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Sotos syndrome

Orpha number ORPHA821
Synonym(s) Cerebral gigantism
Prevalence 1-9 / 1 000 000
Inheritance
  • Autosomal dominant
  • Sporadic
Age of onset Neonatal/infancy
ICD-10
  • Q87.3
OMIM
UMLS
  • C0175695
MeSH
  • D058495
MedDRA
  • 10064387
SNOMED CT
  • 75968004

Summary

Sotos syndrome is an overgrowth condition characterized by cardinal features including excessive growth during childhood, macrocephaly, distinctive facial gestalt and various degrees of learning difficulty, and associated with variable minor features. The exact prevalence remains unknown but hundreds of cases have been reported. The diagnosis is usually suspected after birth because of excessive height and occipitofrontal circumference (OFC), advanced bone age, neonatal complications including hypotonia and feeding difficulties, and facial gestalt (narrow long face, pointed chin, broad domed forehead, scarce fine hair, hypertelorism with down slanting palpebral fissures). Other inconstant clinical abnormalities include scoliosis, cardiac and genitourinary anomalies, seizures and brisk deep tendon reflexes. Variable delays in cognitive and motor development are also observed. The syndrome may also be associated with an increased risk of tumors. Mutations and deletions of the NSD1 gene (located at chromosome 5q35 and coding for a histone methyltransferase implicated in transcriptional regulation) are responsible for more than 75% of cases. FISH analysis, MLPA or multiplex quantitative PCR allow the detection of total/partial NSD1 deletions, and direct sequencing allows detection of NSD1 mutations. The large majority of NSD1 abnormalities occur de novo and there are very few familial cases. Although most cases are sporadic, several reports of autosomal dominant inheritance have been described. Germline mosaicism has never been reported and the recurrence risk for normal parents is very low (<1%). The main differential diagnoses are Weaver syndrome, Beckwith-Wiedeman syndrome, Fragile X syndrome, Simpson-Golabi-Behmel syndrome and 22qter deletion syndrome (see these terms). Management is multidisciplinary. During the neonatal period, therapies are mostly symptomatic, including phototherapy in case of jaundice, treatment of the feedingdifficulties and gastroesophageal reflux, and detection and treatment of hypoglycemia. General pediatric follow-up is important during the first years of life to allow detection and management of clinical complications such as scoliosis and febrile seizures. An adequate psychological and educational program with speech therapy and motor stimulation plays an important role in the global development of the patients. Final body height is difficult to predict but growth tends to normalize after puberty.

Expert reviewer(s)

  • Dr Genevieve BAUJAT
  • Pr Valérie CORMIER-DAIRE

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Detailed information

Summary information
Review article
  • EN (2007)
Practical genetics
  • EN (2008,pdf)
Clinical genetics review
  • EN (2012)
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