SHORT Syndrome

NORD gratefully acknowledges Emily Fishman, NORD Editorial Intern, and A. Micheil Innes, MD, FRCPC, FCCMG, Department of Medical Genetics, University of Calgary, Alberta Children’s Hospital Research Institute for Child and Maternal Health, Calgary, Alberta, Canada, for assistance in the preparation of this report.

Synonyms of SHORT Syndrome

Aarskog-Ose-Pande syndrome
lipodystrophy-Rieger anomaly-diabetes syndrome
Rieger anomaly-partial lipodystrophy syndrome
PIK3R1-associated syndromic insulin resistance with lipoatrophy

General Discussion

SHORT syndrome is a rare condition in which affected individuals have multiple birth defects in different organ systems. SHORT syndrome was first described by RJ Gorlin et al in 1975 based on the striking physical features of two infants born to normal parents. Over time, more affected individuals have been described and the clinical definition of SHORT syndrome has been expanded. Each letter of SHORT syndrome represents one of the common findings in affected persons:

(S) = short stature

(H) = hyperextensibility of joints and/or hernia (inguinal)

(O) = ocular depression (deep-set eyes)

(R) = Rieger anomaly (defective development of the eye that often leads to glaucoma)

(T) = teething delay

Not all of these five features are required for diagnosis of SHORT syndrome.

Other characteristics common in SHORT syndrome are a triangular face, small chin with a dimple, a loss of fat under the skin (lipodystrophy), abnormal position of the ears, hearing loss, intrauterine growth restriction (IUGR) (poor fetal growth and low weight), and delayed speech.

Signs & Symptoms

SHORT syndrome is a disorder that affects multiple organ systems. This condition was initially characterized by short stature, joints that stretch more than usual (hyperextensibility), a particular type of hernia in which the intestine protrudes through a weak spot in the abdominal muscles (inguinal hernia), deep set eyes (ocular depression), defective development of the anterior chamber of the eye that can lead to glaucoma (Rieger anomaly) and delayed eruption of teeth.

In addition to the classic features, other characteristics that are common in SHORT syndrome include a triangular face, small chin with a dimple, abnormal position of the ears, and hearing loss. Loss of fat under the skin (lipodystrophy) is also common, causing difficulty gaining weight and a translucent appearance to the skin. This typically presents first in the face followed by the chest and upper extremities in the first few years of development. Often, the lower extremities are spared from lipodystrophy, but overall body appearance is thin with low body mass index (BMI). Some affected individuals have speech delay and other developmental delays but intelligence is usually normal. In addition to teething delay, development of further dental issues is likely. Insulin resistance is common in mid-childhood to adolescence, often progressing into diabetes mellitus by early adulthood. Babies with SHORT syndrome are usually born at or slightly before term, but often have low birth weight, small head circumference, and shortened length. Individuals with SHORT syndrome are thought to have a normal life-expectancy.

Causes

SHORT syndrome is caused by changes (mutations) in the PIK3R1 gene. This gene is responsible for proper production of the enzyme PI3K. Enzymes are proteins that speed up the progress of cellular reactions. Specifically, PI3K is involved in many cell activities including cell growth and division, transport of materials within cells, movement of cells, and regulation of the hormone insulin.

SHORT syndrome is inherited in an autosomal dominant manner. 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 if affected or can be the result of a new (de novo) mutation in the affected individual. The risk of passing the abnormal gene from an affected parent to an offspring is 50% for each pregnancy. The risk is the same for males and females.

Affected Populations

SHORT syndrome is a very rare disorder with fewer than 50 reported cases in the literature to date. SHORT syndrome is not known to be more prevalent in a certain ethnic group or geographic location.

