Smith-Lemli-Opitz syndrome

General Information (adopted from Orphanet):

Synonyms, Signs: POLYDACTYLY, SEX REVERSAL, RENAL HYPOPLASIA, AND UNILOBAR LUNG
SLO SYNDROME
LETHAL ACRODYSGENITAL SYNDROME
RUTLEDGE LETHAL MULTIPLE CONGENITAL ANOMALY SYNDROME
SLOS
rsh syndrome
7-dehydrocholesterol reductase deficiency
Number of Symptoms 183
OrphanetNr: 818
OMIM Id: 270400
ICD-10: Q87.1
UMLs: C0175694
C2713347
MeSH: D019082
MedDRA:
Snomed: 43929004

Prevalence, inheritance and age of onset:

Prevalence: 3.7 of 100 000 [Orphanet]
Inheritance: Autosomal recessive
[Orphanet]
Age of onset: Neonatal
Infancy
[Orphanet]

Disease classification (adopted from Orphanet):

Parent Diseases: 46,XY disorder of sex development due to cholesterol synthesis defect
 -Rare developmental defect during embryogenesis
 -Rare endocrine disease
 -Rare genetic disease
 -Rare urogenital disease
Craniofacial anomaly with cataract
 -Rare eye disease
 -Rare genetic disease
Developmental anomaly of metabolic origin
 -Rare developmental defect during embryogenesis
 -Rare genetic disease
Genetic malformation syndrome with short stature
 -Rare genetic disease
Malformation syndrome with short stature
 -Rare developmental defect during embryogenesis
Metabolic disease with cataract
 -Rare eye disease
 -Rare genetic disease
Multiple congenital anomalies/dysmorphic syndrome-intellectual deficit
 -Rare developmental defect during embryogenesis
 -Rare genetic disease
Ptosis
 -Rare eye disease
 -Rare genetic disease
Sterol biosynthesis disorder
 -Rare developmental defect during embryogenesis
 -Rare genetic disease
Syndrome associated with Pierre Robin syndrome
 -Rare developmental defect during embryogenesis
 -Rare genetic disease
 -Rare maxillo-facial surgical disease
 -Rare otorhinolaryngologic disease
Syndrome with limb duplication, polydactyly, syndactyly, and/or hyperphalangy
 -Rare bone disease
 -Rare developmental defect during embryogenesis
Syndromic developmental defect of the eye
 -Rare developmental defect during embryogenesis
 -Rare eye disease
 -Rare genetic disease
Syndromic epicanthus
 -Rare eye disease
 -Rare genetic disease
Syndromic neurometabolic disease with non-X-linked intellectual deficit
 -Rare genetic disease
 -Rare neurologic disease
Syndromic renal or urinary tract malformation
 -Rare developmental defect during embryogenesis
 -Rare genetic disease
 -Rare renal disease

