Comprehensive Short Stature Syndrome Panel
Test code: MA2101
The Blueprint Genetics Comprehensive Short Stature Syndrome Panel is a 61 gene test for genetic diagnostics of patients with clinical suspicion of short stature and associated syndromes.
Numerous monogenic causes of growth disorders have been identified. This panel covers several disorders associated with short stature with autosomal recessive and dominant modes of inheritance. This comprehensive Panel includes (but is not limited to) disorders covered by the subpanels: 3-M Syndrome / Primordial Dwarfism Panel, Meier-Gorlin Syndrome Panel and Seckel Syndrome Panel. This Panel is part of the Comprehensive Skeletal / Malformation Syndrome Panel.
About Short Stature Syndromes
The clinical phenotypes of the disorders covered by this panel range in the severity of growth retardation and microcephaly, as well as in the degree of developmental delay, but there can be significant clinical overlap among syndromes. In addition to the disorders covered by the sub-panels, this comprehensive panel covers several other diseases associated with short stature, such as growth delay due to insulin-like growth factor I resistance or IGF1 deficiency (mutations in IGF1R and IGF1), hypothyroidism due to deficient transcription factors involved in pituitary development or function (HESX1, LHX3, LHX4, POU1F1 and PROP1), Rubinstein-Taybi syndrome (CREBBP and EP300) and different forms of disproportionate short stature. Disproportionate short stature can manifest itself as short-limbed dwarfism or short-trunk dwarfism. Achondroplasia (autosomal dominant, mutations is FGFR3) is the most common form of disproportionate growth retardation, its estimated incidence is at about 1/25,000 live births worldwide.
Identification of rare monogenic causes of short stature is critical since the genetic diagnosis may alert the clinician to other medical comorbidities for which the patient is at risk. For example, a male patient with 3-M syndrome will need to be monitored for the development of hypogonadism. Based on genetic studies in children with severe short stature of unknown etiology it has been suggested that monogenic causes of short stature are underdiagnosed in the pediatric endocrine clinic. Factors that increase the likelihood for a monogenic cause of short stature are severe GH deficiency, multiple pituitary hormone deficiency, unequivocal GH insensitivity, small for gestational age without catch-up growth, additional congenital anomalies or dysmorphic features, evidence of a skeletal dysplasia, associated intellectual disability, microcephaly and height below −3 SD.
Results in 3-4 weeks. We do not offer a maternal cell contamination (MCC) test at the moment. We offer prenatal testing only for cases where the maternal cell contamination studies (MCC) are done by a local genetic laboratory. Read more.
|AKT1||Proteus syndrome, Cowden syndrome||AD||3||9|
|ATR||Cutaneous telangiectasia and cancer syndrome, Seckel syndrome||AD/AR||6||13|
|BMP2||Brachydactyly type A2||AD||1||26|
|BMP4||Microphthalmia, syndromic, Orofacial cleft||AD||9||42|
|BMPR1A*||Polyposis, juvenile intestinal||AD||38||108|
|CDC6||Meier-Gorlin syndrome (Ear-patella-short stature syndrome)||AR||1||3|
|CDT1||Meier-Gorlin syndrome (Ear-patella-short stature syndrome)||AR||6||8|
|CENPJ||Seckel syndrome, Microcephaly||AR||23||6|
|CEP152||Seckel syndrome, Microcephaly||AR||13||17|
|CUL7||3-M syndrome, Yakut short stature syndrome||AR||18||68|
|EYA1||Otofaciocervical syndrome, Branchiootic syndrome, Branchiootorenal syndrome||AD||33||186|
|FGD1||Aarskog-Scott syndrome, Mental retardation, syndromic||XL||18||42|
|FGF3||Deafness, congenital with inner ear agenesis, microtia, and microdontia||AR||12||20|
|FGFR3||Lacrimoauriculodentodigital syndrome, Muenke syndrome, Crouzon syndrome with acanthosis nigricans, Camptodactyly, tall stature, and hearing loss (CATSHL) syndrome, Achondroplasia, Hypochondroplasia, Thanatophoric dysplasia type 1, Thanatophoric dysplasia type 2, SADDAN||AD/AR||47||68|
|FOXL2||Premature ovarian failure, Blepharophimosis, epicanthus inversus, and ptosis||AD||69||203|
|GH1*||Isolated growth hormone deficiency, Kowarski syndrome||AD/AR||24||98|
