Entry - #180860 - SILVER-RUSSELL SYNDROME 1; SRS1 - OMIM
# 180860

SILVER-RUSSELL SYNDROME 1; SRS1


Alternative titles; symbols

RUSSELL-SILVER SYNDROME; RSS
SILVER-RUSSELL DWARFISM


Phenotype-Gene Relationships

Location Phenotype Phenotype
MIM number
Inheritance Phenotype
mapping key
Gene/Locus Gene/Locus
MIM number
11p15.5 Silver-Russell syndrome 1 180860 AD 3 ICR1 616186
Clinical Synopsis
 
Phenotypic Series
 

INHERITANCE
- Autosomal dominant
GROWTH
Height
- Short stature
Weight
- Low birth weight
Other
- Intrauterine growth retardation
- Postnatal growth retardation
- Failure to thrive
- Absent postnatal catch-up growth
- Low body mass index (BMI)
HEAD & NECK
Head
- Relative macrocephaly
- Delayed closure of anterior fontanel
- Large anterior fontanel
Face
- Triangular face
- Prominent forehead (early childhood)
- Micrognathia
- Retrognathia
Mouth
- Downturned corners of mouth
- Thin lips
CARDIOVASCULAR
Heart
- Atrial septal defect
- Ventricular septal defect
ABDOMEN
Gastrointestinal
- Feeding problems (early childhood)
GENITOURINARY
External Genitalia (Male)
- Hypospadias
SKELETAL
- Delayed bone age
Skull
- Delayed closure of anterior fontanel
- Large anterior fontanel
Limbs
- Asymmetry of arms and/or legs
Hands
- Ulnar deviation of digits
- Fifth finger clinodactyly
- Fifth finger brachydactyly
SKIN, NAILS, & HAIR
Skin
- Cafe-au-lait spots
NEUROLOGIC
Central Nervous System
- Delayed motor development
ENDOCRINE FEATURES
- Hypoglycemia
MISCELLANEOUS
- Body asymmetry
- Imprinted disorder
- Maternal 11p15 duplications associated with fetal growth retardation
- Genetic heterogeneity
MOLECULAR BASIS
- Caused by epigenetic changes of DNA hypomethylation at the H19/IGF2-imprinting control region (ICR1, 616186)

TEXT

A number sign (#) is used with this entry because 20 to 60% of cases of Silver-Russell syndrome (SRS) are caused by the epigenetic changes of DNA hypomethylation at the H19/IGF2-imprinting control region (ICR1; 616186) on chromosome 11p15.5. ICR1 regulates the imprinted expression of H19 (103280) and IGF2 (147470).


Description

Silver-Russell syndrome-1 (SRS1) is a clinically heterogeneous condition characterized by severe intrauterine growth retardation, poor postnatal growth, craniofacial features such as a triangular shaped face and a broad forehead, body asymmetry, and a variety of minor malformations. The phenotypic expression changes during childhood and adolescence, with the facial features and asymmetry usually becoming more subtle with age. Hypomethylation at distal chromosome 11p15 (ICR1) represents a major cause of the disorder. Opposite epimutations, namely hypermethylation at the same region on 11p15, are observed in about 5 to 10% of patients with Beckwith-Wiedemann syndrome (BWS; 130650), an overgrowth syndrome (Bartholdi et al., 2009).

Genetic Heterogeneity of Silver-Russell Syndrome

SRS2 (618905) is caused by maternal uniparental disomy of chromosome 7. SRS3 (616489) is caused by mutation in the IGF2 gene (147470) on chromosome 11p15. SRS4 (618907) is caused by mutation in the PLAG1 gene (603026) on chromosome 8q12. SRS5 (618908) is caused by mutation in the HMGA2 gene (600698) on chromosome 12q14.


Clinical Features

Silver-Russell syndrome (SRS) was reported independently by Silver et al. (1953) and Russell (1954). Silver et al. (1953) described 2 unrelated children with congenital hemihypertrophy, low birth weight, short stature, and elevated urinary gonadotropins. Russell (1954) described 5 unrelated children with intrauterine growth retardation and characteristic facial features, including triangular shaped face with a broad forehead and pointed, small chin with a wide, thin mouth. Two children had body asymmetry. Although each of these authors emphasized different phenotypic features, the whole picture was later identified as the 'Russell-Silver syndrome' (Patton, 1988).

Chitayat et al. (1988) described hepatocellular carcinoma in a 4-year-old boy with Russell-Silver syndrome. His brother had low birth weight and bilateral clinodactyly of the fifth fingers and grew slowly. Neither brother showed asymmetry. Donnai et al. (1989) described unusually severe Silver-Russell syndrome in 3 children with pre- and postnatal growth deficiency.

Price et al. (1999) reevaluated 57 patients in whom the diagnosis of SRS had been considered definite or likely. In 50 patients the clinical findings complied with a very broad definition of SRS. Notable additional findings included generalized camptodactyly in 11 individuals, many with distal arthrogryposis. Thirteen of the 25 males studied required genital surgery for conditions including hypospadias and inguinal hernia. Severe feeding problems were reported by 56% of parents, and sweating and pallor were described by 52% of parents in the early weeks of life. Fourteen of the 38 individuals of school age had been considered for special education; 4 attended special school. Molecular analysis in 42 subjects identified uniparental disomy (UPD) of chromosome 7 in 4 subjects. The phenotype in these 4 cases was generally milder than that in the non-UPD cases, with only 2 having the classic facial dysmorphism.

Anderson et al. (2002) conducted a study of gastrointestinal complications of SRS by questionnaire distributed by MAGIC, a support group for individuals with SRS. One-hundred thirty-five completed surveys were returned, of which 65 related to children with clear-cut SRS. Of these, 50 (77%) had gastrointestinal symptoms: gastroesophageal reflux disease (34%), esophagitis (25%), food aversion (32%), and failure to thrive (63%).

Andersson Gronlund et al. (2011) identified ophthalmologic abnormalities in 17 of 18 children with Silver-Russell syndrome. Best corrected visual acuity of the better eye was less than 0.1 log of the minimal angle of resolution (less than 20/200; legal blindness) in 11 children, and 11 children had refractive errors. Anisometropia (greater than 1 diopter) was noted in 3 children. Subnormal stereo acuity and near point of convergence were found in 2 of 16 children. The total axial length in both eyes was shorter compared with that of controls. Of 16 children, 3 had small optic discs, 3 had large cup:disc ratio, and 4 had increased tortuosity of retinal vessels. Andersson Gronlund et al. (2011) recommended ophthalmologic examination for children with SRS.

Lokulo-Sodipe et al. (2020) described the clinical features of RSS in a cohort of 33 patients aged 13 years and older (median age, 29.6 years). Most of the patients (60.6%) had height below 2 standard deviations (median, -2.67) despite 70% having received growth hormone treatment. Characteristic childhood dysmorphisms seen in RSS, including triangular face, broad nasal tip, broad nasal bridge, retrognathia, and downslanting palpebral fissures, were seen in only a minority of patients. Features seen more commonly in this cohort included a broad forehead and facial dysmorphism (45%), relative macrocephaly (57.6%), low-set ears (57.6%), and posteriorly rotated ears (54.5%). Feeding issues were not commonly reported, although 18.2% had gastroesophageal reflux. In patients aged 18 years and older, 25% had impaired glucose tolerance, 33% had hypertension, and 52% had hypercholesterolemia. University degrees were completed in 40% of patients aged 21 years and older, which was consistent with educational achievement in the general UK population. There was not a significant correlation between quality of life assessment scores and height, although there was a negative correlation with BMI. Among the 25 patients aged 18 years or older, 9 had children, none of whom had RSS. Lokulo-Sodipe et al. (2020) concluded that the diagnosis of RSS in adults is difficult and requires molecular confirmation because many of the typical characteristics of RSS in childhood are not present in adulthood.


Inheritance

Rimoin (1969) described monozygotic male twins concordant for Silver dwarfism. However, Nyhan and Sakati (1976) and Samn et al. (1990) described monozygotic twins discordant for RSS. Bailey et al. (1995) described triplets, one of whom had RSS. The evidence was strong that he and his triplet brother were monozygotic; the brother was unaffected. The clinical characteristics consistent with RSS were a birth weight of less than 3 SD below the mean for gestational age and lower than either of his same-gestation sibs. The affected child had a small head circumference and a short birth length.

Fuleihan et al. (1971) observed 3 affected sibs among the 6 offspring of consanguineous Lebanese parents. Craniofacial disproportion and other minor anomalies were present. The mother was very short. Another possible familial occurrence was observed by Silver (cited by Gareis et al., 1971), who found that the mother of one of his cases was only 59 inches tall and had triangular facies and incurved fifth fingers. Tanner et al. (1975) reported on a longitudinal study of 39 cases. None of 61 sibs was affected. The authors found no distinction between Silver and Russell syndromes. Escobar et al. (1978) reported affected half brother and sister and reviewed reported familial cases.

Duncan et al. (1990) reported 7 affected persons in two 3-generation families. Three members of each family had an undergrowth of the left side of the body when compared with the normal right side. The authors noted that the clinical features were milder than those reported in sporadic cases. Duncan et al. (1990) found that in 17 reported families, multiple maternal relatives had complete or partial expression of Silver-Russell syndrome. Of 197 probands analyzed, 19% had one or more affected relatives. Two families with affected twins were consistent with new dominant mutation; possible autosomal recessive inheritance was found in 4 families. Because no male-to-male transmission was documented in 21 families in the literature or in the 2 families reported by Duncan et al. (1990), they suggested that X-linked dominant inheritance is a possibility.

