Prader-Willi syndrome

Definition

Prader-Willi syndrome is a congenital (present from birth) disease characterized by obesity, decreased muscle tone, decreased mental capacity, and hypogonadism.

Causes

Prader-Willi is caused by the deletion of a gene on chromosome 15. The majority of patients have a deletion of the father's DNA in this region. The remaining patients frequently have two copies of the mother's chromosome 15. The maternal copy of this gene is turned off in all people. When there is a deletion of the father's DNA (approximately 70% of patients), the disease occurs. This is because the patient is left with only the inactive, maternal copy.

Signs of Prader-Willi may be seen at birth. New infants with the condition are often small and very floppy (hypotonic). Male infants may have undescended testicles. The growing child exhibits slow mental and delayed motor development, increasing obesity, and characteristically small hands and feet.

Rapid weight gain may occur during the first few years because the patient develops uncontrollable hunger which leads to morbid obesity.

Mental development is slow, and the IQ seldom exceeds 80. However, children with Prader-Willi generally are very happy, smile frequently, and are pleasant to be around.

Affected children have an intense craving for food and will do almost anything to get it. This results in uncontrollable weight gain. Morbid obesity (the degree of obesity that seriously affects health) may lead to respiratory failure with hypoxia (low blood oxygen levels), cor pulmonale (right-sided heart failure), and death.

Symptoms

• Floppy newborn infant (hypotonic)
• Small for gestational age
• Undescended testicles in the male infant
• Delayed motor development
• Slow mental development
• Very small hands and feet in comparison to body
• Rapid weight gain
• Insatiable appetite, food craving
• Almond-shaped eyes
• Narrow bifrontal skull
• Morbid obesity
• Skeletal (limb) abnormalities
• Stria

Exams and Tests

• Hypotonia
• Hypomentia
• Hypogonadism
• Obesity

• Hypoxia (chronic)
• Hypercapnia (chronic)
• Cor pulmonale
• Hyperinsulinism
• Abnormal glucose tolerance (see glucose tolerance test)
• Orthopedic, knee, and hip problems
• Failure to respond to luteinizing hormone releasing factor
• Skull and narrow bifrontal diameter

Treatment

Obesity represents the greatest problem to health. Limiting caloric intake will control the obesity but the family, neighbors, school, and other institutions must cooperate closely as the child will attempt to obtain food wherever possible. Exercise can increase lean body mass in children with Prader-Willi syndrome.

Recent studies have demonstrated benefits of growth hormone treatment in causing accelerated growth and decreasing percent body fat. Growth hormone (GH) has also been shown to improve physical strength and agility in patients with Prader-Willi syndrome. There have been some concerns regarding the effect of GH on lung function in children with this condition. Parents should discuss the possible side effects with the child's doctor.

A micropenis (very small penis) in the male infant may be corrected with testosterone.

Hypogonadism may be corrected at puberty with hormone replacement.

Support Groups

For additional resources and support, see:

• Prader-Willi Alliance (www.prader-willi.org)
• Prader-Willi Syndrome Association (www.pwsausa.org)

Outlook (Prognosis)

Appropriate education will be needed for the affected person's IQ level. Weight control will allow for a much more comfortable and healthful life.

Possible Complications

• Diabetes
• Cor pulmonale
• Orthopedic problems

When to Contact a Medical Professional

Call your health care provider if your child has symptoms of this condition. The disorder is frequently suspected at birth.

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