Symptom Information: Sort by abundance 

1
(HPO:0002019) Constipation 194 / 7739
2
(HPO:0002033) Poor suck 37 / 7739
3
(HPO:0002013) Vomiting 10807690 IBIS 191 / 7739
4
(HPO:0001623) Breech presentation 16 / 7739
5
(HPO:0000316) Hypertelorism Occasional [Orphanet] 644 / 7739
6
(HPO:0000520) Proptosis Occasional [Orphanet] 192 / 7739
7
(HPO:0000647) Sclerocornea Occasional [Orphanet] 25 / 7739
8
(HPO:0000612) Iris coloboma Occasional [Orphanet] 116 / 7739
9
(HPO:0000518) Cataract Occasional [Orphanet] 10807690 IBIS 454 / 7739
10
(HPO:0008056) Aplasia/Hypoplasia affecting the eye Occasional [Orphanet] 142 / 7739
11
(HPO:0000639) Nystagmus Occasional [Orphanet] 10807690 IBIS 555 / 7739
12
(HPO:0000486) Strabismus Occasional [Orphanet] 10807690 IBIS 576 / 7739
13
(HPO:0000501) Glaucoma Occasional [Orphanet] 180 / 7739
14
(HPO:0000508) Ptosis Frequent [Orphanet] 10807690 IBIS 459 / 7739
15
(HPO:0002101) Abnormal lung lobation Frequent [Orphanet] 10807690 IBIS 33 / 7739
16
(HPO:0006703) Aplasia/Hypoplasia of the lungs Frequent [Orphanet] 79 / 7739
17
(HPO:0002089) Pulmonary hypoplasia 80 / 7739
18
(HPO:0001602) Laryngeal stenosis Frequent [Orphanet] 21 / 7739
19
(HPO:0002777) Tracheal stenosis Frequent [Orphanet] 35 / 7739
20
(HPO:0004322) Short stature Very frequent [Orphanet] 10807690 IBIS 1232 / 7739
21
(HPO:0008905) Rhizomelia Occasional [Orphanet] 85 / 7739
22
(HPO:0004325) Decreased body weight Very frequent [Orphanet] 492 / 7739
23
(HPO:0001508) Failure to thrive 10807690 IBIS 454 / 7739
24
(HPO:0030680) Abnormality of cardiovascular system morphology Frequent [Orphanet] 355 / 7739
25
(HPO:0001631) Atria septal defect Frequent [Orphanet] 274 / 7739
26
(HPO:0001629) Ventricular septal defect Frequent [Orphanet] 316 / 7739
27
(HPO:0006695) Atrioventricular canal defect Frequent [Orphanet] 27 / 7739
28
(HPO:0002119) Ventriculomegaly Frequent [Orphanet] 253 / 7739
29
(HPO:0001305) Dandy-Walker malformation 79 / 7739
30
(HPO:0001680) Coarctation of aorta 9024558 IBIS 57 / 7739
31
(HPO:0001643) Patent ductus arteriosus Occasional [Orphanet] 228 / 7739
32
(HPO:0010978) Abnormality of immune system physiology Frequent [Orphanet] 148 / 7739
33
(HPO:0000403) Recurrent otitis media 61 / 7739
34
(HPO:0003119) Abnormality of lipid metabolism Very frequent [Orphanet] 60 / 7739
35
(HPO:0010569) Elevated 7-dehydrocholesterol 1 / 7739
36
(HPO:0003146) Hypocholesterolemia 9 / 7739
37
(HPO:0001252) Muscular hypotonia Very frequent [Orphanet] 990 / 7739
38
(HPO:0001290) Generalized hypotonia 51 / 7739
39
(HPO:0008947) Infantile muscular hypotonia 482 / 7739
40
(HPO:0010547) Muscle flaccidity 466 / 7739
41
(HPO:0001324) Muscle weakness 859 / 7739
42
(HPO:0002251) Aganglionic megacolon Occasional [Orphanet] 9024558 IBIS 78 / 7739
43
(HPO:0001276) Hypertonia Occasional [Orphanet] 317 / 7739
44
(HPO:0000718) Aggressive behavior 109 / 7739
45
(HPO:0000717) Autism Frequent [Orphanet] 108 / 7739
46
(HPO:0001249) Intellectual disability 10807690 IBIS 1089 / 7739
47
(HPO:0100716) Self-injurious behavior Frequent [Orphanet] 43 / 7739
48
(HPO:0000742) Self-mutilation 27 / 7739
49
(HPO:0002360) Sleep disturbance Frequent [Orphanet] 113 / 7739
50
(HPO:0006979) Sleep-wake cycle disturbance 5 / 7739
51
(HPO:0000752) Hyperactivity Frequent [Orphanet] 140 / 7739
52
(HPO:0001250) Seizures Occasional [Orphanet] 1245 / 7739
53
(HPO:0001558) Decreased fetal movement 74 / 7739
54
(HPO:0001511) Intrauterine growth retardation Frequent [Orphanet] 358 / 7739
55
(HPO:0001561) Polyhydramnios Frequent [Orphanet] 191 / 7739
56
(HPO:0001162) Postaxial hand polydactyly Frequent [Orphanet] 10807690 IBIS 119 / 7739
57
(HPO:0009778) Short thumb 9678700 IBIS 50 / 7739
58
(HPO:0009623) Proximal placement of thumb Frequent [Orphanet] 9678700 IBIS 50 / 7739
59
(HPO:0009380) Aplasia of the fingers Occasional [Orphanet] 51 / 7739