|GHR||Growth hormone insensitivity syndrome (Laron syndrome)||AD/AR||32||100|
|GHRHR||Isolated growth hormone deficiency||AR||13||47|
|HESX1||Septooptic dysplasia, Pituitary hormone deficiency, combined||AR/AD||11||25|
|IGF1||Insulin-like growth factor I deficiency||AR||4||12|
|IGF1R||Insulin-like growth factor I, resistance||AD/AR||5||62|
|IGFALS||Insulin-like growth factor-binding protein, acid-labile subunit, deficiency||AR||5||28|
|INSR||Hyperinsulinemic hypoglycemia, familial, Rabson-Mendenhall syndrome, Donohoe syndrome||AD/AR||35||175|
|IRS1||Diabetes mellitus, noninsulin-dependent||AD/AR||2||23|
|KRAS*||Noonan syndrome, Cardiofaciocutaneous syndrome||AD||46||38|
|LHX3||Pituitary hormone deficiency, combined||AR||9||14|
|LHX4||Pituitary hormone deficiency, combined||AD||9||17|
|NIPBL||Cornelia de Lange syndrome||AD||246||404|
|NOTCH2*||Alagille syndrome, Hajdu-Cheney syndrome||AD||21||56|
|NR5A1||Adrenocortical insufficiency, Premature ovarian failure, 46,XY sex reversal||AD/AR||21||137|
|ORC1||Meier-Gorlin syndrome (Ear-patella-short stature syndrome)||AR||9||9|
|ORC4||Meier-Gorlin syndrome (Ear-patella-short stature syndrome)||AR||13||5|
|ORC6||Meier-Gorlin syndrome (Ear-patella-short stature syndrome)||AR||5||5|
|OTX2||Microphthalmia, syndromic, Pituitary hormone deficiency, combined, Retinal dystrophy, early-onset, and pituitary dysfunction||AD||16||65|
|PCNT||Microcephalic osteodysplastic primordial dwarfism||AR||30||82|
|PITX2||Axenfeld-Rieger syndrome, Ring dermoid of cornea, Iridogoniodysgenesis, Peters anomaly||AD||13||85|
|POU1F1||Pituitary hormone deficiency, combined||AR||19||42|
|PROP1||Pituitary hormone deficiency, combined||AR||19||34|
|PTCH1||Basal cell nevus syndrome||AD||46||348|
|PTPN11||LEOPARD syndrome, Noonan syndrome, Metachondromatosis||AD||122||129|
|RAF1||LEOPARD syndrome, Noonan syndrome, Dilated cardiomyopathy (DCM)||AD||37||42|
|RBBP8||Seckel syndrome, Jawad syndrome||AR||4||5|
|RNU4ATAC||Roifman syndrome, Microcephalic osteodysplastic primordial dwarfism type 1, Microcephalic osteodysplastic primordial dwarfism type 3||AR||15||18|
|SHH||Holoprosencephaly, Microphthalmia with coloboma||AD||29||212|
|SHOX*||Leri-Weill dyschondrosteosis, Langer mesomelic dysplasia, Short stature||XL/PAR||23||366|
|SMC1A||Cornelia de Lange syndrome||XL||39||54|
|STAT5B*||Growth hormone insensitivity with immunodeficiency||AR||5||11|
|TBX19||Adrenocorticotropic hormone deficiency||AR||5||26|
- * Some regions of the gene are duplicated in the genome leading to limited sensitivity within the regions. Thus, low-quality variants are filtered out from the duplicated regions and only high-quality variants confirmed by other methods are reported out. Read more.
Gene, refers to HGNC approved gene symbol; Inheritance to inheritance patterns such as autosomal dominant (AD), autosomal recessive (AR) and X-linked (XL); ClinVar, refers to a number of variants in the gene classified as pathogenic or likely pathogenic in ClinVar (http://www.ncbi.nlm.nih.gov/clinvar/); HGMD, refers to a number of variants with possible disease association in the gene listed in Human Gene Mutation Database (HGMD, http://www.hgmd.cf.ac.uk/ac/). The list of associated (gene specific) phenotypes are generated from CDG (http://research.nhgri.nih.gov/CGD/) or Orphanet (http://www.orpha.net/) databases.
Blueprint Genetics offers a Comprehensive Short Stature Syndrome Panel that covers classical genes associated with 3-M syndrome, Jawad syndrome, meier-Gorlin syndrome (Ear-patella-short stature syndrome), microcephalic primordial dwarfism disorders (MOPD), Seckel syndrome, short stature and associated syndromes and short stature-onychodysplasia-facial dysmorphism-hypotrichosis syndrome. The genes are carefully selected based on the existing scientific evidence, our experience and most current mutation databases. Candidate genes are excluded from this first-line diagnostic test. The test does not recognise balanced translocations or complex inversions, and it may not detect low-level mosaicism. The test should not be used for analysis of sequence repeats or for diagnosis of disorders caused by mutations in the mitochondrial DNA.