Al-Fifi et al. (1996) reported 2 families with apparent autosomal dominant transmission of RSS. In 1 family, the mother (height 140 cm) and a son and daughter of hers were affected. The mother's father was remarkably short and thin until his late teens, but was later of normal height (25th centile) with triangular face, mild asymmetry, and prominent ears. In the second family, the mother's height and weight were below the third percentile for age before puberty. After puberty, her height reached the 25th percentile but she remained thin. A son and daughter were thought to be affected.

Ounap et al. (2004) described 2 sisters who met the criteria for SRS proposed by Price et al. (1999). The parents had normal facial features, normal height, and normal postnatal growth. Ounap et al. (2004) stated that this was the second well-documented case of familial recurrence of SRS suggesting autosomal recessive inheritance, the other being that of 6 sibs (5 males and 1 female) of normal first-cousin Arab parents (Teebi, 1992). In the family reported by Ounap et al. (2004), Bartholdi et al. (2009) identified hypomethylation at chromosome 11p15. Bartholdi et al. (2009) also reported another family in which 2 sibs had SRS associated with hypomethylation at 11p15. The authors postulated germ cell mosaicism of an incorrect methylation mark at the ICR1 during spermatogenesis in the fathers.

Bartholdi et al. (2009) reported a father and daughter with SRS who both had partial hypomethylation at chromosome 11p15, suggesting vertical transmission. Although the mechanism was difficult to explain, the authors postulated that the missing methylation mark in the father was not reset or corrected (setting of a methylation mark) during spermatogenesis. The findings had implications for genetic counseling.


Diagnosis

On the basis of radiographs of 15 patients, Herman et al. (1987) concluded that no single finding is pathognomonic; however, between the ages of 2 and 10 years, delayed maturation, clinodactyly, fifth middle or distal phalangeal hypoplasia, ivory epiphyses, and a second metacarpal pseudoepiphysis are suggestive.

Price et al. (1999) proposed diagnostic criteria for SRS: (1) birth weight below or equal to -2 SD from the mean; (2) poor postnatal growth below or equal to -2 SD from the mean at diagnosis; (3) preservation of occipitofrontal head circumference (OFC); (4) classic facial phenotype; and (5) asymmetry. Price et al. (1999) noted that some cases associated with uniparental disomy (UDP) (see below) might remain undiagnosed if strict criteria are applied, and suggested that the presence of feeding difficulties may be particularly helpful in making a diagnosis in these cases.

Kim et al. (2021) used methylation-specific multiplex ligation-dependent probe amplification (MS-MPLA) analysis of chromosome 11p15 and bisulfite pyrosequencing (BP) of ICR1, ICR2, MEST (601029), and MEG3 (605636) for molecular diagnosis of patients with SRS. Twenty-eight patients were diagnosed with SRS based on modified Netchine-Harbison clinical scoring system (NH-CSS) criteria. Epigenetic defects were detected in 17 of the 28 patients: 11 patients had abnormal MS-MPLA findings, 14 patients had abnormal BP methylation analysis of ICR1 (11 of whom also had abnormal MS-MPLA findings), and 3 patients had abnormal BP methylation analysis of MEST. Six of the 7 patients who met 5 or more of the NH-CSS criteria were found to have methylation defects, 4 of the 8 patients with 4 NH-CSS criteria were found to have methylation defects, and 7 of the 13 patients with 3 NH-CSS criteria were found to have methylation defects. Kim et al. (2021) concluded that genetic analysis for SRS should be considered even in patients with a low NH-CSS score.


Cytogenetics

Chromosome 11

Chiesa et al. (2012) described 2 maternal 11p15.5 microduplications with contrasting phenotypes. In the first case, a 1.2-Mb inverted duplication of chromosome 11p15 derived from the maternal allele resulted in Silver-Russell syndrome. The duplication encompassed the entire 11p15.5 imprinted gene cluster, and hypermethylation of CpGs throughout the ICR2 region was observed. These findings were consistent with the maintenance of genomic imprinting, with a double dosage of maternal imprinting and resulting in a lack of KCNQ1OT1 (604115) transcription. In the second case, a maternally inherited 160-kb inverted duplication that included only ICR2 and the most 5-prime 20 kb of KCNQ1OT1 resulted in a BWS (130650) phenotype in 5 individuals in 2 generations. This duplication was associated with hypomethylation of ICR2 resulting from partial loss of the imprinted methylation of the maternal allele, expression of a truncated KCNQ1OT1 transcript, and silencing of CDKN1C (600856). Chromatin RNA immunopurification studies suggested that the KCNQ1OT1 RNA interacts with chromatin through its most 5-prime 20-kb sequence, providing a mechanism for the silencing activity of this noncoding RNA. The finding of similar duplications of ICR2 resulting in different methylation imprints suggested that the ICR2 sequence is not sufficient for establishing DNA methylation on the maternal chromosome, and that some other property, possibly orientation-dependent, is needed.

Chromosome 17

Ramirez-Duenas et al. (1992) observed severe Russell-Silver syndrome in a girl with translocation t(17;20)(q25;q13). No evidence of imbalance was found. The father exhibited the same balanced translocation. Ramirez-Duenas et al. (1992) questioned whether the RSS locus is located on either chromosome 17 or 20 and whether the patient's phenotype resulted from either unmasking of heterozygosity or genomic imprinting via paternal disomy. Midro et al. (1993) found the identical chromosome 17 breakpoint (17q25) in an 8-year-old boy with a de novo t(1;17)(q31;q25) and Silver-Russell syndrome.

In a child with RSS, Eggermann et al. (1998) reported a heterozygous paternally inherited deletion of the gene encoding chorionic somatomammotropin hormone (CSH1; 150200), which maps to 17q22-q24. The authors noted that deletions of CSH1 with no phenotypic consequences have been reported; however, a role for the heterozygous deletion in this case was considered possible.

Dorr et al. (2001) prepared a physical and transcript map of the critical region for the RSS translocation breakpoint on 17q23-q24.

Chromosome 1

Van Haelst et al. (2002) reported a patient with phenotypic features of Silver-Russell syndrome who had trisomy 1q32.1-q42.1.

Chromosome X

Li et al. (2004) reported a female infant with a karyotype of 45,X on prenatal amniocytes. After delivery she was noted to have features consistent with Russell-Silver syndrome, including a triangular face with prominent forehead, large eyes, a thin nose, malar hypoplasia, thin upper lip with downturned corner of the mouth, and a pointed chin. Marked body asymmetry was evident at birth, with the left side significantly smaller than the right side. She also had a diphalangeal left fifth finger. Skin fibroblast culture and analysis showed a karyotype of 45,X on the right side and 45,X/46,XX on the left side. The case is another illustration of the genetic heterogeneity of the Russell-Silver phenotype.


Molecular Genetics

Abu-Amero et al. (2008) provided a review of the complex genetic etiology of Silver-Russell syndrome, which primarily involves chromosomes 7 and 11.

Genes on Chromosome 11

Given the crucial role of the 11p15 imprinted region in the control of fetal growth, Gicquel et al. (2005) hypothesized that dysregulation of genes at 11p15 might be involved in syndromic intrauterine growth retardation. In the telomeric imprinting center region ICR1 of the 11p15 region in several individuals with clinically typical Silver-Russell syndrome, they identified an epimutation (demethylation). The epigenetic defect was associated with, and probably responsible for, relaxation of imprinting and biallelic expression of H19 (103280) and downregulation of IGF2 (147470). These findings provided new insight into the pathogenesis of SRS and strongly suggested that the 11p15 imprinted region, in addition to the imprinted region of 7p13-p11.2 and 7q31-qter, is involved in SRS. The loss of paternal methylation in individuals with SRS may have resulted from a deficient acquisition of methylation during spermatogenesis or from a lack of maintenance of methylation after fertilization. The 5 individuals with SRS that carried the epimutation had only a partial loss of methylation, and 4 of them had body asymmetry. These data suggested that the loss of methylation occurred after fertilization and resulted in a mosaic distribution of the epimutation.

The epimutation described in individuals with SRS by Gicquel et al. (2005) is the exact opposite of one of the molecular defects responsible for Beckwith-Wiedemann syndrome (BWS; 130650): approximately 10% of individuals with BWS have hypermethylation of the H19 promoter. The most common epimutation in individuals with BWS involves the centromeric 11p15 subdomain and consists of loss of methylation of the maternal KCNQ1OT1 (604115) allele. Paternal inheritance of a null KCNQ1OT1 allele results in fetal growth retardation by 20 to 25% but does not affect expression of H19 or IGF2. One of the 5 individuals with the epimutation was a monozygotic twin, and her twin had no clinical features of SRS. Both twins had a loss of methylation in the telomeric 11p15 domain in their leukocyte DNA and biallelic expression of H19 in their blood cells. However, in skin fibroblasts, only the affected twin showed abnormal methylation. This observation was consistent with results obtained from BWS-discordant monozygotic twins and suggested that the presence of the epigenetic defect of blood cells of both twins results from shared fetal circulation.

