Neuroblastoma, and Hypospadias

Diseases related with Neuroblastoma and Hypospadias

In the following list you will find some of the most common rare diseases related to Neuroblastoma and Hypospadias that can help you solving undiagnosed cases.


Top matches:

Medium match PLATELET DISORDER, FAMILIAL, WITH ASSOCIATED MYELOID MALIGNANCY; FPDMM


PLATELET DISORDER, FAMILIAL, WITH ASSOCIATED MYELOID MALIGNANCY; FPDMM Is also known as platelet disorder, aspirin-like|thrombocytopenia, familial, with propensity to acute myelogenous leukemia|fpd/aml

Related symptoms:

  • Anemia
  • Thrombocytopenia
  • Hernia
  • Hypospadias
  • Umbilical hernia


SOURCES: OMIM MENDELIAN

More info about PLATELET DISORDER, FAMILIAL, WITH ASSOCIATED MYELOID MALIGNANCY; FPDMM

Medium match BECKWITH-WIEDEMANN SYNDROME DUE TO CDKN1C MUTATION


Related symptoms:

  • Strabismus
  • Cleft palate
  • Cryptorchidism
  • Hepatomegaly
  • Ventricular septal defect


SOURCES: ORPHANET MENDELIAN

More info about BECKWITH-WIEDEMANN SYNDROME DUE TO CDKN1C MUTATION

Medium match MULTIPLE BENIGN CIRCUMFERENTIAL SKIN CREASES ON LIMBS


Congenital symmetric circumferential skin creases is characterized by the folding of excess skin, which leads to ringed creases, primarily of the limbs. Affected individuals also exhibit intellectual disability, cleft palate, and dysmorphic features (summary by Isrie et al., 2015). Genetic Heterogeneity of Congenital Symmetric Circumferential Skin CreasesCSCSC2 (OMIM ) is caused by mutation in the MAPRE2 gene (OMIM ) on chromosome 18q12.

MULTIPLE BENIGN CIRCUMFERENTIAL SKIN CREASES ON LIMBS Is also known as congenital circumferential skin folds|skin creases, multiple benign ring-shaped, of limbs|kunze-riehm syndrome|ccsf|circumferential skin creases, kunze type|michelin tire baby syndrome

Related symptoms:

  • Intellectual disability
  • Seizures
  • Global developmental delay
  • Short stature
  • Generalized hypotonia


SOURCES: ORPHANET OMIM MENDELIAN

More info about MULTIPLE BENIGN CIRCUMFERENTIAL SKIN CREASES ON LIMBS

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Other less relevant matches:

Medium match NOONAN SYNDROME WITH MULTIPLE LENTIGINES


Noonan syndrome with multiple lentigines (NSML), previously known as LEOPARD syndrome, is a rare multisystem genetic disorder characterized by lentigines, hypertrophic cardiomyopathy, short stature, pectus deformity, and dysmorphic facial features.

NOONAN SYNDROME WITH MULTIPLE LENTIGINES Is also known as leopard syndrome|cardiomyopathic lentiginosis|familial multiple lentigines syndrome

Related symptoms:

  • Intellectual disability
  • Seizures
  • Global developmental delay
  • Short stature
  • Generalized hypotonia


SOURCES: ORPHANET OMIM MENDELIAN

More info about NOONAN SYNDROME WITH MULTIPLE LENTIGINES

Medium match NIJMEGEN BREAKAGE SYNDROME


Nijmegen breakage syndrome is a rare genetic disease presenting at birth with microcephaly, dysmorphic facial features, becoming more noticeable with age, growth delay, and later-onset complications such as malignancies and infections.

NIJMEGEN BREAKAGE SYNDROME Is also known as microcephaly-immunodeficiency-lymphoreticuloma syndrome|ataxia-telangiectasia variant v1|microcephaly with normal intelligence, immunodeficiency, and lymphoreticular malignancies|at-v1|berlin breakage syndrome|ataxia-telangiectasia, variant 1|seemanova sy

Related symptoms:

  • Intellectual disability
  • Global developmental delay
  • Short stature
  • Microcephaly
  • Ataxia


SOURCES: ORPHANET OMIM MESH MENDELIAN

More info about NIJMEGEN BREAKAGE SYNDROME

Low match SIMPSON-GOLABI-BEHMEL SYNDROME


Simpson-Golabi-Behmel syndrome (SGBS, also referred to as SGBS type 1) is a rare X-linked multiple congenital anomalies syndrome, characterized by pre- and postnatal overgrowth, distinctive craniofacial features, variable congenital malformations, organomegaly and an increased tumor risk.