Related Disorders

Symptoms of the following disorders can be similar to those of SHORT syndrome. Comparisons may be useful for a differential diagnosis:

Rieger syndrome: a rare disorder inherited as an autosomal dominant trait. The main characteristics of this disorder are facial, dental and eye abnormalities. Facial characteristics include a small jaw, broad nasal bridge and/or a protruding lower lip. Although Rieger anomaly is a classic feature of SHORT syndrome, an individual may have Rieger syndrome alone without the other clinical features of SHORT syndrome. (For more information on this disorder choose “Rieger” as your search term in the Rare Disease Database.)

Russell-Silver syndrome: a rare disorder characterized by intrauterine growth restriction (IUGR) and growth deficiency after birth. This can also be characterized by short stature, a small triangular-shaped face, short arms, and light brown spots on the skin (cafe-au-lait spots). The corners of the mouth turn downward and short incurved fifth fingers are apparent. Intelligence is often normal although in some children intellectual disability may occur. (For more information on this disorder, choose “Russell-Silver” as your search term in the Rare Disease Database.)

Alagille syndrome: a rare genetic disorder that can affect multiple organ systems of the body including the liver, heart, skeleton, eyes and kidneys. Common symptoms, which often develop during the first three months of life, include blockage of the flow of bile from the liver (cholestasis), yellowing of the skin and mucous membranes (jaundice), poor weight gain and growth, severe itching, and pale, loose stools. The eye and dental features of Alagille syndrome are similar to those of SHORT syndrome, but the liver abnormalities of Alagille syndrome are not seen in SHORT syndrome. (For more information on this disorder, choose “Alagille” as your search term in the Rare Disease Database.)

Congenital generalized lipodystrophy (Berardinelli-Seip syndrome): a rare genetic disorder characterized by the near total loss of body fat (adipose tissue) and extreme muscularity that is often present at birth or soon thereafter. Insulin resistance and diabetes mellitus are also common later in life. The degree of lipodystrophy is much more severe in congenital generalized lipodystrophy compared to SHORT syndrome. (For more information on this disorder, choose “congenital generalized lipodystrophy” as your search term in the Rare Disease Database.)

Hutchinson-Gilford progeria syndrome: a rare, fatal, genetic condition of childhood with striking features resembling premature aging. Individuals develop a distinctive facial appearance characterized by a disproportionately small face in comparison to the head; an underdeveloped jaw (micrognathia); malformation and crowding of the teeth; abnormally prominent eyes; a small nose; prominent eyes and a subtle blueness around the mouth. These features are similar to those of SHORT syndrome, but individuals with SHORT syndrome do not the features associated with accelerated aging. (For more information on this disorder, choose “Hutchinson-Gilford progeria” as your search term in the Rare Disease Database.)

Diagnosis

The diagnosis of SHORT syndrome is based on physical findings and molecular genetic testing for mutations in the PIK3R1 gene.

Standard Therapies

No specific treatment exists for SHORT syndrome; however, some features can be treated separately on a case-by-case basis. Rieger anomaly/glaucoma, dental anomalies, insulin resistance/diabetes mellitus, and hearing loss can often be treated by appropriate medical specialists if present. Treatment is symptomatic and supportive. Given the increased risk for insulin resistance, it is generally advisable to avoid growth hormone treatments.

Genetic counseling is recommended for patients and their families.

Investigational Therapies

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 government website.

For information about clinical trials being conducted at the National Institutes of Health (NIH) in Bethesda, MD, contact the NIH Patient Recruitment Office:
Tollfree: (800) 411-1222
TTY: (866) 411-1010
Email: prpl@cc.nih.gov

Some current clinical trials also are posted on the following page on the NORD website:
https://rarediseases.org/for-patients-and-families/information-resources/news-patient-recruitment/

For information about clinical trials sponsored by private sources, contact:
www.centerwatch.com

For information about clinical trials conducted in Europe, contact:
https://www.clinicaltrialsregister.eu/