The H19 differentially methylated region (DMR) controls the allele-specific expression of both the imprinted H19 tumor suppressor gene and the IGF2 growth factor. Hypermethylation of this DMR--and subsequently of the H19 promoter region--is a major cause of the clinical features of gigantism and/or asymmetry seen in Beckwith-Wiedemann syndrome or in isolated hemihypertrophy. Bliek et al. (2006) reported a series of patients with hypomethylation of the H19 locus. The main clinical features of asymmetry and growth retardation were the opposite of those seen in patients with hypermethylation of this region. In addition, they found that complete hypomethylation of the H19 promoter was associated in 2 of 3 patients with the full clinical spectrum of Silver-Russell syndrome.

Following up on the work of Gicquel et al. (2005) on epigenetic mutations in the etiology of SRS, Eggermann et al. (2006) screened a cohort of 51 SRS patients for epimutations in ICR1 (the telomeric imprinting center region of 11p15) and KCNQ1OT1 (604115) by methylation-sensitive Southern blot analyses. ICR1 demethylation was observed in 16 of the 51 SRS patients, corresponding to a frequency of approximately 31%. Changes in methylation at the KCNQ1OT1 locus were not detected. Combining these data with those on maternal duplications in 11p15, nearly 35% of SRS cases are associated with detectable (epi)genetic disturbances in 11p15. Eggermann et al. (2006) suggested that a general involvement of 11p15 changes in growth-retarded patients with only minor or without further dysmorphic features must be considered. SRS and BWS may be regarded as 2 diseases caused by opposite (epi)genetic disturbances of the same chromosomal region displaying opposite clinical pictures.

Schonherr et al. (2007) stated that methylation defects in the imprinted region of 11p15 can be detected in about 30% of patients with SRS. They reported the first patient with SRS with a cryptic duplication restricted to the centromeric imprinting center ICR2 in 11p15. The maternally inherited duplication in this patient included a region of 0.76 to 1.0 Mbp and affected the genes regulated by the ICR2, among them CDKN1C (600856) and LIT1 (604115).

Netchine et al. (2007) screened for 11p15 epimutation and mUPD7 in SRS and non-SRS small-for-gestational-age (SGA) patients to identify epigenetic-phenotypic correlations. Of the 127 SGA patients studied, 58 were diagnosed with SRS; 37 of these (63.8%) displayed partial loss of methylation (LOM) of the 11p15 ICR1 domain, and 3 (5.2%) had mUPD7. No molecular abnormalities were found in the non-SRS SGA group. Birth weight, birth length, and postnatal body mass index (BMI) were lower in the abnormal 11p15 SRS group (ab-ICR1-SRS) than in the normal 11p15 SRS group (-3.4 vs -2.6 SD score (SDS), -4.4 vs -3.4 SDS, and -2.5 vs -1.6 SDS, respectively; p less than 0.05). Among SRS patients, prominent forehead, relative macrocephaly, body asymmetry, and low BMI were significantly associated with ICR1 LOM. All ab-ICR1-SRS patients had at least 4 of 5 criteria of the scoring system. Netchine et al. (2007) concluded that the 11p15 ICR1 epimutation is a major, specific cause of SRS exhibiting failure to thrive. They proposed a clinical scoring system (including a BMI of less than -2 SDS), highly predictive of 11p15 ICR1 LOM, for the diagnosis of SRS.

Bullman et al. (2008) reported a patient with SRS who had mosaic maternal uniparental disomy of chromosome 11 with abnormal methylation of ICR2. MLPA analysis showed 12 informative loci between chromosome 11p15.5 to 11q23.3. The isodisomy was the reciprocal of the mosaic paternal isodisomy seen in patients with BWS.

Azzi et al. (2009) studied the methylation status of 5 maternally and 2 paternally methylated loci in a series of 167 patients with 11p15-related fetal growth disorders. Seven of 74 (9.5%) Russell-Silver (RSS) patients and 16 of 68 (24%) Beckwith-Wiedemann (BWS; 130650) patients showed multilocus loss of methylation (LOM) at regions other than ICR1 and ICR2 11p15, respectively. Moreover, over two-thirds of multilocus LOM RSS patients also had LOM at a second paternally methylated locus, DLK1/GTL2 IG-DMR. No additional clinical features due to LOM of other loci were found, suggesting an (epi)dominant effect of the 11p15 LOM on the clinical phenotype for this series of patients. Surprisingly, 4 patients displayed LOM at both ICR1 and ICR2 11p15; 3 of them had a RSS and 1 patient had a BWS phenotype. The authors concluded that multilocus LOM can also concern RSS patients, and that LOM can involve both paternally and maternally methylated loci in the same patient.

Using PCR-based methylation analysis, Penaherrera et al. (2010) found that 13 (37%) of 35 blood samples from patients with SRS showed methylation levels at H19/IGF2 ICR1 that were more than 2 SD below the mean for controls. Clinically, SRS patients had a lower birth weight (at least 2 SD below the mean), relative macrocephaly, and a higher frequency of body asymmetry compared to SRS patients without these epigenetic changes. One patient had a mediastinal neuroblastoma. Controls had considerable variability in methylation (30 to 47%) at ICR1, which Penaherrera et al. (2010) noted can cause some ambiguity in establishing clear cutoffs for diagnosis.

Exclusion Studies

Previous studies had shown that individuals with a deletion of 15q26.1-qter, which includes the insulin-like growth factor I receptor gene (IGF1R; 147370), may exhibit some phenotypic characteristics resembling those of Russell-Silver syndrome. Abu-Amero et al. (1997) investigated 33 RSS probands, with normal karyotypes, and their parents for the presence of both copies of IGF1R by gene dosage analysis of Southern blot hybridization. All 33 probands had both copies of the gene. Two important functional regions of IGF1R were also investigated for DNA mutations using SSCP analysis; no mutations were found. The patients were from the series of cases studied by Preece et al. (1997).

Penaherrera et al. (2010) found no changes in methylation of the KVDMR1 (see KCNQ1; 607542), PLAGL1 (603044), or PEG10 (609810) genes in blood samples of 35 patients with SRS. Whole genome methylation analysis of a subset of 22 SRS patients, including 10 who had hypomethylation at ICR1, showed no global disruption in methylation in these patients compared to controls.


Genotype/Phenotype Correlations

Binder et al. (2008) compared the genotype in 44 patients with SRS with the endocrine phenotype. Epimutations at 11p15 were found in 19 of the 44, UPD7 in 5, and small structural aberrations of the short arm of chromosome 11 in 2. Of the 44 cases, 18 were negative for any genetic defect known (41%). The most severe phenotype was found in children with 11p15 SRS. Children with UPD7 SRS had a significantly higher birth length than the 11p15 SRS subjects (P less than 0.004) but lost height SD score postpartum, whereas children with 11p15 SRS showed no change in height SD score. There was a trend toward more height gain in children with UPD7 than in those with 11p15 epimutation under GH therapy (+2.5 vs +1.9 height SD score after 3 years) (P = 0.08). Binder et al. (2008) concluded that children with SRS and an 11p15 epimutation have IGFBP3 (146732) excess and show endocrine characteristics suggesting IGF1 (147440) insensitivity, whereas children with SRS and UPD7 were not different with respect to endocrine characteristics from nonsyndromic short children born SGA. This phenotype-genotype correlation implicated divergent endocrine mechanisms of growth failure in SRS.

Bartholdi et al. (2009) found that 106 (53%) of 201 patients with suspected SRS actually fulfilled clinical criteria for the disorder. Hypomethylation at the ICR1 on chromosome 11p15 was observed in 41 (38.5%) of the 106 patients. The majority of patients showed hypomethylation of both H19 and IGF2, but 10 showed selective hypomethylation of H19 and 2 showed selective hypomethylation of IGF2. However, the authors noted that the IGF2-specific probe showed a broader variation in controls as compared to the H19 probe. Seven (6.6%) of the 106 patients had uniparental disomy of chromosome 7. Patients carrying epimutations had higher disease scores than those with maternal uniparental disomy of chromosome 7 or those with no identified defects, indicating that hypomethylation at 11p15 was associated with a more severe phenotype, particularly body asymmetry. No genetic anomaly was detected in 54.7% of patients.


History

Tanner and Ham (1969) suggested that the designation 'Silver dwarf' be reserved for children of short stature and low birth weight who have asymmetry of arms, legs, body or head, and incurved fifth fingers. They suggested that the designation 'Russell dwarf' be reserved for the similar situation when asymmetry is lacking. Patton (1988) noted that this distinction had not been generally accepted.