60
(HPO:0009465) Ulnar deviation of finger Occasional [Orphanet] 48 / 7739
61
(HPO:0001830) Postaxial foot polydactyly Frequent [Orphanet] 10807690 IBIS 37 / 7739
62
(HPO:0001840) Metatarsus adductus 49 / 7739
63
(HPO:0001831) Short toe 52 / 7739
64
(HPO:0001765) Hammertoe 63 / 7739
65
(HPO:0001845) Overlapping toe 18 / 7739
66
(HPO:0001770) Toe syndactyly Very frequent [Orphanet] 149 / 7739
67
(HPO:0004691) 2-3 toe syndactyly 50 / 7739
68
(HPO:0100259) Postaxial polydactyly 85 / 7739
69
(HPO:0006101) Finger syndactyly Occasional [Orphanet] 198 / 7739
70
(HPO:0001762) Talipes equinovarus Occasional [Orphanet] 309 / 7739
71
(HPO:0001884) Talipes calcaneovalgus 14 / 7739
72
(HPO:0002827) Hip dislocation 94 / 7739
73
(HPO:0001385) Hip dysplasia Frequent [Orphanet] 242 / 7739
74
(HPO:0002818) Abnormality of the radius Occasional [Orphanet] 96 / 7739
75
(HPO:0007477) Abnormal dermatoglyphics Very frequent [Orphanet] 72 / 7739
76
(HPO:0001163) Abnormality of the metacarpal bones Frequent [Orphanet] 149 / 7739
77
(HPO:0004279) Short palm Occasional [Orphanet] 323 / 7739
78
(HPO:0009815) Aplasia/hypoplasia of the extremities 6 / 7739
79
(HPO:0003027) Mesomelia Occasional [Orphanet] 58 / 7739
80
(HPO:0002983) Micromelia 130 / 7739
81
(HPO:0000277) Abnormality of the mandible Very frequent [Orphanet] 394 / 7739
82
(HPO:0000347) Micrognathia 426 / 7739
83
(HPO:0000252) Microcephaly Very frequent [Orphanet] 10807690 IBIS 832 / 7739
84
(HPO:0000341) Narrow forehead Frequent [Orphanet] 96 / 7739
85
(HPO:0000772) Abnormality of the ribs Occasional [Orphanet] 146 / 7739
86
(HPO:0003312) Abnormal form of the vertebral bodies Occasional [Orphanet] 172 / 7739
87
(HPO:0000470) Short neck Frequent [Orphanet] 345 / 7739
88
(HPO:0002808) Kyphosis Occasional [Orphanet] 289 / 7739
89
(HPO:0002650) Scoliosis Occasional [Orphanet] 705 / 7739
90
(HPO:0007370) Aplasia/Hypoplasia of the corpus callosum Occasional [Orphanet] 180 / 7739
91
(HPO:0002079) Hypoplasia of the corpus callosum 161 / 7739
92
(HPO:0010655) Epiphyseal stippling 32 / 7739
93
(HPO:0000499) Abnormality of the eyelashes Occasional [Orphanet] 35 / 7739
94
(HPO:0005599) Hypopigmentation of hair Occasional [Orphanet] 38 / 7739
95
(HPO:0002020) Gastroesophageal reflux 101 / 7739
96
(HPO:0002566) Intestinal malrotation 89 / 7739
97
(HPO:0002577) Abnormality of the stomach Very frequent [Orphanet] 84 / 7739
98
(HPO:0002021) Pyloric stenosis Occasional [Orphanet] 10807690 IBIS 51 / 7739
99
(HPO:0002579) Gastrointestinal dysmotility 11 / 7739
100
(HPO:0005264) Abnormality of the gallbladder Occasional [Orphanet] 14 / 7739
101
(HPO:0002611) Cholestatic liver disease 19 / 7739
102
(HPO:0001743) Abnormality of the spleen Occasional [Orphanet] 37 / 7739
103
(HPO:0000775) Abnormality of the diaphragm Occasional [Orphanet] 62 / 7739
104
(HPO:0000826) Precocious puberty 42 / 7739
105
(HPO:0000047) Hypospadias Frequent [Orphanet] 9024558 IBIS 250 / 7739
106
(HPO:0000054) Micropenis Frequent [Orphanet] 9024558 IBIS 257 / 7739
107
(HPO:0000048) Bifid scrotum 9024558 IBIS 36 / 7739
108
(HPO:0000046) Scrotal hypoplasia 9024558 IBIS 54 / 7739
109
(HPO:0000028) Cryptorchidism 9024558 IBIS 347 / 7739
110
(HPO:0000062) Ambiguous genitalia Frequent [Orphanet] 9024558 IBIS 74 / 7739
111
(HPO:0000813) Bicornuate uterus 22 / 7739
112
(HPO:0001153) Septate vagina 6 / 7739
113
(HPO:0000035) Abnormality of the testis Frequent [Orphanet] 296 / 7739
114
(HPO:0000494) Downslanted palpebral fissures Occasional [Orphanet] 328 / 7739
115
(HPO:0000582) Upslanted palpebral fissure Occasional [Orphanet] 185 / 7739
116
(HPO:0000996) Facial capillary hemangioma 4 / 7739
117
(HPO:0000187) Broad alveolar ridges 14 / 7739
118
(HPO:0000168) Abnormality of the gingiva Frequent [Orphanet] 51 / 7739
119
(HPO:0000174) Abnormality of the palate Frequent [Orphanet] 298 / 7739