Supporting Organizations

Genetic and Rare Diseases (GARD) Information Center
- PO Box 8126
- Gaithersburg, MD 20898-8126
- Phone: (301) 251-4925
- Toll-free: (888) 205-2311
- Website: http://rarediseases.info.nih.gov/GARD/
Human Growth Foundation
- 997 Glen Cove Avenue
- Suite 5
- Glen Head, NY 11545
- Phone: (516) 671-4041
- Toll-free: (800) 451-6434
- Email: hgf1@hgfound.org
- Website: http://www.hgfound.org/
Little People of America, Inc.
- 250 El Camino Real Suite 201
- Tustin, CA 92780
- Phone: (714) 368-3689
- Toll-free: (888) 572-2001
- Email: info@lpaonline.org
- Website: http://www.lpaonline.org/
MAGIC Foundation
- 4200 Cantera Dr. #106
- Warrenville, IL 60555
- Phone: (630) 836-8200
- Toll-free: (800) 362-4423
- Email: contactus@magicfoundation.org
- Website: http://www.magicfoundation.org
NIH/National Eye Institute
- 31 Center Dr
- MSC 2510
- Bethesda, MD 20892-2510 United States
- Phone: (301) 496-5248
- Email: 2020@nei.nih.gov
- Website: http://www.nei.nih.gov/
Restricted Growth Association
- PO Box 5137
- Yeovil, BA20 9FF United Kingdom
- Phone: (300) 111-1970
- Email: office@restrictedgrowth.co.uk
- Website: http://www.restrictedgrowth.co.uk

References

TEXTBOOKS

Raygada M and Rennert O. SHORT Syndrome. In: The NORD Guide to Rare Disorders, Philadelphia: Lippincott, Williams and Wilkins, 2003:250.

JOURNAL ARTICLES

Koenig R, Brendel L and Fuchs S. SHORT syndrome. Clin Dysmorph. 2003;12:45-49.

Brodsky MC, Whiteside-Michel J, and Merin LM. Rieger anomaly and congenital glaucoma in the SHORT syndrome. Arch Opthamol. 1996;114:1146-1147.

Lipson AH, Cowell C, Gorlin RJ. The SHORT syndrome: further delineation and natural history. Journal of Medical Genetics. 1989;26(7):473-475. doi:10.1136/jmg.26.7.473.

Toriello HV, Wakefield S, Komar K, et al. Report of a case and further delination of the SHORT syndrome. Am J Med Genet. 1985:22;311-314.

Aarskog D, Ose L, Pande H, et al. Autosomal dominant partial lipodystrophy associated with Rieger anomaly, short stature, and insulinopenic diabetes. AmJ Med Genet. 1983;15:29-38.

INTERNET

Innes AM, Dyment DA. SHORT Syndrome. 2014 May 15. In: Pagon RA, Adam MP, Ardinger HH, et al., editors. GeneReviews® [Internet]. Seattle (WA): University of Washington, Seattle; 1993-2017. Available from: https://www.ncbi.nlm.nih.gov/books/NBK201365/ Accessed June 8, 2017.

PIK3R1 gene. Genetics Home Reference. https://ghr.nlm.nih.gov/gene/PIK3R1#conditions. Reviewed: December 2013. Accessed June 8, 2017.

SHORT syndrome. Genetic and Rare Diseases Information Center. National Institutes of Health. https://rarediseases.info.nih.gov/diseases/7633/short-syndrome . Last updated: 3/7/2016. Accessed June 8, 2017.

Dyment D, Innes AM. SHORT syndrome. Orphanet: The portal for rare diseases and orphan drugs. http://www.orpha.net/consor/cgi-bin/OC_Exp.php?Lng=GB&Expert=3163 Last Update:December 2015. Accessed June 8, 2017.

The Physician’s Guide to Lipodystrophy Disorders. National Organization for Rare Disorders; 2012. http://nordphysicianguides.org/lipodystrophies/
Accessed May 12, 2017.

McKusick VA. SHORT SYNDROME. Online Inheritance in Man (OMIM). https://www.omim.org/entry/269880. Last update: 05/25/2016. Accessed June 8, 2017.

Years Published

1993, 2004, 2007, 2017

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