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Global developmental delay, osteopenia and ectodermal defect: a new syndrome
Raffaella Zannolli1, Sabrina Buoni, Francesca Macucci
1Department of Paediatrics, Obstetrics and Reproductive Medicine, Section of Paediatrics, Policlinico Le Scotte, University of Siena, Siena, Italy. zannolli@unisi.it
Insights
This study identifies a new syndrome in children with global developmental delay, characterized by osteopenia and unique skin defects. Early recognition of these phenotypes may indicate a specific genetic cause.
Area of Science:
- Pediatric Neurology
- Clinical Genetics
- Dermatology
Background:
- Global developmental delay (GDD) is a significant social issue often diagnosed late.
- Phenotypic characterization of GDD, particularly with central nervous system (CNS) impairment, requires further investigation.
Observation:
- Three children presented with GDD, osteopenia, and distinct skin abnormalities.
- Skin defects included abnormal keratin differentiation, sweat gland alterations, and melanocyte dysfunction.
- Ultrastructural analysis revealed hyperkeratosis, granular layer thickening, and issues with melanosome migration.
Findings:
- The observed combination of GDD, osteopenia, and specific skin defects suggests a previously unrecognized syndrome.
- Detailed skin biopsy findings point towards a potential genetic basis affecting keratinocytes, sweat glands, and melanocytes.
- Neurological, imaging, metabolic, and genetic evaluations were integrated to define the syndrome's characteristics.
Implications:
- This report highlights a novel association that could serve as a key diagnostic sign for a specific genetic disorder.
- Recognition of this syndrome may lead to earlier diagnosis and targeted interventions for affected children.
- Further research into the genetic underpinnings of this syndrome is warranted to improve patient outcomes.
Unlabelled:
Global developmental delay is a serious social problem. It is often unrecognized and the phenotypes are inadequately studied. To investigate the phenotypes of children with aspecific central nervous system (CNS) impairment (poor speech, maladaptive behavioral symptoms such as temper tantrums, aggressiveness, poor concentration and attention, impulsiveness, and mental retardation).
Setting:
Tertiary care hospital.
Patients:
Three children (two male siblings, and one unrelated girl).
Methods:
We used the results from clinical neurological evaluations; imaging and electrodiagnostic studies; metabolic and genetic tests; skin biopsies and bone mineral densitometry. All three children suffered from (A) global developmental delay, (B) osteopenia, and (C) identical skin defects. The skin ultrastructural abnormalities were abnormal keratin differentiation, consisting of hyperkeratosis and granular layer thickening; sweat gland abnormalities, consisting of focal, cytoplasmic clear changes in eccrine secretory cells; and melanocyte abnormalities, with both morphological changes (reduced number and size without evident dendritic processes), and functional changes (defects in the migration of melanosomes in the keratinocytes). These patients present a previously unrecognized syndrome. We retain useful to report this new association, to be recognized, in the next future, as a specific key-sign of a well-defined genetic defect.
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