Duane-radial ray syndrome, also called Okihiro syndrome, is an autosomal dominant SALL4-related multiple congenital anomaly syndrome. The shared mechanism is disruption of SALL4 zinc-finger transcription-factor function during embryonic development, producing Duane anomaly, radial ray malformations, renal and ocular abnormalities, hearing loss, and variable cardiac, anorectal, spinal, and foot malformations.
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name: Duane-Radial Ray Syndrome
creation_date: "2026-05-10T00:00:00Z"
updated_date: "2026-05-10T00:00:00Z"
description: >-
Duane-radial ray syndrome, also called Okihiro syndrome, is an autosomal
dominant SALL4-related multiple congenital anomaly syndrome. The shared
mechanism is disruption of SALL4 zinc-finger transcription-factor function
during embryonic development, producing Duane anomaly, radial ray
malformations, renal and ocular abnormalities, hearing loss, and variable
cardiac, anorectal, spinal, and foot malformations.
category: Mendelian
parents:
- autosomal dominant disease
- congenital limb malformation
- dysostosis
- syndromic disease
synonyms:
- Okihiro syndrome
- DRRS
- SALL4-related disorder
- acro-renal-ocular syndrome
disease_term:
preferred_term: Duane-radial ray syndrome
term:
id: MONDO:0011812
label: Duane-radial ray syndrome
has_subtypes:
- name: Okihiro
display_name: Okihiro syndrome / Duane-radial ray syndrome
description: >-
Core Duane-radial ray presentation with Duane anomaly, radial defects,
renal abnormalities, hearing loss, and less frequent anorectal and spinal
malformations.
evidence:
- reference: ORPHA:93293
reference_title: Okihiro syndrome
supports: SUPPORT
evidence_source: OTHER
snippet: "A rare multiple congenital anomalies syndrome characterized by the association of uni- or bilateral radial defects"
explanation: >-
Orphanet defines Okihiro syndrome as the core Duane-radial ray
syndrome entity.
- name: Acro-renal-ocular overlap
display_name: Acro-renal-ocular overlap within the SALL4-related spectrum
description: >-
An overlapping SALL4-related phenotype with radial ray malformations, renal
abnormalities, and structural ocular anomalies including coloboma, with
overlap with Okihiro syndrome.
evidence:
- reference: ORPHA:959
reference_title: Acro-renal-ocular syndrome
supports: SUPPORT
evidence_source: OTHER
snippet: "The phenotype overlaps with other <i>SALL4</i>-related disorders including Okihiro syndrome and Holt-Oram syndrome."
explanation: >-
Orphanet explicitly places acro-renal-ocular syndrome within the
overlapping SALL4-related disorder spectrum.
- name: Holt-Oram-like presentation
display_name: SALL4-related Holt-Oram-like presentation
description: >-
Rare SALL4-related presentation resembling Holt-Oram syndrome, with radial
ray and cardiac malformations without the full Duane-radial ray spectrum.
evidence:
- reference: PMID:20301547
reference_title: SALL4-Related Disorders.
supports: SUPPORT
evidence_source: OTHER
snippet: "HOS (i.e., radial ray malformations and cardiac malformations without additional"
explanation: >-
GeneReviews describes a rare SALL4-related Holt-Oram-like presentation.
inheritance:
- name: Autosomal dominant
inheritance_term:
preferred_term: Autosomal dominant inheritance
term:
id: HP:0000006
label: Autosomal dominant inheritance
de_novo_rate: Approximately 40%-50% of cases are caused by a de novo pathogenic variant.
description: >-
SALL4-related disorders are autosomal dominant; many affected individuals
have a de novo pathogenic variant, and each child of an affected individual
has a 50% recurrence risk.
evidence:
- reference: ORPHA:93293
reference_title: Okihiro syndrome
supports: SUPPORT
evidence_source: OTHER
snippet: "Autosomal dominant"
explanation: Orphanet lists autosomal dominant inheritance.