Analytical validation is a continuous process at Blueprint Genetics. Our mission is to improve the quality of the sequencing process and each modification is followed by our standardized validation process. Average sensitivity and specificity in Blueprint NGS Panels is 99.3% and 99.9% for detecting SNPs. Sensitivity to for indels vary depending on the size of the alteration: 1-10bps (96.0%), 11-20 bps (88.4%) and 21-30 bps (66.7%). The longest detected indel was 46 bps by sequence analysis. Detection limit for Del/Dup (CNV) analysis varies through the genome depending on exon size, sequencing coverage and sequence content. The sensitivity is 71.5% for single exon deletions and duplications and 99% for three exons’ deletions and duplications. We have validated the assays for different starting materials including EDTA-blood, isolated DNA (no FFPE) and saliva that all provide high-quality results. The diagnostic yield varies substantially depending on the used assay, referring healthcare professional, hospital and country. Blueprint Genetics’ Plus Analysis (Seq+Del/Dup) maximizes the chance to find molecular genetic diagnosis for your patient although Sequence Analysis or Del/Dup Analysis may be cost-effective first line test if your patient’s phenotype is suggestive for a specific mutation profile.
The sequencing data generated in our laboratory is analyzed with our proprietary data analysis and annotation pipeline, integrating state-of-the art algorithms and industry-standard software solutions. Incorporation of rigorous quality control steps throughout the workflow of the pipeline ensures the consistency, validity and accuracy of results. The highest relevance in the reported variants is achieved through elimination of false positive findings based on variability data for thousands of publicly available human reference sequences and validation against our in-house curated mutation database as well as the most current and relevant human mutation databases. Reference databases currently used are the 1000 Genomes Project (http://www.1000genomes.org), the NHLBI GO Exome Sequencing Project (ESP; http://evs.gs.washington.edu/EVS), the Exome Aggregation Consortium (ExAC; http://exac.broadinstitute.org), ClinVar database of genotype-phenotype associations (http://www.ncbi.nlm.nih.gov/clinvar) and the Human Gene Mutation Database (http://www.hgmd.cf.ac.uk). The consequence of variants in coding and splice regions are estimated using the following in silico variant prediction tools: SIFT (http://sift.jcvi.org), Polyphen (http://genetics.bwh.harvard.edu/pph2/), and Mutation Taster (http://www.mutationtaster.org).
Through our online ordering and statement reporting system, Nucleus, the customer can access specific details of the analysis of the patient. This includes coverage and quality specifications and other relevant information on the analysis. This represents our mission to build fully transparent diagnostics where the customer gains easy access to crucial details of the analysis process.
In addition to our cutting-edge patented sequencing technology and proprietary bioinformatics pipeline, we also provide the customers with the best-informed clinical report on the market. Clinical interpretation requires fundamental clinical and genetic understanding. At Blueprint Genetics our geneticists and clinicians, who together evaluate the results from the sequence analysis pipeline in the context of phenotype information provided in the requisition form, prepare the clinical statement. Our goal is to provide clinically meaningful statements that are understandable for all medical professionals, even without training in genetics.
Variants reported in the statement are always classified using the Blueprint Genetics Variant Classification Scheme modified from the ACMG guidelines (Richards et al. 2015), which has been developed by evaluating existing literature, databases and with thousands of clinical cases analyzed in our laboratory. Variant classification forms the corner stone of clinical interpretation and following patient management decisions. Our statement also includes allele frequencies in reference populations and in silico predictions. We also provide PubMed IDs to the articles or submission numbers to public databases that have been used in the interpretation of the detected variants. In our conclusion, we summarize all the existing information and provide our rationale for the classification of the variant.
A final component of the analysis is the Sanger confirmation of the variants classified as likely pathogenic or pathogenic. This does not only bring confidence to the results obtained by our NGS solution but establishes the mutation specific test for family members. Sanger sequencing is also used occasionally with other variants reported in the statement. In the case of variant of uncertain significance (VUS) we do not recommend risk stratification based on the genetic finding. Furthermore, in the case VUS we do not recommend use of genetic information in patient management or genetic counseling. For some cases Blueprint Genetics offers a special free of charge service to investigate the role of identified VUS.
We constantly follow genetic literature adapting new relevant information and findings to our diagnostics. Relevant novel discoveries can be rapidly translated and adopted into our diagnostics without delay. These processes ensure that our diagnostic panels and clinical statements remain the most up-to-date on the market.
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ICD & CPT codes
Commonly used ICD-10 codes when ordering the Comprehensive Short Stature Syndrome Panel
|Q87.1||Short stature and associated syndromes|
Accepted sample types
- EDTA blood, min. 1 ml
- Purified DNA, min. 5μg
- Saliva (Oragene DNA OG-500 kit)
Label the sample tube with your patient’s name, date of birth and the date of sample collection.
Note that we do not accept DNA samples isolated from formalin-fixed paraffin-embedded (FFPE) tissue.