SIMPSON-GOLABI-BEHMEL SYNDROME Is also known as sgbs|sgbs1|simpson-golabi-behmel syndrome type 1|golabi-rosen syndrome|sdys|x-linked dysplasia gigantism syndrome|dysplasia gigantism syndrome, x-linked|simpson dysmorphia syndrome|dgsx|bulldog syndrome

Related symptoms:

  • Intellectual disability
  • Seizures
  • Global developmental delay
  • Generalized hypotonia
  • Hearing impairment


SOURCES: ORPHANET OMIM MENDELIAN

More info about SIMPSON-GOLABI-BEHMEL SYNDROME

Low match 1P36 DELETION SYNDROME


1p36 deletion syndrome is a chromosomal anomaly characterized by distinctive facial dysmorphic features, hypotonia, developmental delay, intellectual disability, seizures, heart defects, hearing impairment and prenatal onset growth deficiency.

1P36 DELETION SYNDROME Is also known as del(1)(p36)|monosomy 1p36|monosomy 1pter|deletion 1pter|deletion 1p36|monosomy 1p36 syndrome|subtelomeric 1p36 deletion

Related symptoms:

  • Intellectual disability
  • Seizures
  • Global developmental delay
  • Short stature
  • Generalized hypotonia


SOURCES: ORPHANET OMIM MESH MENDELIAN

More info about 1P36 DELETION SYNDROME

Low match RUBINSTEIN-TAYBI SYNDROME 1; RSTS1


Rubinstein-Taybi syndrome is a multiple congenital anomaly syndrome characterized by mental retardation, postnatal growth deficiency, microcephaly, broad thumbs and halluces, and dysmorphic facial features. The facial appearance is striking, with highly arched eyebrows, long eyelashes, downslanting palpebral fissures, broad nasal bridge, beaked nose with the nasal septum, highly arched palate, mild micrognathia, and characteristic grimacing or abnormal smile. Affected individuals also have an increased risk of tumor formation (Rubinstein and Taybi, 1963; review by Hennekam, 2006).Floating-Harbor syndrome (OMIM ), which shows phenotypic overlap with Rubinstein-Taybi syndrome, is caused by mutation in the SRCAP gene (OMIM ), a coactivator for CREBBP. Genetic Heterogeneity of Rubinstein-Taybi SyndromeRubinstein-Taybi syndrome-1 (RSTS1) constitutes about 50 to 70% of patients with the disorder. Rubinstein-Taybi syndrome-2 (RSTS2 ) comprises about 3% of patients and is primarily due to de novo heterozygous mutation in the EP300 gene (OMIM ) on chromosome 22q13 (Bartsch et al., 2010).See also chromosome 16p13.3 deletion syndrome (OMIM ), a severe form of Rubinstein-Taybi syndrome resulting from a contiguous gene deletion involving the CREBBP gene as well as other neighboring genes.

RUBINSTEIN-TAYBI SYNDROME 1; RSTS1 Is also known as broad thumbs and great toes, characteristic facies, and mental retardation|rubinstein syndrome|rsts|broad thumb-hallux syndrome

Related symptoms:

  • Intellectual disability
  • Seizures
  • Short stature
  • Generalized hypotonia
  • Hearing impairment


SOURCES: OMIM MENDELIAN

More info about RUBINSTEIN-TAYBI SYNDROME 1; RSTS1

Low match PALLISTER-HALL SYNDROME; PHS


Pallister-Hall syndrome is a pleiotropic autosomal dominant disorder comprising hypothalamic hamartoma, pituitary dysfunction, central polydactyly, and visceral malformations (Biesecker et al., 1996).