- reference: PMID:20301547
reference_title: SALL4-Related Disorders.
supports: SUPPORT
evidence_source: OTHER
snippet: "is approximately 40%-50%. Each child of an individual with a SALL4-related"
explanation: >-
GeneReviews provides the approximate de novo rate for SALL4-related
disorders.
pathophysiology:
- name: SALL4 Haploinsufficiency and DNA-Binding Defect
description: >-
Heterozygous SALL4 nonsense, frameshift, deletion, or selected missense
variants reduce SALL4 transcription-factor function by haploinsufficiency
or impaired AT-rich DNA binding.
genes:
- preferred_term: SALL4
term:
id: hgnc:15924
label: SALL4
molecular_functions:
- preferred_term: DNA-binding transcription factor activity, RNA polymerase II-specific
term:
id: GO:0000981
label: DNA-binding transcription factor activity, RNA polymerase II-specific
modifier: DECREASED
biological_processes:
- preferred_term: embryo development
term:
id: GO:0009790
label: embryo development
modifier: ABNORMAL
evidence:
- reference: PMID:16086360
reference_title: >-
SALL4 mutations in Okihiro syndrome (Duane-radial ray syndrome),
acro-renal-ocular syndrome, and related disorders.
supports: SUPPORT
evidence_source: OTHER
snippet: "deletions. All of the mutations lead to preterminal stop codons and are thought"
explanation: >-
This review supports SALL4 haploinsufficiency as a major mechanism for
truncating variants.
- reference: PMID:36635047
reference_title: Structure of SALL4 zinc finger domain reveals link between AT-rich DNA binding and Okihiro syndrome.
supports: SUPPORT
evidence_source: IN_VITRO
snippet: "reduced overall binding to DNA but not the preference for AT-rich sequences."
explanation: >-
Structural and DNA-binding data support impaired SALL4 DNA binding for
patient-reported missense variants in the zinc-finger domain.
downstream:
- target: Embryonic Limb-Renal-Ocular Developmental Disruption
causal_link_type: DIRECT
description: >-
Reduced or altered SALL4 transcription-factor function perturbs the
developmental programs needed for limb, renal, ocular, and related
organogenesis.
evidence:
- reference: PMID:36635047
reference_title: Structure of SALL4 zinc finger domain reveals link between AT-rich DNA binding and Okihiro syndrome.
supports: SUPPORT
evidence_source: IN_VITRO
snippet: "required for the development of multiple organs, including limbs. Mutations in"
explanation: >-
The abstract directly links SALL4 function to embryonic identity and
multiorgan development, including limb development.
- name: Embryonic Limb-Renal-Ocular Developmental Disruption
description: >-
Abnormal SALL4-dependent embryonic transcriptional regulation disrupts
limb morphogenesis, kidney development, eye development, and broader
congenital organ patterning.
genes:
- preferred_term: SALL4
term:
id: hgnc:15924
label: SALL4
biological_processes:
- preferred_term: embryonic limb morphogenesis
term:
id: GO:0030326
label: embryonic limb morphogenesis
modifier: ABNORMAL
- preferred_term: kidney development
term:
id: GO:0001822
label: kidney development
modifier: ABNORMAL
- preferred_term: eye development
term:
id: GO:0001654
label: eye development
modifier: ABNORMAL
evidence:
- reference: PMID:20301547
reference_title: SALL4-Related Disorders.
supports: SUPPORT
evidence_source: OTHER
snippet: "be distinct entities. DRRS is characterized by uni- or bilateral Duane anomaly"
explanation: >-
GeneReviews links the disorder to congenital ocular motility and radial
ray developmental abnormalities.
- reference: ORPHA:959
reference_title: Acro-renal-ocular syndrome
supports: SUPPORT
evidence_source: OTHER
snippet: "A rare syndrome of multiple congenital anomalies characterized by radial ray malformations, renal abnormalities"
explanation: >-
Orphanet supports the radial and renal developmental pattern in the
overlapping SALL4-related spectrum.
downstream:
- target: SALL4-Related Congenital Anomaly Spectrum
causal_link_type: DIRECT
description: >-
Disrupted embryonic limb, renal, ocular, and related organ development
produces the recognizable Duane-radial ray / acro-renal-ocular clinical
spectrum.
evidence:
- reference: PMID:16086360
reference_title: >-
SALL4 mutations in Okihiro syndrome (Duane-radial ray syndrome),
acro-renal-ocular syndrome, and related disorders.
supports: SUPPORT
evidence_source: OTHER
snippet: "Other abnormalities reported in this condition are anal, renal, cardiac, ear,"
explanation: >-
The review summarizes the multiorgan congenital anomaly spectrum
downstream of SALL4-related disease.
