|Classification and external resources|
|ICD-10||E70.3 (ILDS E70.32)|
Waardenburg syndrome (also Waardenburg Shah Syndrome, Waardenburg-Klein syndrome, Mende's syndrome II, Van der Hoeve-Halbertsma-Waardenburg syndrome, Ptosis-Epicanthus syndrome, Van der Hoeve-Halbertsma-Gualdi syndrome, Waardenburg type Pierpont, Van der Hoeve-Waardenburg-Klein syndrome, Waardenburg's syndrome II and Vogt’s syndrome) is a rare genetic disorder most often characterized by varying degrees of deafness, minor defects in structures arising from the neural crest, and pigmentation anomalies. Disruptions in myogenesis, particularly mutations in Pax3, can cause Waardenburg syndrome I and III.
It was first described in 1951.
Eponyms and classification
Waardenburg syndrome is named after Dutch ophthalmologist Petrus Johannes Waardenburg (1886–1979), who described the syndrome in detail in 1951. The condition he described is now categorized as WS1. Swiss ophthalmologist David Klein also made contributions towards the understanding of the syndrome.
Other types have been identified, but they are less common.
Signs and symptoms
There are five major and five minor diagnostic criteria for Waardenburg syndrome.
- sensorineural hearing loss
- iris pigmentary abnormality (two eyes different color or iris bicolor or characteristic brilliant blue iris)
- hair hypopigmentation (white forelock or white hairs at other sites on the body) (poliosis)
- dystopia canthorum (lateral displacement of inner canthi)
- first‐degree relative previously diagnosed with Waardenburg syndrome
- skin hypopigmentation (congenital leukoderma/white skin patches)
- medial eyebrow flare (synophrys)
- broad nasal root (dystopia canthorum)
- hypoplasia alae nasi
- premature graying of the hair (before age 30).
The overall incidence is ~1/42,000 to 1/50,000 people. Types I and II are the most common types of the syndrome, whereas types III and IV are rare. Type 4 is also known as Waardenburg‐Shah syndrome (association of Waardenburg syndrome with Hirschsprung disease).
Type 4 is rare with only 48 cases reported up to 2002.
About 1 in 30 students in schools for the deaf have Waardenburg syndrome. All races and both sexes are affected equally. The highly variable presentation of the syndrome makes it difficult to arrive at precise figures for its prevalence.
Subtypes of the syndrome are traceable to different genetic variations:
|Type||OMIM||Gene||Locus||Also known as|
|Type I, WS1||193500||PAX3||2q35||-|
|Type IIa, WS2A (originally WS2)||193510||MITF||3p14.1-p12.3||-|
|Type IIb, WS2B||600193||WS2B||1p21-p13.3||-|
|Type IIc, WS2C||606662||WS2C||8p23||-|
|Type IId, WS2D (very rare)||608890||SNAI2||8q11||-|
|Type III, WS3||148820||PAX3||2q35||Klein-Waardenburg syndrome|
|Type IVa, WS4A||277580||EDNRB||13q22|
|Type IVb, WS4B||613265||EDN3||20q13|
|Type IVc, WS4C||613266||SOX10||22q13|
Symptoms vary from one type of the syndrome to another and from one patient to another, but they include:
- Very pale or brilliantly blue eyes, eyes of two different colors (complete heterochromia), or eyes with one iris having two different colours (sectoral heterochromia);
- A forelock of white hair (poliosis), or premature graying of the hair;
- Appearance of wide-set eyes due to a prominent, broad nasal root (dystopia canthorum)—particularly associated with type I) also known as telecanthus;
- Moderate to profound hearing loss (higher frequency associated with type II);
- A low hairline and eyebrows that touch in the middle.
- Patches of white pigmentation on the skin have been observed in some people. Sometimes, abnormalities of the arms, associated with type III, have been observed.
- Type IV may include neurologic manifestations.
Waardenburg syndrome has also been associated with a variety of other congenital disorders, such as intestinal and spinal defects, elevation of the scapula, and cleft lip and palate. Sometimes this is concurrent with Hirschsprung disease.
This condition is usually inherited in an autosomal dominant pattern, which means one copy of the altered gene is sufficient to cause the disorder. In most cases, an affected person has one parent with the condition. A small percentage of cases result from new mutations in the gene; these cases occur in people with no history of the disorder in their family.
Some cases of type II and type IV Waardenburg syndrome appear to have an autosomal recessive pattern of inheritance, which means two copies of the gene must be altered for a person to be affected by the disorder. Most often, the parents of a child with an autosomal recessive disorder are not affected but are carriers of one copy of the altered gene.
Waardenburg syndrome is usually inherited in an autosomal dominant pattern.
Types II and IV Waardenburg syndrome may sometimes have an autosomal recessive pattern of inheritance.
There is currently no treatment or cure for Waardenburg syndrome. The symptom most likely to be of practical importance is deafness, and this is treated as any other irreversible deafness would be. In marked cases there may be cosmetic issues. Other abnormalities (neurological, structural, Hirschsprung disease) associated with the syndrome are treated symptomatically.