PALLISTER-HALL SYNDROME; PHS Is also known as hypothalamic hamartoblastoma, hypopituitarism, imperforate anus, and postaxial polydactyly

Related symptoms:

  • Intellectual disability
  • Seizures
  • Global developmental delay
  • Short stature
  • Growth delay


SOURCES: OMIM MESH MENDELIAN

More info about PALLISTER-HALL SYNDROME; PHS

Low match CHOROID PLEXUS CARCINOMA


Choroid plexus carcinoma is a rare and highly aggressive malignant type of choroid plexus tumor (see this term) occurring almost exclusively in children, presenting with cerebrospinal fluid obstruction in the lateral ventricles (most common), the fourth and third ventricles or in multiple ventricles, leading to hydrocephalus and increased intracranial pressure, and manifesting with nausea, vomiting, abnormal eye movements, gait impairment, seizures and enlarged head circumference.

CHOROID PLEXUS CARCINOMA Is also known as sgs

Related symptoms:

  • Intellectual disability
  • Seizures
  • Global developmental delay
  • Hearing impairment
  • Hypertelorism


SOURCES: OMIM ORPHANET MENDELIAN

More info about CHOROID PLEXUS CARCINOMA

Top 5 symptoms//phenotypes associated to Neuroblastoma and Hypospadias

Symptoms // Phenotype % cases
Intellectual disability Common - Between 50% and 80% cases
Global developmental delay Common - Between 50% and 80% cases
Seizures Common - Between 50% and 80% cases
Depressed nasal bridge Common - Between 50% and 80% cases
Cryptorchidism Common - Between 50% and 80% cases
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Other less frequent symptoms

Patients with Neuroblastoma and Hypospadias. may also develop some of the following symptoms:

Common Symptoms - More than 50% cases


Micrognathia

Uncommon Symptoms - Between 30% and 50% cases


Abnormality of cardiovascular system morphology

Common Symptoms - More than 50% cases


Cleft palate

Uncommon Symptoms - Between 30% and 50% cases


Hearing impairment

Common Symptoms - More than 50% cases


Short stature

Uncommon Symptoms - Between 30% and 50% cases


Growth delay Low-set ears Wide nasal bridge Abnormal heart morphology Abnormality of the kidney Generalized hypotonia Ventricular septal defect Short neck Patent ductus arteriosus Abnormal facial shape Scoliosis Neoplasm Hypertelorism Hydronephrosis Cleft upper lip Posteriorly rotated ears Epicanthus Anteverted nares Umbilical hernia Abnormality of the face Pectus excavatum Atrial septal defect Upslanted palpebral fissure Renal cyst Muscular hypotonia Microcephaly Polydactyly Low-set, posteriorly rotated ears Abnormality of the genital system Scrotal hypoplasia Syndactyly Downslanted palpebral fissures Delayed speech and language development Pulmonic stenosis Hypoplasia of the corpus callosum Micropenis Mandibular prognathia Delayed skeletal maturation Arrhythmia Intrauterine growth retardation Ptosis Cafe-au-lait spot Failure to thrive Hydroureter Hypertrichosis Microtia Abnormality of the pinna Narrow mouth Abnormal lung lobation Telangiectasia Brachycephaly High palate Behavioral abnormality Postaxial hand polydactyly Macroglossia Agenesis of corpus callosum Inguinal hernia Short nose Bifid uvula Abnormality of the skeletal system Cataract Strabismus Coarse facial features Single transverse palmar crease Hypothyroidism Clinodactyly of the 5th finger Leukemia Embryonal neoplasm Hernia