120
(HPO:0000175) Cleft palate 10807690 IBIS 349 / 7739
121
(HPO:0002705) High, narrow palate Very frequent [Orphanet] 308 / 7739
122
(HPO:0009804) Reduced number of teeth Occasional [Orphanet] 137 / 7739
123
(HPO:0000682) Abnormality of dental enamel Occasional [Orphanet] 102 / 7739
124
(HPO:0006482) Abnormality of dental morphology Very frequent [Orphanet] 81 / 7739
125
(HPO:0000678) Dental crowding 65 / 7739
126
(HPO:0011069) Increased number of teeth Occasional [Orphanet] 39 / 7739
127
(HPO:0000695) Natal tooth Occasional [Orphanet] 42 / 7739
128
(HPO:0010297) Bifid tongue Occasional [Orphanet] 17 / 7739
129
(HPO:0000171) Microglossia Occasional [Orphanet] 27 / 7739
130
(HPO:0000343) Long philtrum Frequent [Orphanet] 262 / 7739
131
(HPO:0000154) Wide mouth Frequent [Orphanet] 137 / 7739
132
(HPO:0000463) Anteverted nares Very frequent [Orphanet] 10807690 IBIS 305 / 7739
133
(HPO:0000453) Choanal atresia Occasional [Orphanet] 76 / 7739
134
(HPO:0005280) Depressed nasal bridge 381 / 7739
135
(HPO:0000431) Wide nasal bridge 290 / 7739
136
(HPO:0000445) Wide nose Very frequent [Orphanet] 190 / 7739
137
(HPO:0000286) Epicanthus Occasional [Orphanet] 371 / 7739
138
(HPO:0000407) Sensorineural hearing impairment Occasional [Orphanet] 524 / 7739
139
(HPO:0004404) Abnormality of the nipple Frequent [Orphanet] 54 / 7739
140
(HPO:0000357) Abnormal location of ears Frequent [Orphanet] 328 / 7739
141
(HPO:0000369) Low-set ears 372 / 7739
142
(HPO:0000358) Posteriorly rotated ears 163 / 7739
143
(HPO:0001052) Nevus flammeus Frequent [Orphanet] 88 / 7739
144
(HPO:0000992) Cutaneous photosensitivity Frequent [Orphanet] 75 / 7739
145
(HPO:0007537) Severe photosensitivity 2 / 7739
146
(HPO:0000965) Cutis marmorata Frequent [Orphanet] 46 / 7739
147
(HPO:0000964) Eczema 81 / 7739
148
(HPO:0100542) Abnormal localization of kidney Occasional [Orphanet] 64 / 7739
149
(HPO:0000126) Hydronephrosis 119 / 7739
150
(HPO:0000107) Renal cyst Occasional [Orphanet] 126 / 7739
151
(HPO:0000800) Cystic renal dysplasia 31 / 7739
152
(HPO:0000113) Polycystic kidney dysplasia 75 / 7739
153
(HPO:0008678) Renal hypoplasia/aplasia Occasional [Orphanet] 127 / 7739
154
(HPO:0000104) Renal agenesis 68 / 7739
155
(HPO:0000089) Renal hypoplasia 78 / 7739
156
(HPO:0000074) Ureteropelvic junction obstruction 15 / 7739
157
(HPO:0000069) Abnormality of the ureter Occasional [Orphanet] 47 / 7739
158
(HPO:0000072) Hydroureter Occasional [Orphanet] 146 / 7739
159
(HPO:0000365) Hearing impairment 539 / 7739
160
(HPO:0010880) Increased nuchal translucency Very frequent [Orphanet] 13 / 7739
161
(HPO:0001622) Premature birth 100 / 7739
162
(HPO:0012443) Abnormality of brain morphology Occasional [Orphanet] 45 / 7739
163
(HPO:0002334) Abnormality of the cerebellar vermis Frequent [Orphanet] 137 / 7739
164
(HPO:0012795) Abnormality of the optic disc Occasional [Orphanet] 187 / 7739
165
(HPO:0000007) Autosomal recessive inheritance 2538 / 7739
166
(HPO:0011420) Death Occasional [Orphanet] 184 / 7739
167
(HPO:0030043) Hip Subluxation 9 / 7739
168
(HPO:0001360) Holoprosencephaly 29 / 7739
169
(HPO:0000238) Hydrocephalus 278 / 7739
170
(HPO:0007333) Hypoplasia of the frontal lobes 5 / 7739
171
(HPO:0012815) Hypoplastic female external genitalia Frequent [Orphanet] 36 / 7739
172
(HPO:0007165) Periventricular gray matter heterotopia 4 / 7739
173
(OMIM) Abnormal sleep pattern 2 / 7739
174
(OMIM) Birth weight <2,500gm 2 / 7739
175
(OMIM) Blonde hair 1 / 7739
176
(OMIM) Broad, short toes 3 / 7739
177
(OMIM) Incomplete lobulation of the lungs 1 / 7739
178
(OMIM) Large central front teeth 1 / 7739
179
(OMIM) Low cholesterol 1 / 7739
180
(OMIM) Microurethra 1 / 7739
181
(OMIM) Periventricular gray matter heterotopias 1 / 7739
182
(OMIM) Shrill screaming 1 / 7739
183
(OMIM) Single kidney 2 / 7739

