Achondroplasia
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Achondroplasia

(Achondroplastic Dwarfism)

En Español (Spanish Version)

Definition

Achondroplasia is a genetic disorder that causes dwarfism (short stature). It is a disorder in which bone and cartilage do not grow normally. It is the most common cause of dwarfism.

This condition leads to patients attaining a full-grown height of less than four feet. The greatest shortening occurs in the humerus (the bone between the shoulder and the elbow) and the femur (the bone between the hip and the knee). There may also be underdevelopment of the face.

Achondroplasia is the most common form of inherited disproportionate short stature. It occurs in one in 26,000 to one in 40,000 live births.

Causes

Achondroplasia is a genetic disorder. It is caused by mutations in the FGFR3 gene that inhibits growth of cartilage at the growth plate. FGFR3 encodes a protein called Fibroblast Growth Factor Receptor 3. This protein is the site of action of a major growth factor responsible for lengthening bones. When this growth factor cannot act properly due to the absence of its receptor, the growth of bones, at the growth plate's cartilage, is slowed. This leads to shorter bones, abnormally shaped bones, and shorter stature.

The gene for achondroplasia can be passed from one generation to the next. If a parent has the disorder, there is a 50% chance of passing the gene for achondroplasia to offspring. In most cases of achondroplasia (80%-90%), it more commonly is the result of a spontaneous mutation (a sudden genetic defect) that occurs in the developing embryo.

Risk Factors

A risk factor is something that increases your chances of getting a disease or condition. Those at risk of inheriting achondroplasia are:

  • Children of a parent with achondroplasia
  • Children of normal-sized parents who carry a mutated FGFR3 gene
  • Advanced paternal age causing spontaneous mutations

Symptoms

Patients with achondroplasia have:

  • Short stature, a long trunk, and shortened limbs, which are noticeable at birth
  • Adults usually reach a height of between 42-56 inches
  • The head is large and the forehead is prominent
  • Portions of the face can be underdeveloped
  • At birth, the legs appear straight, but as a child begins to walk, he or she develops a knock-knee or bowed-leg deformity
  • The hands and the feet appear large, but the fingers and toes are short and stubby
  • Straightening of the arm at the elbow may be restricted, but usually does not keep a patient with achondroplasia from doing any specific activities
  • Children may develop an excessive curve of the lower back and a waddling walking pattern

Other common symptoms include:

  • Weight control problems
  • Bowed legs
  • Middle ear infections , especially in children
    • If not treated properly, can result in hearing loss
  • Dental problems (from overcrowding of teeth)
  • Hydrocephalus (water on the brain)
  • Neurologic and respiratory problems
  • Fatigue, pain, and numbness in the:
    • Lower back
    • Spine
  • Spinal compression may occur in the upper back or where the spinal cord exits from the skull in the back of the neck
    • Compression at this latter site may cause sleep apnea or even death if not recognized and treated early
    • MRI or CT scan evaluation can help detect these complications

The prognosis depends on the severity of the disease. Patients who have two copies of the deficient gene (ie, one from each parent, also known as homozygous) generally die a few weeks to months after birth. Those with one copy (ie, from only one parent, also known as heterozygous) have a normal life span and intelligence, although children often take longer to develop normal motor skills and there is an increased risk of death in the first year of life due to respiratory problems. They are usually independent in their daily life activities. Many of these patients, in fact, have gone on to do great things in life.

Diagnosis

Diagnosis includes:

  • Clinical evaluation
  • Radiographs
  • Molecular genetic testing can be used to detect a mutation in the FGFR3 gene. Such testing is 99% sensitive and is available in clinical laboratories. A doctor can usually diagnose the disorder in a newborn from observing physical symptoms. To confirm that dwarfism is caused by achondroplasia, x-rays are taken.
It is important to follow the doctor's advice to make sure that spinal stenosis does not develop. The physician evaluates the strength of the extremities and bladder control. Weakness and loss of bladder control are both signs of developing spinal stenosis.

Spinal Stenosis

Stenosis of spine with punched nerve

© 2008 Nucleus Medical Art, Inc.

Treatment

Unfortunately, there is currently no treatment that can cure this condition. Because we now know that achondroplasia is caused by an absence of growth factor receptor, scientists are exploring ways to create alternate growth factors which can bypass the missing receptor and lead to normal bone growth. Such treatments are still well in the future but may offer the possibility of enhanced stature to future families who have children with achondroplasia.

Medication

Treatment with human growth hormone has been used for over a decade and effectively increases bone growth rate, at least in the first year of life. There have been few studies looking at whether children treated with growth hormone achieve greater (or normal) adult heights.

Surgery

Surgery is sometimes needed to correct specific skeletal deformities.

  • Spinal fusion—a surgery to permanently connect otherwise separate vertebrae. Surgery performed for patient with significant spinal kyphosis.
  • Laminectomy—a surgery to open the spinal canal to relieve pressure pressure on the compressed spinal cord from spinal stenosis . Spinal stenosis, a narrowing of the spinal canal, is the most serious complication of achondroplasia.
  • Osteotomy—the bones of the leg are cut and allowed to heal in the correct anatomical position. Procedure is for patients with severe knock-knee or bowed legs.

While osteotomy has primarily been used to correct deformities, in recent years bone lengthening procedures have been used for many short children, including those with achondroplasia. The procedures are lengthy, traumatic, and very demanding for both children and their families. Complications, sometimes serious, are common. One center has reported an average leg length (height) gain of about seven inches and an average increase in arm length of about four inches for achondroplastic individuals who undergo surgery. The combination of growth hormone therapy followed by lengthening surgery may provide benefit in achieving near-normal stature and proportions.

RESOURCES:

American Academy of Pediatrics
http://www.aap.org

Little People of America
http://www.lpaonline.org

March of Dimes
http://www.modimes.org

CANADIAN RESOURCES:

Little People of Ontario
http://www.lpo.on.ca/

References:

Aldegheri R, Dall'Oca C. Limb lengthening in short stature patients. J Pediatr Orthop B . 2001 Jul;10(3):238-47.

American Academy of Pediatrics website. Available at: http://www.aap.org .

Aviezer D, Golembo M, Yayon A. Fibroblast growth factor receptor-3 as a therapeutic target for achondroplasia--genetic short limbed dwarfism. Curr Drug Targets . 2003 Jul;4(5):353-65.

The Merck Manual of Medical Information . Simon and Schuster, Inc.; 2000.

National Library of Medicine website. Available at: http://www.aap.org .

Robbins Pathologic Basis of Disease . WB Saunders Company; 1999.



Last reviewed November 2007 by Mark A. Best, MD, MPH, MBA, FCAP, FASCP

Please be aware that this information is provided to supplement the care provided by your physician. It is neither intended nor implied to be a substitute for professional medical advice. CALL YOUR HEALTHCARE PROVIDER IMMEDIATELY IF YOU THINK YOU MAY HAVE A MEDICAL EMERGENCY. Always seek the advice of your physician or other qualified health provider prior to starting any new treatment or with any questions you may have regarding a medical condition.


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