Waardenburg syndrome is known to occur in ferrets. The affected animal will usually have a small white stripe along the top or back of its head, sometimes down the back of the neck (known as a blaze) or a solid white head (from nose to shoulders; ferrets with this are known as a panda marked ferret) and a somewhat, although barely noticeably, flatter skull than normal ferrets. As a ferret's sense of hearing is poor to begin with it is not easily noticeable except for when the affected animal does not react to loud noises that non-affected ones will respond to. As the disorder is easily spread to offspring, the affected animal will not be used for breeding by private, reputable breeders, although it may still be neutered and sold as a pet. However, largely as a result of mass-breeding due to the "exotic" markings it gives (when compared to a standard sable/pole cat marked or albino ferret), 75% of US ferrets with a blaze or white head sold from pet stores are deaf.
Domesticated cats with blue eyes and white coats are often completely deaf. Whether or not this is a result of Waardenburg syndrome remains unclear. Deafness is far more common in white cats than in those with other coat colors. According to the ASPCA Complete Guide to Cats, "17 to 20 percent of white cats with nonblue eyes are deaf; 40 percent of "odd-eyed" white cats with one blue eye are deaf; and 65 to 85 percent of blue-eyed white cats are deaf." In the 1980's, college genetic classes taught that the genes for deafness and white coat color were closely linked, resulting in the majority of cats with completely white coats and bluer eyes being deaf. The newer evidence cited above refutes this simplistic idea.
In popular culture
In the season 6 episode of Bones (TV Series), 'The Signs in the Silence', the team must solve a case in which the suspected killer has Waardenburg syndrome.
Enzo Macleod, protagonist of Peter May's series The Enzo Files, has Waardenburg syndrome. His eyes are different colors and he has a white streak in his hair. See pp. 17-18 of "Extraordinary People" (2006) by Peter Mays.
The book Reconstructing Amelia by Kimberly McCreight features several characters with Waardenburg symptoms.
- Waardenburg-Klein syndrome is named after Petrus Johannes Waardenburg (1886–1979), a Dutch ophthalmologist and geneticist, and David Klein, a Swiss human geneticist and ophthalmologist.
- Mende's syndrome II is named after Irmgard Mende (1938-), a German-American physician.
- Van der Hoeve-Halbertsma-Waardenburg Syndrome is named after Jan Van der Hoeve (1878-1952), a Dutch ophthalmologist, Nicolaas Adolf Halbertsma (1889-1968), Dutch physician and Petrus Johannes Waardenburg (1886–1979).
- Van der Hoeve-Halbertsma-Gualdi syndrome is named for Jan Van der Hoeve (1878-1952), Nicolaas Adolf Halbertsma (1889-1968) and Vincenzo Gualdi (1891-1976),an Italian physician.
- Vogt’s syndrome is named for Cecile Vogt (1875-1962), a French-German neuropathologist.
- Waardenburg PJ (September 1951). "A New Syndrome Combining Developmental Anomalies of the Eyelids, Eyebrows and Noseroot with Pigmentary Anomalies of the Iris and Head Hair and with Congenital Deafness; Dystopia canthi medialis et punctorum lacrimalium lateroversa, Hyperplasia supercilii medialis et radicis nasi, Heterochromia iridum totalis sive partialis, Albinismus circumscriptus (leucismus, poliosis) et Surditas congenita (surdimutitas)". Am. J. Hum. Genet. 3 (3): 195–253. PMC 1716407. PMID 14902764.
- Petrus Johannes Waardenburg at Who Named It?
- Klein-Waardenburg syndrome at Who Named It?
- Arias S (1971). "Genetic Heterogeneity in the Waardenburg Syndrome". Birth Defects Original Article Series 7 (4): 87–101. PMID 5006208.
- Egbalian F (2008). "Waardenburg-Shah Syndrome; A Case Report and Review of the Literature". Iranian Journal of Pediatrics 18 (1): 71–74.
- Matulich E. "Deafness in Ferrets". Cypresskeep.com.
- Webb AA, Cullen CC (2010). "Coat color and coat color pattern-related neurologic and neuro-ophthalmic diseases". The Canadian Veterinary Journal 51 (6): 653–657. PMC 2871368. PMID 20808581.
- Geigy CA, Heid S, Steffen F, Danielson K, Jaggy A, Gaillard C (2007). "Does a pleiotropic gene explain deafness and blue irises in white cats?". Veterinary Journal 173 (3): 548–553. doi:10.1016/j.tvjl.2006.07.021. PMID 16956778.
- Richards J (1999). ASPCA Complete Guide to Cats: Everything You Need to Know About Choosing and Caring for Your Pet. Chronicle Books. p. 71. ISBN 9780811819299.
- DeeAnn Williams Visk, personal recollection.
- GeneReviews/NCBI/NIH/UW entry on Waardenburg Syndrome Type I
- OMIM Genetic disorder catalog — Waardenburg syndrome