Adams-Oliver syndrome Health Article

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.

Treatment and management

The treatment for AOS is different for each individual and is tailored to the specific symptoms. If leg-length discrepancy is present, corrective shoes that increase the sole for the unaffected leg to prevent scoliosis and ambulation difficulties can be worn. Orthopedic devices such as prostheses are sometimes recommended. Patients should be referred to a physician specializing in treating patients with limb defects early in life. Surgery for congenital defects and skin grafting for scalp defects may be necessary (about 30% of patients required skin grafting in one study).

Special devices for writing or other activities may be necessary if hand malformations are present.

About 30% of patients in one study suffered major hemmorrhage from the scalp defect. Twenty percent of patients had local infection of the scalp defect. Treatment such as transfusion or antibiotic therapy may be required in these cases.

Appropriate special education services are necessary for those with mental retardation. Counseling and support related to limb defeciency issues are essential for coping. Support groups can provide valuable peer referrals and information.

Prognosis

AOS does not usually alter lifespan, although complications from associated abnormalities such as mental retardation can cause problems. About 5% of the scalp defects that hemorrhaged severly were fatal. Rare cases of meningitis as a result of infection of the scalp defect have been reported. Asymmetry of the limbs can interfere with their proper function and cause pain. Psychological issues relating to disfigurement are possible.

BOOKS

Sybert V.P. "Aplasia cutis congenita: a report of 12 new families and review of the literature." Pediatric Dermatology, volume 3. Blackwell Scientific Publications, 1985 pps 1-14.

PERIODICALS

Amor D., et al. "Polymicrogyria associated with scalp and limb defects: Variant of Adams-Oliver syndrome." American Journal of Medical Genetics 93 (2000): 328.

Swartz, E.N., et al. "Vascular abnormalities in Adams-Oliver syndrome: Cause or effect?" American Journal of Medical Genetics 82 (1999): 49.

ORGANIZATIONS

Cherub Association of Families & Friends of Limb Disorder Children. 8401 Powers Rd., Batavia, NY 14020. (716) 762-9997.

REACH—Association for Children with Hand or Arm Deficiency. 12 Wilson Way, Earl's Barton, Northamptonshire, United Kingdom, NN6 9NZ. 01 604 811041.

WEBSITES

OMIM—Online Mendelian inheritance in Man <http://www.ncbi.nlm.nig.gov>.

Amy Vance, MS, CGC