Achondroplasia

[ey-kon-druh-pley-zhuh, -zhee-uh, -zee-uh]

Achondroplasia is a type of autosomal dominant genetic disorder that is a common cause of dwarfism. Achondroplastic dwarfs have short stature, with an average adult height of 131 cm (4 feet, 3.8 inches) for males and 123 cm (4 feet, 0.6 inches) for females.

The prevalence is approximately 1 in 25,000.

Epidemiology

Achondroplasia is one of several congenital conditions with similar presentations, such as osteogenesis imperfecta, multiple epiphyseal dysplasia tarda, achondrogenesis, osteopetrosis, and thanatophoric dysplasia. This makes estimates of prevalence difficult, with changing and subjective diagnostic criteria over time. One detailed and long-running study in the Netherlands found that the prevalence determined at birth was only 1.3 per 100,000 live births. However, another study at the same time found a rate of 1 per 10,000.

Causes

Achondroplasia is a result of an autosomal dominant mutation in the fibroblast growth factor receptor gene 3 which causes an abnormality of cartilage formation. FGFR3 normally has a negative regulatory effect on bone growth. In achondroplasia, the mutated form of the receptor is constitutively active and this leads to severely shortened bones.

Animals with achondroplasia have one normal copy of the fibroblast growth factor receptor 3 gene and one mutant copy. Two copies of the mutant gene are invariably fatal before, or shortly after birth. Only one copy of the gene needs to be present for the disorder to occur. Therefore, a person with achondroplasia has a 50% chance of passing on the gene to their offspring, meaning that there will be a 50% chance that each child will have achondroplasia. Since two copies (Homozygous) are fatal, if two people with achondroplasia have a child, there is a 25% chance of the child dying shortly after birth, a 50% chance the child will have achondroplasia, and a 25% chance the child will have a normal phenotype. However, in the majority of cases, people with achondroplasia are born to parents who don't have the condition. This is the result of a new mutation.

New gene mutations are associated with increasing paternal age (over 35 years). Studies have demonstrated that new gene mutations are exclusively inherited from the father and occur during spermatogenesis (as opposed to resulting from a gonadal mosaicism). More than 99% of achondroplasia is caused by two different mutations in the fibroblast growth factor receptor 3 (FGFR3). In about 98% of cases, a G to A point mutation at nucleotide 1138 of the FGFR3 gene causes a glycine to arginine substitution (Bellus et al 1995, Shiang et al 1994, Rousseau et al 1996). About 1% of cases are caused by a G to C point mutation at nucleotide 1138.

There are two other syndromes with a genetic basis similar to achondroplasia: hypochondroplasia and thanatophoric dysplasia.

Diagnosis

Achondroplasia can be detected before birth by the use of prenatal ultrasound. A DNA test can be performed before birth to detect homozygosity, where two copies of the mutant gene are inherited, a condition which is lethal and leads to stillbirths. Other indicators of achondroplasia include slow motor movement and low muscle tone (hypotonia). One result of low muscle tone is that walking doesn't occur until between 24 and 36 months. Because of short stature, obesity is often associated with the condition. Children often have middle ear infections (otitis media) because of abnormal drainage of the tube from the middle ear to the throat due to the abnormal skull structure. To help with the drainage many children have a surgical procedure to place tubes in their ears. Because of abnormal skull structure, overcrowding of the teeth occurs and malocclusion often results, which makes oral hygiene difficult.

Radiologic findings

A skeletal survey is useful to confirm the diagnosis of achondroplasia. Skull demonstrate a large skull with a narrow foramen magnum, and relatively small skull base. The vertebral bodies are short and flattened with relatively large intervertebral disk height, and there is congenitally narrowed spinal canal. The iliac wings are small and squared, with a narrow sciatic notch and horizontal acetabular roof. The tubular bones are short and thick with metaphyseal cupping and flaring and irregular growth plates. Fibular overgrowth is present. The hand is broad with short metacarpals and phalanges, and a trident configuration. The ribs are short with cupped anterior ends. If the radiographic features are not classic, a search for a different diagnosis should be entertained. Because of the extremely deformed bone structure, people with achondroplasia are often double jointed.

The diagnosis can be made by fetal ultrasound by progressive discordance between the femur length and biparietal diameter by age. The trident hand configuration can be seen if the fingers are fully extended.

Treatment

At present, there is no treatment for achondroplasia.

Although used by those without achondroplasia to aid in growth, growth hormone does not help people with achondroplasia. However, if desired, the controversial surgery of limb-lengthening will lengthen the legs and arms of someone with achondroplasia, although in some cases when this surgery is undergone, some affected individuals may experience their limbs becoming "locked to their torso".

Miscellanous

Reported by the Fox News Channel, Jyoti Amge, a 14-year-old girl from India, broke the world record for the shortest person on earth. Diagnosed with achondroplasia, she is 23 inches (58 cm) tall, and weighs 11 lbs (5 kg).

The condition was present in the pre-Columbian New World (evidence from the skeletal remains), and in documentation by skeletons, wall paintings, figurines in the ancient Egypt from pre-Dynastic times (up to 30th Dynasty). The ancient Egyptian word for people affected by the condition was nemew. They held various offices and were regarded as highly intelligent. Several of them must have been persons of importance and wealth, being found in elaborate tombs.