Rare Symptoms - Less than 30% cases


Redundant neck skin Aplasia/Hypoplasia of the abdominal wall musculature Hepatoblastoma Proptosis Freckling Polyhydramnios Muscle weakness Immunodeficiency External genital hypoplasia Bundle branch block Rib fusion Abnormality of the voice Bilateral cryptorchidism Short foot Thick vermilion border Postnatal growth retardation Webbed neck Respiratory tract infection Ventriculomegaly Toe syndactyly Tetralogy of Fallot Intestinal malrotation Neurological speech impairment Dysphagia Frontal bossing Camptodactyly of finger Spina bifida occulta Brachydactyly Feeding difficulties Thrombocytopenia Narrow palpebral fissure Flared iliac wings Postaxial polydactyly Macrocephaly Hypertension Dental malocclusion Nail dysplasia Low anterior hairline Hypoplasia of penis Penoscrotal hypospadias Talipes equinovarus Abnormality of the ribs Small nail Broad thumb Renal dysplasia Rhabdomyosarcoma Abnormality of chromosome stability Choanal atresia Sloping forehead Hyperactivity Obesity Respiratory failure Retrognathia Medulloblastoma Hypoplastic labia minora Small for gestational age Anal atresia Low hanging columella Hydrocephalus Neurodegeneration Prominent nose Otitis media Convex nasal ridge Abnormality of the dentition Intellectual disability, severe Cardiomyopathy Intellectual disability, moderate Bicuspid aortic valve Malar flattening Coloboma Tethered cord Hepatic steatosis Intellectual disability, mild Long philtrum Cerebral atrophy High forehead Blepharophimosis Nevus Diastasis recti Abnormality of the skin Overweight Feeding difficulties in infancy Dandy-Walker malformation Hypoplasia of dental enamel Primitive neuroectodermal tumor Generalized hirsutism Infantile spasms Coarctation of aorta Self-mutilation Splenomegaly Lymphoma Myelodysplasia Wide anterior fontanel Acute lymphoblastic leukemia Acute leukemia Stereotypy Hepatomegaly Hypoglycemia Hypsarrhythmia Overgrowth Omphalocele Mitral regurgitation Large for gestational age Supernumerary nipple Delayed cranial suture closure Enlarged kidney Camptodactyly Microphthalmia Short distal phalanx of finger Midface retrusion Gastroesophageal reflux Constipation Lower limb asymmetry EEG abnormality Sensorineural hearing impairment Cognitive impairment Abnormality of the musculature Deeply set eye Tricuspid regurgitation Autism Dilatation Prominent forehead Hamartoma Hypoplastic nipples Neonatal hypotonia Dysphasia Hypermelanotic macule Coronal craniosynostosis Polyphagia Abnormality of the renal pelvis Solitary renal cyst Dilation of lateral ventricles Hyperreflexia Abnormal eyebrow morphology Macule Agenesis of the anterior commissure Respiratory distress Abnormality of the immune system High hypermetropia Abnormal heart valve morphology Flexion contracture Absent septum pellucidum Metatarsus adductus Abnormality of the testis Hand polydactyly Delayed gross motor development Abnormality of vision Thin upper lip vermilion Pyloric stenosis Pes planus Abnormality of the gastrointestinal tract Patent foramen ovale Failure to thrive in infancy Glaucoma Optic nerve coloboma Ocular albinism Self-injurious behavior Clitoral hypertrophy Missing ribs Short 5th finger Congenital sensorineural hearing impairment Hemiplegia/hemiparesis Abnormality of the neck Abnormal parietal bone morphology 11 pairs of ribs Abnormality of the cerebral ventricles Periventricular leukomalacia Hyperplastic labia majora Abnormal left ventricle morphology Epileptic spasms Horizontal eyebrow Delayed closure of the anterior fontanelle Muscle flaccidity Annular pancreas Thickened helices Colpocephaly Aortic arch aneurysm Abnormal renal physiology Arnold-Chiari type I malformation Abnormality of brain morphology Foot polydactyly Expressive language delay Abnormality of the optic disc Biliary tract abnormality Cavum septum pellucidum Abnormality of the anus Gastric ulcer Abnormality of the mandible Hiatus hernia Abnormality of female external genitalia Lambdoidal craniosynostosis Impaired social interactions Abnormality of the spleen Spinal canal stenosis Aplasia/Hypoplasia involving bones of the feet Anteriorly placed anus Abnormal corpus callosum morphology Telangiectasia of the skin Bilobate gallbladder Widened subarachnoid space Abnormality of the femoral neck Ebstein anomaly of the tricuspid valve Bifid ribs Hypoplastic female external