REFERENCES

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  11. Bliek, J., Terhal, P., van den Bogaard, M.-J., Maas, S., Hamel, B., Salieb-Beugelaar, G., Simon, M., Letteboer, T., van der Smagt, J., Kroes, H., Mannens, M. Hypomethylation of the H19 gene causes not only Silver-Russell syndrome (SRS) but also isolated asymmetry or an SRS-like phenotype. Am. J. Hum. Genet. 78: 604-614, 2006. [PubMed: 16532391, images, related citations] [Full Text]

  12. Bullman, H., Lever, M., Robinson, D. O., Mackay, D. J. G., Holder, S. E., Wakeling, E. L. Mosaic maternal uniparental disomy of chromosome 11 in a patient with Silver-Russell syndrome. (Letter) J. Med. Genet. 45: 396-399, 2008. [PubMed: 18474587, related citations] [Full Text]

  13. Chiesa, N., De Crescenzo, A., Mishra, K., Perone, L., Carella, M., Palumbo, O., Mussa, A., Sparago, A., Cerrato, F., Russo, S., Lapi, E., Cubellis, M. V., Kanduri, C., Cirillo Silengo, M., Riccio, A., Ferrero, G. B. The KCNQ1OT1 imprinting control region and non-coding RNA: new properties derived from the study of Beckwith-Wiedemann syndrome and Silver-Russell syndrome cases. Hum. Molec. Genet. 21: 10-25, 2012. [PubMed: 21920939, images, related citations] [Full Text]

  14. Chitayat, D., Friedman, J. M., Anderson, L., Dimmick, J. E. Hepatocellular carcinoma in a child with familial Russell-Silver syndrome. Am. J. Med. Genet. 31: 909-914, 1988. [PubMed: 2853572, related citations] [Full Text]

  15. Donnai, D., Thompson, E., Allanson, J., Baraitser, M. Severe Silver-Russell syndrome. J. Med. Genet. 26: 447-451, 1989. [PubMed: 2746617, related citations] [Full Text]

  16. Dorr, S., Midro, A. T., Farber, C., Giannakudis, J., Hansmann, I. Construction of a detailed physical and transcript map of the candidate region for Russell-Silver syndrome on chromosome 17q23-q24. Genomics 71: 174-184, 2001. [PubMed: 11161811, related citations] [Full Text]

  17. Duncan, P. A., Hall, J. G., Shapiro, L. R., Vibert, B. K. Three-generation dominant transmission of the Silver-Russell syndrome. Am. J. Med. Genet. 35: 245-250, 1990. [PubMed: 2178417, related citations] [Full Text]

  18. Eggermann, T., Eggermann, K., Mergenthaler, S., Kuner, R., Kaiser, P., Ranke, M. B., Wollmann, H. A. Paternally inherited deletion of CSH1 in a patient with Silver-Russell syndrome. J. Med. Genet. 35: 784-786, 1998. [PubMed: 9733042, related citations] [Full Text]

  19. Eggermann, T., Schonherr, N., Meyer, E., Obermann, C., Mavany, M., Eggermann, K., Ranke, M. B., Wollmann, H. A. Epigenetic mutations in 11p15 in Silver-Russell syndrome are restricted to the telomeric imprinting domain. (Letter) J. Med. Genet. 43: 615-616, 2006. [PubMed: 16236811, related citations] [Full Text]

  20. Escobar, V., Gleiser, S., Weaver, D. D. Phenotypic and genetic analysis of the Silver-Russell syndrome. Clin. Genet. 13: 278-288, 1978. [PubMed: 639337, related citations] [Full Text]

  21. Fuleihan, D. S., Der Kaloustian, V. M., Najjar, S. S. The Russell-Silver syndrome: report of three siblings. J. Pediat. 78: 654-657, 1971. [PubMed: 5547822, related citations] [Full Text]

  22. Gareis, F. J., Smith, D. W., Summitt, R. L. The Russell-Silver syndrome without asymmetry. J. Pediat. 79: 775-781, 1971. [PubMed: 5116700, related citations] [Full Text]

  23. Gicquel, C., Rossignol, S., Cabrol, S., Houang, M., Steunou, V., Barbu, V., Danton, F., Thibaud, N., Le Merrer, M., Burglen, L., Bertrand, A.-M., Netchine, I., Le Bouc, Y. Epimutation of the telomeric imprinting center region on chromosome 11p15 in Silver-Russell syndrome. Nature Genet. 37: 1003-1007, 2005. [PubMed: 16086014, related citations] [Full Text]

  24. Herman, T. E., Crawford, J. D., Cleveland, R. H., Kushner, D. C. Hand radiographs in Russell-Silver syndrome. Pediatrics 79: 743-744, 1987. [PubMed: 3575032, related citations]

  25. Kim, S. Y., Shin, C. H., Lee, Y. A., Shin, C. H., Yang, S. W., Cho, T.-J., Ko, J. M. Clinical application of sequential epigenetic analysis for diagnosis of Silver-Russell syndrome. Ann. Lab. Med. 41: 401-408, 2021. [PubMed: 33536359, related citations] [Full Text]

  26. Li, C. C., Chodirker, B. N., Dawson, A. J., Chudley, A. E. Severe hemihypotrophy in a female infant with mosaic Turner syndrome: a variant of Russell-Silver syndrome? Clin. Dysmorph. 13: 95-98, 2004. [PubMed: 15057125, related citations]

  27. Lokulo-Sodipe, O., Ballard, L., Child, J., Inskip, H. M., Byrne, C. D., Ishida, M., Moore, G. E., Wakeling, E. L., Fenwick, A., Mackay, D. J. G., Davies, J. H., Temple, I. K. Phenotype of genetically confirmed Silver-Russell syndrome beyond childhood. J. Med. Genet. 57: 683-691, 2020. [PubMed: 32054688, related citations] [Full Text]

  28. Midro, A. T., Debek, K., Sawicka, A., Marcinkiewicz, D., Rogowska, M. Second observation of Silver-Russel (sic) syndrome in a carrier of a reciprocal translocation with one breakpoint at site 17q25. (Letter) Clin. Genet. 44: 53-55, 1993. [PubMed: 8403458, related citations] [Full Text]

  29. Moseley, J. E., Moloshok, R. E., Freiberger, R. H. The Silver syndrome: congenital asymmetry, short stature and variations in sexual development. Am. J. Roentgen. Radium Ther. Nucl. Med. 97: 74-81, 1966. [PubMed: 5938052, related citations] [Full Text]

  30. Netchine, I., Rossignol, S., Dufourg, M.-N., Azzi, S., Rousseau, A., Perin, L., Houang, M., Steunou, V., Esteva, B., Thibaud, N., Demay, M.-C. R., Danton, F., and 10 others. 11p15 imprinting center region 1 loss of methylation is a common and specific cause of typical Russell-Silver syndrome: clinical scoring system and epigenetic-phenotypic correlations. J. Clin. Endocr. Metab. 92: 3148-3154, 2007. Note: Erratum: J. Clin. Endocr. Metab. 92: 4305 only, 2007. [PubMed: 17504900, related citations] [Full Text]

  31. Nyhan, W. L., Sakati, N. O. Silver syndrome: Silver-Russell syndrome, Russell-Silver syndrome. In: Genetic and Malformation Syndromes in Clinical Medicine. Chicago: Year Book Med. Pub. 1976. Pp. 298-300.

  32. Ounap, K., Reimand, T., Magi, M.-L., Bartsch, O. Two sisters with Silver-Russell phenotype. Am. J. Med. Genet. 131A: 301-306, 2004. [PubMed: 15523618, related citations] [Full Text]

  33. Patton, M. A. Russell-Silver syndrome. J. Med. Genet. 25: 557-560, 1988. [PubMed: 3050100, related citations] [Full Text]

  34. Penaherrera, M. S., Weindler, S., Van Allen, M. I., Yong, S.-L., Metzger, D. L., McGillivray, B., Boerkoel, C., Langlois, S., Robinson, W. P. Methylation profiling in individuals with Russell-Silver syndrome. Am. J. Med. Genet. 152A: 347-355, 2010. [PubMed: 20082469, related citations] [Full Text]

  35. Preece, M. A., Price, S. M., Davies, V., Clough, L., Stanier, P., Trembath, R. C., Moore, G. E. Maternal uniparental disomy 7 in Silver-Russell syndrome. J. Med. Genet. 34: 6-9, 1997. [PubMed: 9032641, related citations] [Full Text]

  36. Price, S. M., Stanhope, R., Garrett, C., Preece, M. A., Trembath, R. C. The spectrum of Silver-Russell syndrome: a clinical and molecular genetic study and new diagnostic criteria. J. Med. Genet. 36: 837-842, 1999. [PubMed: 10544228, related citations]

  37. Ramirez-Duenas, M. L., Medina, C., Ocampo-Campos, R., Rivera, H. Severe Silver-Russell syndrome and translocation (17;20)(q25;q13). Clin. Genet. 41: 51-53, 1992. [PubMed: 1633648, related citations] [Full Text]

  38. Rimoin, D. L. The Silver syndrome in twins. Birth Defects Orig. Art. Ser. V(2): 183-187, 1969.

  39. Robichaux, V., Fraikor, A., Favara, B., Richer, M. Silver-Russell syndrome: a family with symmetric and asymmetric siblings. Arch. Path. Lab. Med. 105: 157-159, 1981. [PubMed: 6894081, related citations]

  40. Russell, A. A syndrome of intra-uterine-dwarfism recognizable at birth with cranio-facial dysostosis, disproportionate short arms, and other anomalies (5 examples). Proc. Roy. Soc. Med. 47: 1040-1044, 1954. [PubMed: 13237189, related citations]

  41. Samn, M., Lewis, K., Blumberg, B. Monozygotic twins discordant for the Russell-Silver syndrome. Am. J. Med. Genet. 37: 543-545, 1990. [PubMed: 2260605, related citations] [Full Text]

  42. Schonherr, N., Meyer, E., Roos, A., Schmidt, A., Wollmann, H. A., Eggermann, T. The centromeric 11p15 imprinting centre is also involved in Silver-Russell syndrome. J. Med. Genet. 44: 59-63, 2007. [PubMed: 16963484, images, related citations] [Full Text]