- name: SALL4-Related Congenital Anomaly Spectrum
description: >-
The clinical disorder combines Duane anomaly, radial ray defects, renal and
ocular abnormalities, hearing impairment, and variable anorectal, cardiac,
spinal, and foot malformations with marked phenotypic variability.
evidence:
- reference: ORPHA:93293
reference_title: Okihiro syndrome
supports: SUPPORT
evidence_source: OTHER
snippet: "A rare multiple congenital anomalies syndrome characterized by the association of uni- or bilateral radial defects"
explanation: >-
The Orphanet definition supports a multiple congenital anomaly spectrum.
- reference: PMID:26791099
reference_title: Novel frameshift variant in gene SALL4 causing Okihiro syndrome.
supports: SUPPORT
evidence_source: HUMAN_CLINICAL
snippet: "a broad spectrum of phenotypes, ranging from the severe one presented by the"
explanation: >-
This family report supports broad phenotypic variability among affected
individuals with a SALL4 frameshift variant.
phenotypes:
- name: Duane anomaly
category: Ophthalmologic
description: >-
Congenital limitation of horizontal eye movement with globe retraction is
the defining ocular motility feature.
phenotype_term:
preferred_term: Duane anomaly
term:
id: HP:0009921
label: Duane anomaly
evidence:
- reference: ORPHA:93293
reference_title: Okihiro syndrome
supports: SUPPORT
evidence_source: OTHER
snippet: "uni- or bilateral Duane anomaly"
explanation: Orphanet lists unilateral or bilateral Duane anomaly as a defining feature.
- name: Radial ray defects
category: Musculoskeletal
description: >-
Radial ray malformations include radius hypoplasia or aplasia, radial
deviation, thumb aplasia or hypoplasia, triphalangeal thumbs, and thumb
duplication.
phenotype_term:
preferred_term: radial ray malformation
term:
id: HP:0002818
label: Abnormal morphology of the radius
evidence:
- reference: ORPHA:93293
reference_title: Okihiro syndrome
supports: SUPPORT
evidence_source: OTHER
snippet: "uni- or bilateral radial defects"
explanation: Orphanet lists unilateral or bilateral radial defects.
- reference: PMID:20301547
reference_title: SALL4-Related Disorders.
supports: SUPPORT
evidence_source: OTHER
snippet: "and radial ray malformation that can include thenar hypoplasia"
explanation: GeneReviews identifies radial ray malformation as a core feature.
- name: Aplasia/hypoplasia of the radius
category: Musculoskeletal
subtype: Acro-renal-ocular overlap
frequency: VERY_FREQUENT
description: >-
Radius underdevelopment or absence is a high-frequency radial ray feature
in the acro-renal-ocular overlap portion of the SALL4 spectrum.
phenotype_term:
preferred_term: Aplasia/Hypoplasia of the radius
term:
id: HP:0006501
label: Aplasia/Hypoplasia of the radius
evidence:
- reference: ORPHA:959
reference_title: Acro-renal-ocular syndrome
supports: SUPPORT
evidence_source: OTHER
snippet: "HP:0006501 | Aplasia/Hypoplasia of the radius | Very frequent (99-80%)"
explanation: Orphanet records radius aplasia/hypoplasia as very frequent in the acro-renal-ocular overlap phenotype.
- name: Abnormal thumb morphology
category: Musculoskeletal
subtype: Acro-renal-ocular overlap
frequency: VERY_FREQUENT
description: >-
Thumb abnormalities include hypoplastic, short, absent, triphalangeal, or
duplicated thumbs.
phenotype_term:
preferred_term: Abnormal thumb morphology
term:
id: HP:0001172
label: Abnormal thumb morphology
evidence:
- reference: ORPHA:959
reference_title: Acro-renal-ocular syndrome
supports: SUPPORT
evidence_source: OTHER
snippet: "HP:0001172 | Abnormal thumb morphology | Very frequent (99-80%)"
explanation: Orphanet records abnormal thumb morphology as very frequent.
