Patient with
problems in sex determination, uterus
without ovaries, and external penis. Dense
hair distribution on body (in the pubic).
She has a big genital vagina, clitoris is
very pronounced (large) and lift cornet. She
hasn't testes. Barr body count 28%,
progesterone 5.35 (normal up to 1.13 ng/ml),
testosterone 210 (normal up to 100 ng %) and
17-ketosteroids 58.37 (normal up to 14 mg/24
hours). AGS - homozygote mutation in CYP21A2
gene; c.518T>A (p.Ile173Asn)
At birth:
weight: 3.860 kg; length: 52 cm, cranial
perimeter: 37 cm; at 4 years: weight: 31.300
kg; height: 1m18 (=> + 2DS) cranial
perimeter: 54 cm (=> +2.5 DS); walk at 11
months, no langage, urinary continence is
acquired, autistic disorder, no dysmorphy,
advanced statural growth (+2 DS), global
delayed development
born at term; APGAR 3/?/10; 2900g,
47cm, 33cm; child with shrill cry, beaked
nose, small palpebral fissures,
micrognathia, high arched palate, right hand
simian crease; during live severe growth
retardation; at age of 20 no speech and
severe mental retardation; weight of only 19
kg and 120 cm tall.
min(7)(:p11.2→q11.1:)
FISH-data: RP11-10F11 (56.45 MB) on sSMC
aCGH: 45.07-64.85
CR-FISH: break in p between 55.47 and
56,46 maternal (iso-)disomy UPD 7
seq[GRCh37] +der(7)(:q11.21q11.21::p11.2→]q11.21:)
chr7:g.[63674966~_63681708::ATTTGTAAAAAAACTTT::62394403_63674966inv::57645143_cen_62050000]add
pre- and
postnatal growth-retardation; height at age
of 4.5 9cm below 3rd percentile, weight: 3kg
below 3rd percentile; macrocephalus; macro
cornea; Silver Russel syndrome confirmed by
molecular genetics
Intrauterine
growth retardation from 34th week of
pregnancy → birth induced at 38 weeks of
gestation; birth weight 2305 g (<3rd
percentile), length 45 cm (<10th
percentile) and OFC 34 cm (50th percentile).
At 1y, growth retardation: length 68 cm
(<3rd percentile), weight 5740 g (<3rd
percentile) OFC 45 cm (10-25th percentile).
Triangular face, large, low set ears and
mild psychomotor retardation; could not roll
over or sit up alone → Silver Russel
syndrome signs.