  43. Silver, H. K., Kiyasu, W., George, J., Deamer, W. C. Syndrome of congenital hemihypertrophy, shortness of stature, and elevated urinary gonadotropins. Pediatrics 12: 368-376, 1953. [PubMed: 13099907, related citations]

  44. Silver, H. K. Asymmetry, short stature, and variations in sexual development: a syndrome of congenital malformations. Am. J. Dis. Child. 107: 495-515, 1964. [PubMed: 14120415, related citations] [Full Text]

  45. Tanner, J. M., Ham, T. J. Low birthweight dwarfism with asymmetry (Silver's syndrome): treatment with human growth hormone. Arch. Dis. Child. 44: 231-243, 1969. [PubMed: 5779433, related citations] [Full Text]

  46. Tanner, J. M., Lejarraga, H., Cameron, N. The natural history of the Silver-Russell syndrome: a longitudinal study of thirty-nine cases. Pediat. Res. 9: 611-623, 1975. [PubMed: 168551, related citations] [Full Text]

  47. Teebi, A. S. Autosomal recessive Silver-Russell syndrome. Clin. Dysmorph. 1: 151-156, 1992. [PubMed: 1285272, related citations]

  48. van Haelst, M. M., Eussen, H. J. F. M. M., Visscher, F., de Ruijter, J. L. M., Drop, S. L. S., Lindhout, D., Wouters, C. H., Govaerts, L. C. P. Silver-Russell phenotype in a patient with pure trisomy 1q32.1-q42.1: further delineation of the pure 1q trisomy syndrome. (Letter) J. Med. Genet. 39: 582-585, 2002. [PubMed: 12161598, related citations] [Full Text]

  49. Weiss, G. R., Garnick, M. B. Testicular cancer in a Russell-Silver dwarf. J. Urol. 126: 836-837, 1981. [PubMed: 6119370, related citations] [Full Text]


Hilary J. Vernon - updated : 11/04/2020
Matthew B. Gross - updated : 1/15/2015
Cassandra L. Kniffin - updated : 12/11/2014
Jane Kelly - updated : 8/15/2011
Cassandra L. Kniffin - updated : 7/7/2011
George E. Tiller - updated : 11/1/2010
Cassandra L. Kniffin - updated : 6/1/2009
Cassandra L. Kniffin - updated : 3/23/2009
John A. Phillips, III - updated : 2/26/2009
Cassandra L. Kniffin - updated : 10/2/2008
Cassandra L. Kniffin - updated : 8/15/2008
John A. Phillips, III - updated : 3/24/2008
Victor A. McKusick - updated : 2/21/2007
Victor A. McKusick - updated : 10/10/2006
Victor A. McKusick - updated : 9/13/2006
Victor A. McKusick - updated : 3/15/2006
Victor A. McKusick - updated : 9/27/2005
Patricia A. Hartz - updated : 2/3/2005
Victor A. McKusick - updated : 1/3/2005
Siobhan M. Dolan - updated : 7/29/2004
Cassandra L. Kniffin - reorganized : 11/17/2003
Deborah L. Stone - updated : 2/12/2003
Victor A. McKusick - updated : 11/19/2002
Victor A. McKusick - updated : 11/7/2002
Michael J. Wright - updated : 7/1/2002
Victor A. McKusick - updated : 1/4/2002
Victor A. McKusick - updated : 10/19/2001
Michael B. Petersen - updated : 8/16/2001
Victor A. McKusick - updated : 1/24/2001
Michael J. Wright - updated : 1/9/2001
Victor A. McKusick - updated : 10/5/2000
Michael J. Wright - updated : 2/7/2000
Victor A. McKusick - updated : 12/29/1999
Victor A. McKusick - updated : 10/19/1999
Victor A. McKusick - updated : 11/30/1998
Michael J. Wright - updated : 10/7/1998
Victor A. McKusick - updated : 3/13/1998
Victor A. McKusick - updated : 11/7/1997
Victor A. McKusick - updated : 4/1/1997
Creation Date:
Victor A. McKusick : 5/16/1994
carol : 03/04/2022
carol : 03/03/2022
carol : 11/04/2020
alopez : 07/13/2020
alopez : 06/12/2020
carol : 10/14/2016
mcolton : 03/04/2015
mgross : 1/15/2015
alopez : 12/12/2014
mcolton : 12/12/2014
ckniffin : 12/11/2014
terry : 4/4/2013
terry : 12/5/2012
carol : 8/23/2011
terry : 8/15/2011
wwang : 7/14/2011
ckniffin : 7/7/2011
alopez : 11/2/2010
terry : 11/1/2010
terry : 12/17/2009
wwang : 6/10/2009
ckniffin : 6/1/2009
wwang : 4/7/2009
ckniffin : 3/23/2009
alopez : 2/26/2009
wwang : 10/10/2008
ckniffin : 10/2/2008
wwang : 8/19/2008
wwang : 8/19/2008
ckniffin : 8/15/2008
carol : 3/24/2008
alopez : 2/26/2007
terry : 2/21/2007
alopez : 10/11/2006
terry : 10/10/2006
alopez : 9/18/2006
terry : 9/13/2006
alopez : 3/21/2006
terry : 3/15/2006
alopez : 9/28/2005
terry : 9/27/2005
joanna : 6/13/2005
mgross : 2/3/2005
tkritzer : 1/13/2005
terry : 1/3/2005
carol : 9/2/2004
carol : 7/29/2004
terry : 7/29/2004
mgross : 3/17/2004
carol : 11/17/2003
ckniffin : 11/5/2003
terry : 5/16/2003
carol : 2/12/2003
alopez : 11/25/2002
tkritzer : 11/22/2002
tkritzer : 11/19/2002
tkritzer : 11/19/2002
tkritzer : 11/13/2002
terry : 11/7/2002
alopez : 7/3/2002
terry : 7/1/2002
carol : 1/4/2002
terry : 1/4/2002
carol : 11/12/2001
carol : 11/12/2001
mgross : 10/19/2001
terry : 10/19/2001
carol : 8/16/2001
carol : 1/25/2001
terry : 1/24/2001
alopez : 1/10/2001
alopez : 1/9/2001
terry : 10/5/2000
carol : 10/5/2000
terry : 2/10/2000
alopez : 2/7/2000
alopez : 2/7/2000
mgross : 1/3/2000
terry : 12/29/1999
carol : 10/19/1999
carol : 6/21/1999
carol : 11/30/1998
carol : 10/12/1998
terry : 10/7/1998
terry : 5/29/1998
psherman : 3/13/1998
terry : 3/6/1998
jenny : 11/7/1997
alopez : 11/5/1997
dholmes : 10/22/1997
terry : 4/1/1997
terry : 3/20/1997
mark : 2/17/1996
terry : 2/14/1996
mark : 9/13/1995
carol : 5/16/1994

# 180860

SILVER-RUSSELL SYNDROME 1; SRS1


Alternative titles; symbols

RUSSELL-SILVER SYNDROME; RSS
SILVER-RUSSELL DWARFISM


SNOMEDCT: 15069006;   ICD10CM: Q87.19;   ORPHA: 813;   DO: 14681;  


Phenotype-Gene Relationships

Location Phenotype Phenotype
MIM number
Inheritance Phenotype
mapping key
Gene/Locus Gene/Locus
MIM number
11p15.5 Silver-Russell syndrome 1 180860 Autosomal dominant 3 ICR1 616186

TEXT

A number sign (#) is used with this entry because 20 to 60% of cases of Silver-Russell syndrome (SRS) are caused by the epigenetic changes of DNA hypomethylation at the H19/IGF2-imprinting control region (ICR1; 616186) on chromosome 11p15.5. ICR1 regulates the imprinted expression of H19 (103280) and IGF2 (147470).


Description

Silver-Russell syndrome-1 (SRS1) is a clinically heterogeneous condition characterized by severe intrauterine growth retardation, poor postnatal growth, craniofacial features such as a triangular shaped face and a broad forehead, body asymmetry, and a variety of minor malformations. The phenotypic expression changes during childhood and adolescence, with the facial features and asymmetry usually becoming more subtle with age. Hypomethylation at distal chromosome 11p15 (ICR1) represents a major cause of the disorder. Opposite epimutations, namely hypermethylation at the same region on 11p15, are observed in about 5 to 10% of patients with Beckwith-Wiedemann syndrome (BWS; 130650), an overgrowth syndrome (Bartholdi et al., 2009).

Genetic Heterogeneity of Silver-Russell Syndrome

SRS2 (618905) is caused by maternal uniparental disomy of chromosome 7. SRS3 (616489) is caused by mutation in the IGF2 gene (147470) on chromosome 11p15. SRS4 (618907) is caused by mutation in the PLAG1 gene (603026) on chromosome 8q12. SRS5 (618908) is caused by mutation in the HMGA2 gene (600698) on chromosome 12q14.


Clinical Features

Silver-Russell syndrome (SRS) was reported independently by Silver et al. (1953) and Russell (1954). Silver et al. (1953) described 2 unrelated children with congenital hemihypertrophy, low birth weight, short stature, and elevated urinary gonadotropins. Russell (1954) described 5 unrelated children with intrauterine growth retardation and characteristic facial features, including triangular shaped face with a broad forehead and pointed, small chin with a wide, thin mouth. Two children had body asymmetry. Although each of these authors emphasized different phenotypic features, the whole picture was later identified as the 'Russell-Silver syndrome' (Patton, 1988).