genitalia Abnormality of the hairline Slender long bone Oppositional defiant disorder Aortic root aneurysm Asymmetry of the ears Congenital hypothyroidism Noncompaction cardiomyopathy Cranial nerve VI palsy Abnormal social behavior Talipes valgus Delayed CNS myelination Volvulus Abnormal external genitalia Submucous cleft hard palate Left ventricular noncompaction Congenital talipes calcaneovalgus Anemia Joint laxity Thyroid dysgenesis Hypoplasia of the epiglottis Hydrometrocolpos Radial head subluxation Laryngeal cleft Hypothalamic hamartoma Mesoaxial polydactyly Mesoaxial hand polydactyly Bilateral choanal atresia Y-shaped metacarpals Distal urethral duplication Bifid epiglottis Preductal coarctation of the aorta Distal shortening of limbs Midline facial capillary hemangioma Mandibular aplasia Microphallus Diverticulosis of trachea Hypopituitarism Atresia of the external auditory canal Precocious puberty Adrenal insufficiency Ectopic kidney Mesomelia Natal tooth Oligodactyly Vaginal atresia Postaxial foot polydactyly Adrenal hypoplasia Microglossia Short 4th metacarpal Upper airway obstruction Decreased circulating cortisol level Panhypopituitarism Mesoaxial foot polydactyly Spasticity Holoprosencephaly Ureteral stenosis Wide cranial sutures Sclerosis of skull base Teratoma Abnormality of the nasopharynx Hyperconvex nail Widely patent fontanelles and sutures Thickened cortex of long bones Alacrima Facial hemangioma Sacrococcygeal teratoma Hypoplasia of first ribs Metopic suture patent to nasal root Aplasia/Hypoplasia of the pubic bone Increased density of long bones Long clavicles Short sternum Paralysis Opisthotonus Confusion Sensory impairment Progressive neurologic deterioration Wormian bones Radioulnar synostosis Diabetes insipidus Tibial bowing Bicornuate uterus Shallow orbits Arachnoid cyst Vocal cord paralysis Choanal stenosis Hypoplastic labia majora Broad ribs Short 1st metacarpal Cutaneous syndactyly Microretrognathia Unsteady gait Capillary hemangioma Neurofibromas Dislocated radial head Shawl scrotum Poor coordination Patellar dislocation Obstructive sleep apnea Hypoplastic iliac wing Truncal obesity Short attention span Meningioma Dyslexia Abnormality of refraction Avascular necrosis of the capital femoral epiphysis Pheochromocytoma Congenital glaucoma Broad hallux Nasolacrimal duct obstruction Hypoplasia of the maxilla Joint hypermobility Thick eyebrow Hirsutism Iris coloboma Highly arched eyebrow Recurrent fractures Low posterior hairline Impulsivity Aganglionic megacolon Long eyelashes Dental crowding Exotropia Narrow palate Recurrent upper respiratory tract infections Laryngomalacia Abnormal cornea morphology Broad distal phalanx of finger Hemivertebrae Plantar crease between first and second toes Talon cusp Enlarged tonsils Papillary cystadenoma of the epididymis High axial triradius Abnormal number of teeth Radial deviation of thumb terminal phalanx Dyspnea Premature thelarche Hip dislocation Growth hormone deficiency Renal agenesis Decreased testicular size Limb undergrowth Renal hypoplasia Deviated nasal septum Narrow maxilla Phonophobia Prominent fingertip pads Facial grimacing Abnormality of the cervical spine Parietal foramina Infantile muscular hypotonia Bimanual synkinesia Frontal upsweep of hair Duane anomaly Large foramen magnum Keloids Chorioretinal dystrophy Dyscalculia Duplication of phalanx of hallux Vascular ring Bifid uterus Agoraphobia Short upper lip Ureteral duplication Sacral dimple Premature skin wrinkling Hypoplasia of the ovary Abnormal pulmonary valve morphology Abnormal endocardium morphology Multiple lentigines Excessive wrinkled skin Abnormality of the pulmonary artery Abnormal localization of kidney Abnormal aortic valve morphology Shield chest Abnormal mitral valve morphology Wolff-Parkinson-White syndrome Right ventricular hypertrophy Sprengel anomaly Ataxia Severe sensorineural hearing impairment Curly hair Multiple cafe-au-lait spots Atrioventricular canal defect Decreased fertility Abnormality of the ear Melanocytic nevus Hyperextensible skin Melanoma Scapular winging Left ventricular hypertrophy Subcutaneous nodule Myocardial infarction Numerous nevi Skeletal muscle atrophy Specific learning disability Bronchiectasis Anal stenosis Autoimmune hemolytic anemia Long nose Non-midline cleft lip Combined immunodeficiency Abnormality