Associated genes:

ClinVar (via SNiPA)

Gene symbol Variation Clinical significance Reference

Additional Information:

Description: (OMIM) Smith-Lemli-Opitz syndrome is an autosomal recessive multiple congenital malformation and mental retardation syndrome. Although historically a clinical distinction was often made between a classic 'type I' disorder and a more severe 'type II' disorder, in reality the syndrome ...
Diagnosis OMIM In 2 adult brothers formerly described as having SLO syndrome (de Die-Smulders and Fryns, 1990), de Die-Smulders et al. (1996) reported confirmation of the diagnosis by the finding of low levels of cholesterol (15 to 27% of normal) ...
Clinical Description OMIM Smith et al. (1964) reported 3 unrelated males with a strikingly similar combination of congenital anomalies: microcephaly, mental retardation, hypotonia, incomplete development of the male genitalia, short nose with anteverted nostrils, and, in 2, pyloric stenosis. A deceased ...
Genotype-Phenotype Correlations OMIM Koo et al. (2010) reported a girl who had a severe form of SLOS at birth, with multiple congenital anomalies affecting many organ systems. However, after birth, she showed less neurologic impairment than expected. She rolled from side ...
Molecular genetics OMIM In 3 unrelated patients with SLOS, Wassif et al. (1998) identified 4 different mutations in the DHCR7 gene (602858.0001-602858.0004). Fitzky et al. (1998) identified mutations in the DHCR7 gene (see, e.g., 602858.0009 and 602858.0011) in patients with SLOS. ...
Population genetics OMIM In British Columbia, Lowry (1982) found the RSH syndrome (Opitz's designation for SLOS) to be the second most frequent recessive disorder (after cystic fibrosis). Chasalow et al. (1985) suggested that the carrier frequency of this disorder may be ...
Diagnosis GeneReviews Clinical diagnostic criteria have not been established for Smith-Lemli-Opitz syndrome (SLOS). A pattern of congenital anomalies suggests the diagnosis. The following are the most commonly observed features:...
Clinical Description GeneReviews Classic Smith-Lemli-Opitz syndrome (SLOS) is characterized by prenatal and postnatal growth retardation, microcephaly, moderate to severe intellectual disability, and multiple major and minor malformations including characteristic facial features, cleft palate, abnormal gingivae, cardiac defects, hypospadias, ambiguous genitalia (failure of masculinization of male genitalia), postaxial polydactyly, and 2-3 toe syndactyly [Cunniff et al 1997, Ryan et al 1998, Krajewska-Walasek et al 1999, Kelley & Hennekam 2000]. Individuals with milder forms may have only subtle facial characteristics, hypotonia, 2-3 toe syndactyly, and mild developmental delay. Clinical variability is noted even within families as sibs with SLOS have been reported with medical and developmental problems of different degrees....
Genotype-Phenotype Correlations GeneReviews Biochemical. Although strict correlations between the serum concentration of cholesterol and clinical outcome are not possible, most studies have identified an inverse correlation between serum concentration of cholesterol and clinical severity [Tint et al 1995, Cunniff et al 1997, Yu et al 2000b]. Mortality is particularly high in the group of individuals with the lowest cholesterol concentrations (~10 mg/dL)....
Differential Diagnosis GeneReviews Although many malformation syndromes share at least some of the clinical features of SLOS (e.g., polydactyly, hypospadias, cleft palate), they rarely have more than two of these features in common. In particular, the Y-shaped 2-3 toe syndactyly, present in most individuals with SLOS, is rarely seen in other disorders. The biochemical findings (Clinical Diagnosis) should allow for ready differentiation between individuals with SLOS and those with conditions that are clinically and biochemically similar....
Management GeneReviews To establish the extent of disease in an individual diagnosed with Smith-Lemli-Opitz syndrome (SLOS), the following evaluations are recommended:...
Molecular genetics GeneReviews Information in the Molecular Genetics and OMIM tables may differ from that elsewhere in the GeneReview: tables may contain more recent information. —ED....