Chitayat et al. (1988) described hepatocellular carcinoma in a 4-year-old boy with Russell-Silver syndrome. His brother had low birth weight and bilateral clinodactyly of the fifth fingers and grew slowly. Neither brother showed asymmetry. Donnai et al. (1989) described unusually severe Silver-Russell syndrome in 3 children with pre- and postnatal growth deficiency.

Price et al. (1999) reevaluated 57 patients in whom the diagnosis of SRS had been considered definite or likely. In 50 patients the clinical findings complied with a very broad definition of SRS. Notable additional findings included generalized camptodactyly in 11 individuals, many with distal arthrogryposis. Thirteen of the 25 males studied required genital surgery for conditions including hypospadias and inguinal hernia. Severe feeding problems were reported by 56% of parents, and sweating and pallor were described by 52% of parents in the early weeks of life. Fourteen of the 38 individuals of school age had been considered for special education; 4 attended special school. Molecular analysis in 42 subjects identified uniparental disomy (UPD) of chromosome 7 in 4 subjects. The phenotype in these 4 cases was generally milder than that in the non-UPD cases, with only 2 having the classic facial dysmorphism.

Anderson et al. (2002) conducted a study of gastrointestinal complications of SRS by questionnaire distributed by MAGIC, a support group for individuals with SRS. One-hundred thirty-five completed surveys were returned, of which 65 related to children with clear-cut SRS. Of these, 50 (77%) had gastrointestinal symptoms: gastroesophageal reflux disease (34%), esophagitis (25%), food aversion (32%), and failure to thrive (63%).

Andersson Gronlund et al. (2011) identified ophthalmologic abnormalities in 17 of 18 children with Silver-Russell syndrome. Best corrected visual acuity of the better eye was less than 0.1 log of the minimal angle of resolution (less than 20/200; legal blindness) in 11 children, and 11 children had refractive errors. Anisometropia (greater than 1 diopter) was noted in 3 children. Subnormal stereo acuity and near point of convergence were found in 2 of 16 children. The total axial length in both eyes was shorter compared with that of controls. Of 16 children, 3 had small optic discs, 3 had large cup:disc ratio, and 4 had increased tortuosity of retinal vessels. Andersson Gronlund et al. (2011) recommended ophthalmologic examination for children with SRS.

Lokulo-Sodipe et al. (2020) described the clinical features of RSS in a cohort of 33 patients aged 13 years and older (median age, 29.6 years). Most of the patients (60.6%) had height below 2 standard deviations (median, -2.67) despite 70% having received growth hormone treatment. Characteristic childhood dysmorphisms seen in RSS, including triangular face, broad nasal tip, broad nasal bridge, retrognathia, and downslanting palpebral fissures, were seen in only a minority of patients. Features seen more commonly in this cohort included a broad forehead and facial dysmorphism (45%), relative macrocephaly (57.6%), low-set ears (57.6%), and posteriorly rotated ears (54.5%). Feeding issues were not commonly reported, although 18.2% had gastroesophageal reflux. In patients aged 18 years and older, 25% had impaired glucose tolerance, 33% had hypertension, and 52% had hypercholesterolemia. University degrees were completed in 40% of patients aged 21 years and older, which was consistent with educational achievement in the general UK population. There was not a significant correlation between quality of life assessment scores and height, although there was a negative correlation with BMI. Among the 25 patients aged 18 years or older, 9 had children, none of whom had RSS. Lokulo-Sodipe et al. (2020) concluded that the diagnosis of RSS in adults is difficult and requires molecular confirmation because many of the typical characteristics of RSS in childhood are not present in adulthood.


Inheritance

Rimoin (1969) described monozygotic male twins concordant for Silver dwarfism. However, Nyhan and Sakati (1976) and Samn et al. (1990) described monozygotic twins discordant for RSS. Bailey et al. (1995) described triplets, one of whom had RSS. The evidence was strong that he and his triplet brother were monozygotic; the brother was unaffected. The clinical characteristics consistent with RSS were a birth weight of less than 3 SD below the mean for gestational age and lower than either of his same-gestation sibs. The affected child had a small head circumference and a short birth length.

Fuleihan et al. (1971) observed 3 affected sibs among the 6 offspring of consanguineous Lebanese parents. Craniofacial disproportion and other minor anomalies were present. The mother was very short. Another possible familial occurrence was observed by Silver (cited by Gareis et al., 1971), who found that the mother of one of his cases was only 59 inches tall and had triangular facies and incurved fifth fingers. Tanner et al. (1975) reported on a longitudinal study of 39 cases. None of 61 sibs was affected. The authors found no distinction between Silver and Russell syndromes. Escobar et al. (1978) reported affected half brother and sister and reviewed reported familial cases.

Duncan et al. (1990) reported 7 affected persons in two 3-generation families. Three members of each family had an undergrowth of the left side of the body when compared with the normal right side. The authors noted that the clinical features were milder than those reported in sporadic cases. Duncan et al. (1990) found that in 17 reported families, multiple maternal relatives had complete or partial expression of Silver-Russell syndrome. Of 197 probands analyzed, 19% had one or more affected relatives. Two families with affected twins were consistent with new dominant mutation; possible autosomal recessive inheritance was found in 4 families. Because no male-to-male transmission was documented in 21 families in the literature or in the 2 families reported by Duncan et al. (1990), they suggested that X-linked dominant inheritance is a possibility.

Al-Fifi et al. (1996) reported 2 families with apparent autosomal dominant transmission of RSS. In 1 family, the mother (height 140 cm) and a son and daughter of hers were affected. The mother's father was remarkably short and thin until his late teens, but was later of normal height (25th centile) with triangular face, mild asymmetry, and prominent ears. In the second family, the mother's height and weight were below the third percentile for age before puberty. After puberty, her height reached the 25th percentile but she remained thin. A son and daughter were thought to be affected.

Ounap et al. (2004) described 2 sisters who met the criteria for SRS proposed by Price et al. (1999). The parents had normal facial features, normal height, and normal postnatal growth. Ounap et al. (2004) stated that this was the second well-documented case of familial recurrence of SRS suggesting autosomal recessive inheritance, the other being that of 6 sibs (5 males and 1 female) of normal first-cousin Arab parents (Teebi, 1992). In the family reported by Ounap et al. (2004), Bartholdi et al. (2009) identified hypomethylation at chromosome 11p15. Bartholdi et al. (2009) also reported another family in which 2 sibs had SRS associated with hypomethylation at 11p15. The authors postulated germ cell mosaicism of an incorrect methylation mark at the ICR1 during spermatogenesis in the fathers.

Bartholdi et al. (2009) reported a father and daughter with SRS who both had partial hypomethylation at chromosome 11p15, suggesting vertical transmission. Although the mechanism was difficult to explain, the authors postulated that the missing methylation mark in the father was not reset or corrected (setting of a methylation mark) during spermatogenesis. The findings had implications for genetic counseling.


Diagnosis

On the basis of radiographs of 15 patients, Herman et al. (1987) concluded that no single finding is pathognomonic; however, between the ages of 2 and 10 years, delayed maturation, clinodactyly, fifth middle or distal phalangeal hypoplasia, ivory epiphyses, and a second metacarpal pseudoepiphysis are suggestive.

Price et al. (1999) proposed diagnostic criteria for SRS: (1) birth weight below or equal to -2 SD from the mean; (2) poor postnatal growth below or equal to -2 SD from the mean at diagnosis; (3) preservation of occipitofrontal head circumference (OFC); (4) classic facial phenotype; and (5) asymmetry. Price et al. (1999) noted that some cases associated with uniparental disomy (UDP) (see below) might remain undiagnosed if strict criteria are applied, and suggested that the presence of feeding difficulties may be particularly helpful in making a diagnosis in these cases.

Kim et al. (2021) used methylation-specific multiplex ligation-dependent probe amplification (MS-MPLA) analysis of chromosome 11p15 and bisulfite pyrosequencing (BP) of ICR1, ICR2, MEST (601029), and MEG3 (605636) for molecular diagnosis of patients with SRS. Twenty-eight patients were diagnosed with SRS based on modified Netchine-Harbison clinical scoring system (NH-CSS) criteria. Epigenetic defects were detected in 17 of the 28 patients: 11 patients had abnormal MS-MPLA findings, 14 patients had abnormal BP methylation analysis of ICR1 (11 of whom also had abnormal MS-MPLA findings), and 3 patients had abnormal BP methylation analysis of MEST. Six of the 7 patients who met 5 or more of the NH-CSS criteria were found to have methylation defects, 4 of the 8 patients with 4 NH-CSS criteria were found to have methylation defects, and 7 of the 13 patients with 3 NH-CSS criteria were found to have methylation defects. Kim et al. (2021) concluded that genetic analysis for SRS should be considered even in patients with a low NH-CSS score.


