaad.2021.08.019. PMID: 34419524
Valdebran M, Wine Lee L
Curr Opin Pediatr 2020 Aug;32(4):498-505. doi: 10.1097/MOP.0000000000000925. PMID: 32692048
Rotter A, Samorano LP, Rivitti-Machado MC, Oliveira ZNP, Gontijo B
An Bras Dermatol 2018 Jun;93(3):405-411. doi: 10.1590/abd1806-4841.20187693. PMID: 29924216Free PMC Article
Garzon MC, Epstein LG, Heyer GL, Frommelt PC, Orbach DB, Baylis AL, Blei F, Burrows PE, Chamlin SL, Chun RH, Hess CP, Joachim S, Johnson K, Kim W, Liang MG, Maheshwari M, McCoy GN, Metry DW, Monrad PA, Pope E, Powell J, Shwayder TA, Siegel DH, Tollefson MM, Vadivelu S, Lew SM, Frieden IJ, Drolet BA
J Pediatr 2016 Nov;178:24-33.e2. Epub 2016 Sep 19 doi: 10.1016/j.jpeds.2016.07.054. PMID: 27659028Free PMC Article
O-Lee TJ, Messner A
Otolaryngol Clin North Am 2008 Oct;41(5):903-11, viii-ix. doi: 10.1016/j.otc.2008.04.009. PMID: 18775341

Therapy

Rotter A, Samorano LP, Rivitti-Machado MC, Oliveira ZNP, Gontijo B
An Bras Dermatol 2018 Jun;93(3):405-411. doi: 10.1590/abd1806-4841.20187693. PMID: 29924216Free PMC Article
Hagen R, Ghareeb E, Jalali O, Zinn Z
Curr Opin Pediatr 2018 Aug;30(4):499-504. doi: 10.1097/MOP.0000000000000650. PMID: 29846253
Winter PR, Itinteang T, Leadbitter P, Tan ST
Acta Paediatr 2016 Feb;105(2):145-53. Epub 2015 Nov 27 doi: 10.1111/apa.13242. PMID: 26469095
Spence-Shishido AA, Good WV, Baselga E, Frieden IJ
Clin Dermatol 2015 Mar-Apr;33(2):170-82. doi: 10.1016/j.clindermatol.2014.10.009. PMID: 25704937
O-Lee TJ, Messner A
Otolaryngol Clin North Am 2008 Oct;41(5):903-11, viii-ix. doi: 10.1016/j.otc.2008.04.009. PMID: 18775341

Prognosis

Siegel DH
Am J Med Genet C Semin Med Genet 2018 Dec;178(4):407-413. doi: 10.1002/ajmg.c.31659. PMID: 30580483
Tortora D, Severino M, Accogli A, Martinetti C, Vercellino N, Capra V, Rossi A, Pavanello M
World Neurosurg 2017 Dec;108:291-302. Epub 2017 Sep 5 doi: 10.1016/j.wneu.2017.08.176. PMID: 28887276
Spence-Shishido AA, Good WV, Baselga E, Frieden IJ
Clin Dermatol 2015 Mar-Apr;33(2):170-82. doi: 10.1016/j.clindermatol.2014.10.009. PMID: 25704937
Bayer ML, Frommelt PC, Blei F, Breur JM, Cordisco MR, Frieden IJ, Goddard DS, Holland KE, Krol AL, Maheshwari M, Metry DW, Morel KD, North PE, Pope E, Shieh JT, Southern JF, Wargon O, Siegel DH, Drolet BA
Am J Cardiol 2013 Dec 15;112(12):1948-52. Epub 2013 Sep 28 doi: 10.1016/j.amjcard.2013.08.025. PMID: 24079520Free PMC Article
Haggstrom AN, Skillman S, Garzon MC, Drolet BA, Holland K, Matt B, McCuaig C, Metry DW, Morel K, Powell J, Frieden IJ
Arch Otolaryngol Head Neck Surg 2011 Jul;137(7):680-7. doi: 10.1001/archoto.2011.113. PMID: 21768412

Clinical prediction guides

Braun M, Frieden IJ, Siegel DH, George E, Hess CP, Fox CK, Chamlin SL, Drolet BA, Metry D, Pope E, Powell J, Holland K, Ulschmid C, Liang MG, Barry KK, Ho T, Cotter C, Baselga E, Bosquez D, Jain SN, Bui JK, Lara-Corrales I, Funk T, Small A, Baghoomian W, Yan AC, Treat JR, Hogrogian GS, Huang C, Haggstrom A, List M, McCuaig CC, Barrio V, Mancini AJ, Lawley LP, Grunnet-Satcher K, Horii KA, Newell B, Nopper A, Garzon MC, Scollan ME, Mathes EF
J Pediatr 2024 Apr;267:113907. Epub 2024 Jan 12 doi: 10.1016/j.jpeds.2024.113907. PMID: 38218370
Sepulveda W, Sepulveda F
J Matern Fetal Neonatal Med 2022 Jul;35(14):2751-2758. Epub 2020 Jul 28 doi: 10.1080/14767058.2020.1799349. PMID: 32723018
Disse SC, Toelle SP, Schroeder S, Theiler M, Weibel L, Broser P, Langner C, Siegel D, Brockmann K, Schoenfelder I, Meyer S
Neuroepidemiology 2020;54(5):383-391. Epub 2020 Jul 1 doi: 10.1159/000508187. PMID: 32610335
Steiner JE, McCoy GN, Hess CP, Dobyns WB, Metry DW, Drolet BA, Maheshwari M, Siegel DH
Am J Med Genet A 2018 Jan;176(1):48-55. Epub 2017 Nov 24 doi: 10.1002/ajmg.a.38523. PMID: 29171184Free PMC Article
Haggstrom AN, Skillman S, Garzon MC, Drolet BA, Holland K, Matt B, McCuaig C, Metry DW, Morel K, Powell J, Frieden IJ
Arch Otolaryngol Head Neck Surg 2011 Jul;137(7):680-7. doi: 10.1001/archoto.2011.113. PMID: 21768412

Recent systematic reviews

Kleinman EP, Blei F, Adams D, Greenberger S
Pediatr Res 2023 May;93(6):1470-1479. Epub 2022 Sep 30 doi: 10.1038/s41390-022-02325-z. PMID: 36180586
Siegel DH, Tefft KA, Kelly T, Johnson C, Metry D, Burrows P, Pope E, Cordisco M, Holland KE, Maheshwari M, Keith P, Garzon M, Hess C, Frieden IJ, Fullerton HJ, Drolet BA
Stroke 2012 Jun;43(6):1672-4. Epub 2012 Mar 22 doi: 10.1161/STROKEAHA.112.650952. PMID: 22442177

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