Adams-Oliver Syndrome Health Article

Demographics

Adams-Oliver syndrome was first described in 1945. There have been over 125 cases reported in the medical literature. There does not appear to be any ethnic difference in prevalence of this condition.

Signs and symptoms

Limb defects are the most common occurrence in Adams-Oliver syndrome, affecting about 84% of patients. The type of limb defect is usually asymmetrical (not the same on both sides), with a tendency to involve both sides of the body (bilateral), more often the lower limbs than the upper limbs. There is a wide range of severity in the limb defects, from something minimal like small or missing finger or toenails (called nail hypoplasia), to the more severe absence of hands, feet, or lower legs. Other more moderate limb defects that have been reported include webbing (syndactyly) of the skin (cutaneous syndactyly) or bones (bony syndactyly) of the fingers or toes, claw-hand malformation (ectrodactly), and brachydactyly (shortened fingers or toes). Brachydactyly is the most common limb defect in AOS.

Congenital cutis aplasia is the second most common problem and is present in about 75% of patients with Adams-Oliver syndrome. In 64% of patients with congenital cutis aplasia, there is also an underlying scull defect. More rarely, scull defects can be seen without scalp defects and may be mistaken for an enlarged soft spot (fontanelle).

Congenital heart defects have been reported to occur in between 13%-20% of patients with Adams-Oliver syndrome.

Many different types of vascular (involving the blood vessels) and valvular (with heart valves) problems have been reported in these patients.

Other clinical features seen with AOS, include short stature, kidney (renal) malformations, cleft palate, small eyes (micropthalmia), spina bifida occulta, extra (accessory) nipples, undescended testes, skin lesions, and neurological abnormalities. Mental retardation is present in a few cases.

Diagnosis

Aplasia cutis congenita is a physical finding that has many causes. To determine whether a patient has Adams-Oliver syndrome clinically, all individuals with aplasia cutis congenita should have a complete pregnancy and family history taken, as well as a complete medical evaluation. When possible, relevant family members should be examined for evidence of the condition. When aplasia cutis congenita is discovered at birth, the placenta should be evaluated. Physical exam of the affected infant includes evaluation of other related structures, specifically teeth, hair, and other areas of skin, nails, and central nervous system. Once this evaluation has been completed and a specific diagnosis of Adams-Oliver syndrome has been established or refuted, genetic counseling can be provided.

Prenatal diagnosis by ultrasound of the limb defects and possibly some other abnormalities associated with AOS is possible, but clinical confirmation of the diagnosis occurs after birth. Since the gene (or genes) causing AOS have not been isolated, prenatal diagnostic procedures such as amniocentesis or chorionic villus sampling are not indicated.