Cytogenetics

Chromosome 11

Chiesa et al. (2012) described 2 maternal 11p15.5 microduplications with contrasting phenotypes. In the first case, a 1.2-Mb inverted duplication of chromosome 11p15 derived from the maternal allele resulted in Silver-Russell syndrome. The duplication encompassed the entire 11p15.5 imprinted gene cluster, and hypermethylation of CpGs throughout the ICR2 region was observed. These findings were consistent with the maintenance of genomic imprinting, with a double dosage of maternal imprinting and resulting in a lack of KCNQ1OT1 (604115) transcription. In the second case, a maternally inherited 160-kb inverted duplication that included only ICR2 and the most 5-prime 20 kb of KCNQ1OT1 resulted in a BWS (130650) phenotype in 5 individuals in 2 generations. This duplication was associated with hypomethylation of ICR2 resulting from partial loss of the imprinted methylation of the maternal allele, expression of a truncated KCNQ1OT1 transcript, and silencing of CDKN1C (600856). Chromatin RNA immunopurification studies suggested that the KCNQ1OT1 RNA interacts with chromatin through its most 5-prime 20-kb sequence, providing a mechanism for the silencing activity of this noncoding RNA. The finding of similar duplications of ICR2 resulting in different methylation imprints suggested that the ICR2 sequence is not sufficient for establishing DNA methylation on the maternal chromosome, and that some other property, possibly orientation-dependent, is needed.

Chromosome 17

Ramirez-Duenas et al. (1992) observed severe Russell-Silver syndrome in a girl with translocation t(17;20)(q25;q13). No evidence of imbalance was found. The father exhibited the same balanced translocation. Ramirez-Duenas et al. (1992) questioned whether the RSS locus is located on either chromosome 17 or 20 and whether the patient's phenotype resulted from either unmasking of heterozygosity or genomic imprinting via paternal disomy. Midro et al. (1993) found the identical chromosome 17 breakpoint (17q25) in an 8-year-old boy with a de novo t(1;17)(q31;q25) and Silver-Russell syndrome.

In a child with RSS, Eggermann et al. (1998) reported a heterozygous paternally inherited deletion of the gene encoding chorionic somatomammotropin hormone (CSH1; 150200), which maps to 17q22-q24. The authors noted that deletions of CSH1 with no phenotypic consequences have been reported; however, a role for the heterozygous deletion in this case was considered possible.

Dorr et al. (2001) prepared a physical and transcript map of the critical region for the RSS translocation breakpoint on 17q23-q24.

Chromosome 1

Van Haelst et al. (2002) reported a patient with phenotypic features of Silver-Russell syndrome who had trisomy 1q32.1-q42.1.

Chromosome X

Li et al. (2004) reported a female infant with a karyotype of 45,X on prenatal amniocytes. After delivery she was noted to have features consistent with Russell-Silver syndrome, including a triangular face with prominent forehead, large eyes, a thin nose, malar hypoplasia, thin upper lip with downturned corner of the mouth, and a pointed chin. Marked body asymmetry was evident at birth, with the left side significantly smaller than the right side. She also had a diphalangeal left fifth finger. Skin fibroblast culture and analysis showed a karyotype of 45,X on the right side and 45,X/46,XX on the left side. The case is another illustration of the genetic heterogeneity of the Russell-Silver phenotype.


Molecular Genetics

Abu-Amero et al. (2008) provided a review of the complex genetic etiology of Silver-Russell syndrome, which primarily involves chromosomes 7 and 11.

Genes on Chromosome 11

Given the crucial role of the 11p15 imprinted region in the control of fetal growth, Gicquel et al. (2005) hypothesized that dysregulation of genes at 11p15 might be involved in syndromic intrauterine growth retardation. In the telomeric imprinting center region ICR1 of the 11p15 region in several individuals with clinically typical Silver-Russell syndrome, they identified an epimutation (demethylation). The epigenetic defect was associated with, and probably responsible for, relaxation of imprinting and biallelic expression of H19 (103280) and downregulation of IGF2 (147470). These findings provided new insight into the pathogenesis of SRS and strongly suggested that the 11p15 imprinted region, in addition to the imprinted region of 7p13-p11.2 and 7q31-qter, is involved in SRS. The loss of paternal methylation in individuals with SRS may have resulted from a deficient acquisition of methylation during spermatogenesis or from a lack of maintenance of methylation after fertilization. The 5 individuals with SRS that carried the epimutation had only a partial loss of methylation, and 4 of them had body asymmetry. These data suggested that the loss of methylation occurred after fertilization and resulted in a mosaic distribution of the epimutation.

The epimutation described in individuals with SRS by Gicquel et al. (2005) is the exact opposite of one of the molecular defects responsible for Beckwith-Wiedemann syndrome (BWS; 130650): approximately 10% of individuals with BWS have hypermethylation of the H19 promoter. The most common epimutation in individuals with BWS involves the centromeric 11p15 subdomain and consists of loss of methylation of the maternal KCNQ1OT1 (604115) allele. Paternal inheritance of a null KCNQ1OT1 allele results in fetal growth retardation by 20 to 25% but does not affect expression of H19 or IGF2. One of the 5 individuals with the epimutation was a monozygotic twin, and her twin had no clinical features of SRS. Both twins had a loss of methylation in the telomeric 11p15 domain in their leukocyte DNA and biallelic expression of H19 in their blood cells. However, in skin fibroblasts, only the affected twin showed abnormal methylation. This observation was consistent with results obtained from BWS-discordant monozygotic twins and suggested that the presence of the epigenetic defect of blood cells of both twins results from shared fetal circulation.

The H19 differentially methylated region (DMR) controls the allele-specific expression of both the imprinted H19 tumor suppressor gene and the IGF2 growth factor. Hypermethylation of this DMR--and subsequently of the H19 promoter region--is a major cause of the clinical features of gigantism and/or asymmetry seen in Beckwith-Wiedemann syndrome or in isolated hemihypertrophy. Bliek et al. (2006) reported a series of patients with hypomethylation of the H19 locus. The main clinical features of asymmetry and growth retardation were the opposite of those seen in patients with hypermethylation of this region. In addition, they found that complete hypomethylation of the H19 promoter was associated in 2 of 3 patients with the full clinical spectrum of Silver-Russell syndrome.

Following up on the work of Gicquel et al. (2005) on epigenetic mutations in the etiology of SRS, Eggermann et al. (2006) screened a cohort of 51 SRS patients for epimutations in ICR1 (the telomeric imprinting center region of 11p15) and KCNQ1OT1 (604115) by methylation-sensitive Southern blot analyses. ICR1 demethylation was observed in 16 of the 51 SRS patients, corresponding to a frequency of approximately 31%. Changes in methylation at the KCNQ1OT1 locus were not detected. Combining these data with those on maternal duplications in 11p15, nearly 35% of SRS cases are associated with detectable (epi)genetic disturbances in 11p15. Eggermann et al. (2006) suggested that a general involvement of 11p15 changes in growth-retarded patients with only minor or without further dysmorphic features must be considered. SRS and BWS may be regarded as 2 diseases caused by opposite (epi)genetic disturbances of the same chromosomal region displaying opposite clinical pictures.

Schonherr et al. (2007) stated that methylation defects in the imprinted region of 11p15 can be detected in about 30% of patients with SRS. They reported the first patient with SRS with a cryptic duplication restricted to the centromeric imprinting center ICR2 in 11p15. The maternally inherited duplication in this patient included a region of 0.76 to 1.0 Mbp and affected the genes regulated by the ICR2, among them CDKN1C (600856) and LIT1 (604115).

Netchine et al. (2007) screened for 11p15 epimutation and mUPD7 in SRS and non-SRS small-for-gestational-age (SGA) patients to identify epigenetic-phenotypic correlations. Of the 127 SGA patients studied, 58 were diagnosed with SRS; 37 of these (63.8%) displayed partial loss of methylation (LOM) of the 11p15 ICR1 domain, and 3 (5.2%) had mUPD7. No molecular abnormalities were found in the non-SRS SGA group. Birth weight, birth length, and postnatal body mass index (BMI) were lower in the abnormal 11p15 SRS group (ab-ICR1-SRS) than in the normal 11p15 SRS group (-3.4 vs -2.6 SD score (SDS), -4.4 vs -3.4 SDS, and -2.5 vs -1.6 SDS, respectively; p less than 0.05). Among SRS patients, prominent forehead, relative macrocephaly, body asymmetry, and low BMI were significantly associated with ICR1 LOM. All ab-ICR1-SRS patients had at least 4 of 5 criteria of the scoring system. Netchine et al. (2007) concluded that the 11p15 ICR1 epimutation is a major, specific cause of SRS exhibiting failure to thrive. They proposed a clinical scoring system (including a BMI of less than -2 SDS), highly predictive of 11p15 ICR1 LOM, for the diagnosis of SRS.

Bullman et al. (2008) reported a patient with SRS who had mosaic maternal uniparental disomy of chromosome 11 with abnormal methylation of ICR2. MLPA analysis showed 12 informative loci between chromosome 11p15.5 to 11q23.3. The isodisomy was the reciprocal of the mosaic paternal isodisomy seen in patients with BWS.

Azzi et al. (2009) studied the methylation status of 5 maternally and 2 paternally methylated loci in a series of 167 patients with 11p15-related fetal growth disorders. Seven of 74 (9.5%) Russell-Silver (RSS) patients and 16 of 68 (24%) Beckwith-Wiedemann (BWS; 130650) patients showed multilocus loss of methylation (LOM) at regions other than ICR1 and ICR2 11p15, respectively. Moreover, over two-thirds of multilocus LOM RSS patients also had LOM at a second paternally methylated locus, DLK1/GTL2 IG-DMR. No additional clinical features due to LOM of other loci were found, suggesting an (epi)dominant effect of the 11p15 LOM on the clinical phenotype for this series of patients. Surprisingly, 4 patients displayed LOM at both ICR1 and ICR2 11p15; 3 of them had a RSS and 1 patient had a BWS phenotype. The authors concluded that multilocus LOM can also concern RSS patients, and that LOM can involve both paternally and maternally methylated loci in the same patient.