of neuronal migration Premature ovarian insufficiency Deep philtrum Cachexia Recurrent pneumonia Lymphopenia Abnormality of the hair Sinusitis Chronic diarrhea Respiratory insufficiency Recurrent urinary tract infections Primary amenorrhea Cutaneous photosensitivity Amenorrhea Hemolytic anemia Prominent nasal bridge Attention deficit hyperactivity disorder Mental deterioration Abnormality of the nervous system Macrotia Recurrent respiratory infections Pneumonia Diarrhea Mitral valve prolapse Triangular face Abnormal eyelid morphology Syringomyelia Postauricular pit Auricular pit Prune belly Anterior creases of earlobe Abdominal wall defect Abnormality of earlobe Visceromegaly Hemihypertrophy Skin tags Abnormality of the vasculature Neonatal hypoglycemia Nevus flammeus Central hypotonia Psoriasiform dermatitis Edema Abnormality of the outer ear Premature birth Apnea Refractory anemia Impaired platelet aggregation Acute monocytic leukemia Acute myeloid leukemia Prolonged bleeding time Purpura Epistaxis Abnormal bleeding Neutropenia Bruising susceptibility Motor delay Congestive heart failure Joint hyperflexibility Cerebellar vermis atrophy Delayed puberty Pectus carinatum Hypertrophic cardiomyopathy Hyperkeratosis Localized neuroblastoma Increased number of skin folds Abnormality of the scrotum Upper limb asymmetry Median cleft palate Broad eyebrow Periorbital fullness External ear malformation Irregular hyperpigmentation Long fingers Telecanthus Overlapping toe Overfolded helix Optic nerve hypoplasia Cutis laxa Thickened skin Short palpebral fissure Febrile seizures Wide intermamillary distance Full cheeks Microcornea Flat face Severe global developmental delay Retinopathy Hearing abnormality Recurrent bronchitis Aplasia/Hypoplasia of the corpus callosum Nystagmus Aggressive behavior Conductive hearing impairment Cerebral cortical atrophy Hypogonadism Pes cavus Clinodactyly Absent speech Kyphosis Myopathy Gait disturbance Optic atrophy Myopia Visual impairment Two carpal ossification centers present at birth Joint stiffness Cyst of the ductus choledochus Cleft lower lip Submucous cleft lip Six lumbar vertebrae Duplication of renal pelvis Penoscrotal transposition Birth length greater than 97th percentile Nephroblastomatosis Broad secondary alveolar ridge Narrow sacroiliac notch 2-3 finger syndactyly Posterior helix pit Short sacroiliac notch Abnormality of the eye Abnormality of the liver Broad toe Ventricular hypertrophy Leukoencephalopathy Hypercholesterolemia Cranial nerve paralysis Abnormal intestine morphology Spastic tetraparesis Pointed chin Short phalanx of finger Large fontanelles Decreased body weight Heterotopia Pachygyria Depressed nasal ridge Tetraparesis Interphalangeal joint contracture of finger Abnormal cardiac septum morphology Optic disc pallor Abnormal blistering of the skin Epileptic encephalopathy Hip dysplasia Delayed myelination Brain atrophy Polymicrogyria Oral cleft Poor speech Synophrys Hypermetropia Abnormality of the cerebral white matter Dilated cardiomyopathy Short 2nd finger Meckel diverticulum B-cell lymphoma Cleft lip Cerebellar vermis hypoplasia Congenital diaphragmatic hernia Broad nasal tip Retinal detachment High, narrow palate Wide nose Short palm Thin vermilion border Facial asymmetry Congenital cataract Finger syndactyly Wide mouth Irritability Blindness Tall stature Progressive vitiligo Mastoiditis Malar prominence Dysgammaglobulinemia Anorectal anomaly Recurrent infection of the gastrointestinal tract T-cell lymphoma Pollakisuria B lymphocytopenia Decrease in T cell count Abnormal hair quantity Glioma Recurrent sinopulmonary infections Clumsiness Cerebral visual impairment Cervical ribs Vertebral fusion Pancreatic islet-cell hyperplasia Chordee Increased IgE level Ankyloglossia Abnormality of the helix Furrowed tongue Renal neoplasm Duodenal atresia Polysplenia Broad foot Transposition of the great arteries Broad palm Abnormality of digit Vertebral segmentation defect Preauricular skin tag Prolonged QT interval Bilateral talipes equinovarus Preauricular pit Cupped ear Nephroblastoma Abnormality of the hand Relative macrocephaly Accelerated skeletal maturation Multicystic kidney dysplasia Congenital hip dislocation Cardiac arrest Hoarse voice Short toe Wide distal femoral metaphysis



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