Using PCR-based methylation analysis, Penaherrera et al. (2010) found that 13 (37%) of 35 blood samples from patients with SRS showed methylation levels at H19/IGF2 ICR1 that were more than 2 SD below the mean for controls. Clinically, SRS patients had a lower birth weight (at least 2 SD below the mean), relative macrocephaly, and a higher frequency of body asymmetry compared to SRS patients without these epigenetic changes. One patient had a mediastinal neuroblastoma. Controls had considerable variability in methylation (30 to 47%) at ICR1, which Penaherrera et al. (2010) noted can cause some ambiguity in establishing clear cutoffs for diagnosis.

Exclusion Studies

Previous studies had shown that individuals with a deletion of 15q26.1-qter, which includes the insulin-like growth factor I receptor gene (IGF1R; 147370), may exhibit some phenotypic characteristics resembling those of Russell-Silver syndrome. Abu-Amero et al. (1997) investigated 33 RSS probands, with normal karyotypes, and their parents for the presence of both copies of IGF1R by gene dosage analysis of Southern blot hybridization. All 33 probands had both copies of the gene. Two important functional regions of IGF1R were also investigated for DNA mutations using SSCP analysis; no mutations were found. The patients were from the series of cases studied by Preece et al. (1997).

Penaherrera et al. (2010) found no changes in methylation of the KVDMR1 (see KCNQ1; 607542), PLAGL1 (603044), or PEG10 (609810) genes in blood samples of 35 patients with SRS. Whole genome methylation analysis of a subset of 22 SRS patients, including 10 who had hypomethylation at ICR1, showed no global disruption in methylation in these patients compared to controls.


Genotype/Phenotype Correlations

Binder et al. (2008) compared the genotype in 44 patients with SRS with the endocrine phenotype. Epimutations at 11p15 were found in 19 of the 44, UPD7 in 5, and small structural aberrations of the short arm of chromosome 11 in 2. Of the 44 cases, 18 were negative for any genetic defect known (41%). The most severe phenotype was found in children with 11p15 SRS. Children with UPD7 SRS had a significantly higher birth length than the 11p15 SRS subjects (P less than 0.004) but lost height SD score postpartum, whereas children with 11p15 SRS showed no change in height SD score. There was a trend toward more height gain in children with UPD7 than in those with 11p15 epimutation under GH therapy (+2.5 vs +1.9 height SD score after 3 years) (P = 0.08). Binder et al. (2008) concluded that children with SRS and an 11p15 epimutation have IGFBP3 (146732) excess and show endocrine characteristics suggesting IGF1 (147440) insensitivity, whereas children with SRS and UPD7 were not different with respect to endocrine characteristics from nonsyndromic short children born SGA. This phenotype-genotype correlation implicated divergent endocrine mechanisms of growth failure in SRS.

Bartholdi et al. (2009) found that 106 (53%) of 201 patients with suspected SRS actually fulfilled clinical criteria for the disorder. Hypomethylation at the ICR1 on chromosome 11p15 was observed in 41 (38.5%) of the 106 patients. The majority of patients showed hypomethylation of both H19 and IGF2, but 10 showed selective hypomethylation of H19 and 2 showed selective hypomethylation of IGF2. However, the authors noted that the IGF2-specific probe showed a broader variation in controls as compared to the H19 probe. Seven (6.6%) of the 106 patients had uniparental disomy of chromosome 7. Patients carrying epimutations had higher disease scores than those with maternal uniparental disomy of chromosome 7 or those with no identified defects, indicating that hypomethylation at 11p15 was associated with a more severe phenotype, particularly body asymmetry. No genetic anomaly was detected in 54.7% of patients.


History

Tanner and Ham (1969) suggested that the designation 'Silver dwarf' be reserved for children of short stature and low birth weight who have asymmetry of arms, legs, body or head, and incurved fifth fingers. They suggested that the designation 'Russell dwarf' be reserved for the similar situation when asymmetry is lacking. Patton (1988) noted that this distinction had not been generally accepted.


See Also:

Angehrn et al. (1979); Moseley et al. (1966); Robichaux et al. (1981); Silver (1964); Weiss and Garnick (1981)

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Contributors:
Hilary J. Vernon - updated : 11/04/2020
Matthew B. Gross - updated : 1/15/2015
Cassandra L. Kniffin - updated : 12/11/2014
Jane Kelly - updated : 8/15/2011
Cassandra L. Kniffin - updated : 7/7/2011
George E. Tiller - updated : 11/1/2010
Cassandra L. Kniffin - updated : 6/1/2009
Cassandra L. Kniffin - updated : 3/23/2009
John A. Phillips, III - updated : 2/26/2009
Cassandra L. Kniffin - updated : 10/2/2008
Cassandra L. Kniffin - updated : 8/15/2008
John A. Phillips, III - updated : 3/24/2008
Victor A. McKusick - updated : 2/21/2007
Victor A. McKusick - updated : 10/10/2006
Victor A. McKusick - updated : 9/13/2006
Victor A. McKusick - updated : 3/15/2006
Victor A. McKusick - updated : 9/27/2005
Patricia A. Hartz - updated : 2/3/2005
Victor A. McKusick - updated : 1/3/2005
Siobhan M. Dolan - updated : 7/29/2004
Cassandra L. Kniffin - reorganized : 11/17/2003
Deborah L. Stone - updated : 2/12/2003
Victor A. McKusick - updated : 11/19/2002
Victor A. McKusick - updated : 11/7/2002
Michael J. Wright - updated : 7/1/2002
Victor A. McKusick - updated : 1/4/2002
Victor A. McKusick - updated : 10/19/2001
Michael B. Petersen - updated : 8/16/2001
Victor A. McKusick - updated : 1/24/2001
Michael J. Wright - updated : 1/9/2001
Victor A. McKusick - updated : 10/5/2000
Michael J. Wright - updated : 2/7/2000
Victor A. McKusick - updated : 12/29/1999
Victor A. McKusick - updated : 10/19/1999
Victor A. McKusick - updated : 11/30/1998
Michael J. Wright - updated : 10/7/1998
Victor A. McKusick - updated : 3/13/1998
Victor A. McKusick - updated : 11/7/1997
Victor A. McKusick - updated : 4/1/1997

Creation Date:
Victor A. McKusick : 5/16/1994

Edit History:
carol : 03/04/2022
carol : 03/03/2022
carol : 11/04/2020
alopez : 07/13/2020
alopez : 06/12/2020
carol : 10/14/2016
mcolton : 03/04/2015
mgross : 1/15/2015
alopez : 12/12/2014
mcolton : 12/12/2014
ckniffin : 12/11/2014
terry : 4/4/2013
terry : 12/5/2012
carol : 8/23/2011
terry : 8/15/2011
wwang : 7/14/2011
ckniffin : 7/7/2011
alopez : 11/2/2010
terry : 11/1/2010
terry : 12/17/2009
wwang : 6/10/2009
ckniffin : 6/1/2009
wwang : 4/7/2009
ckniffin : 3/23/2009
alopez : 2/26/2009
wwang : 10/10/2008
ckniffin : 10/2/2008
wwang : 8/19/2008
wwang : 8/19/2008
ckniffin : 8/15/2008
carol : 3/24/2008
alopez : 2/26/2007
terry : 2/21/2007
alopez : 10/11/2006
terry : 10/10/2006
alopez : 9/18/2006
terry : 9/13/2006
alopez : 3/21/2006
terry : 3/15/2006
alopez : 9/28/2005
terry : 9/27/2005
joanna : 6/13/2005
mgross : 2/3/2005
tkritzer : 1/13/2005
terry : 1/3/2005
carol : 9/2/2004
carol : 7/29/2004
terry : 7/29/2004
mgross : 3/17/2004
carol : 11/17/2003
ckniffin : 11/5/2003
terry : 5/16/2003
carol : 2/12/2003
alopez : 11/25/2002
tkritzer : 11/22/2002
tkritzer : 11/19/2002
tkritzer : 11/19/2002
tkritzer : 11/13/2002
terry : 11/7/2002
alopez : 7/3/2002
terry : 7/1/2002
carol : 1/4/2002
terry : 1/4/2002
carol : 11/12/2001
carol : 11/12/2001
mgross : 10/19/2001
terry : 10/19/2001
carol : 8/16/2001
carol : 1/25/2001
terry : 1/24/2001
alopez : 1/10/2001
alopez : 1/9/2001
terry : 10/5/2000
carol : 10/5/2000
terry : 2/10/2000
alopez : 2/7/2000
alopez : 2/7/2000
mgross : 1/3/2000
terry : 12/29/1999
carol : 10/19/1999
carol : 6/21/1999
carol : 11/30/1998
carol : 10/12/1998
terry : 10/7/1998
terry : 5/29/1998
psherman : 3/13/1998
terry : 3/6/1998
jenny : 11/7/1997
alopez : 11/5/1997
dholmes : 10/22/1997
terry : 4/1/1997
terry : 3/20/1997
mark : 2/17/1996
terry : 2/14/1996
mark : 9/13/1995
carol : 5/16/1994