- name: Short thumb
category: Musculoskeletal
subtype: Acro-renal-ocular overlap
frequency: VERY_FREQUENT
description: Thumb hypoplasia is a frequent expression of radial ray involvement.
phenotype_term:
preferred_term: Short thumb
term:
id: HP:0009778
label: Short thumb
evidence:
- reference: ORPHA:959
reference_title: Acro-renal-ocular syndrome
supports: SUPPORT
evidence_source: OTHER
snippet: "HP:0009778 | Short thumb | Very frequent (99-80%)"
explanation: Orphanet records short thumb as very frequent.
- name: Short distal phalanx of the thumb
category: Musculoskeletal
subtype: Acro-renal-ocular overlap
frequency: VERY_FREQUENT
description: Short distal phalanx of the thumb is a high-frequency thumb manifestation.
phenotype_term:
preferred_term: Short distal phalanx of the thumb
term:
id: HP:0009650
label: Short distal phalanx of the thumb
evidence:
- reference: ORPHA:959
reference_title: Acro-renal-ocular syndrome
supports: SUPPORT
evidence_source: OTHER
snippet: "HP:0009650 | Short distal phalanx of the thumb | Very frequent (99-80%)"
explanation: Orphanet records short distal phalanx of the thumb as very frequent.
- name: Triphalangeal thumb
category: Musculoskeletal
subtype: Acro-renal-ocular overlap
frequency: FREQUENT
description: Triphalangeal thumbs are part of the radial ray malformation spectrum.
phenotype_term:
preferred_term: Triphalangeal thumb
term:
id: HP:0001199
label: Triphalangeal thumb
evidence:
- reference: ORPHA:959
reference_title: Acro-renal-ocular syndrome
supports: SUPPORT
evidence_source: OTHER
snippet: "HP:0001199 | Triphalangeal thumb | Frequent (79-30%)"
explanation: Orphanet records triphalangeal thumb as frequent.
- name: Preaxial hand polydactyly
category: Musculoskeletal
subtype: Acro-renal-ocular overlap
frequency: FREQUENT
description: Thumb duplication and related preaxial polydactyly occur in the SALL4 spectrum.
phenotype_term:
preferred_term: Preaxial hand polydactyly
term:
id: HP:0001177
label: Preaxial hand polydactyly
evidence:
- reference: ORPHA:959
reference_title: Acro-renal-ocular syndrome
supports: SUPPORT
evidence_source: OTHER
snippet: "HP:0001177 | Preaxial hand polydactyly | Frequent (79-30%)"
explanation: Orphanet records preaxial hand polydactyly as frequent.
- name: Hypoplasia of the ulna
category: Musculoskeletal
subtype: Acro-renal-ocular overlap
frequency: FREQUENT
description: Ulnar hypoplasia can accompany the radial ray pattern.
phenotype_term:
preferred_term: Hypoplasia of the ulna
term:
id: HP:0003022
label: Hypoplasia of the ulna
evidence:
- reference: ORPHA:959
reference_title: Acro-renal-ocular syndrome
supports: SUPPORT
evidence_source: OTHER
snippet: "HP:0003022 | Hypoplasia of the ulna | Frequent (79-30%)"
explanation: Orphanet records hypoplasia of the ulna as frequent.
- name: Renal malrotation
category: Renal
subtype: Acro-renal-ocular overlap
frequency: VERY_FREQUENT
description: Renal malrotation is one form of congenital renal abnormality in the SALL4 spectrum.
phenotype_term:
preferred_term: Renal malrotation
term:
id: HP:0004712
label: Renal malrotation
evidence:
- reference: ORPHA:959
reference_title: Acro-renal-ocular syndrome
supports: SUPPORT
evidence_source: OTHER
snippet: "HP:0004712 | Renal malrotation | Very frequent (99-80%)"
explanation: Orphanet records renal malrotation as very frequent.
- name: Horseshoe kidney
category: Renal
subtype: Acro-renal-ocular overlap
frequency: VERY_FREQUENT
description: Horseshoe kidney is a common renal position/fusion anomaly in acro-renal-ocular syndrome.
phenotype_term:
preferred_term: Horseshoe kidney
term:
id: HP:0000085
label: Horseshoe kidney
evidence:
- reference: ORPHA:959
reference_title: Acro-renal-ocular syndrome
supports: SUPPORT
evidence_source: OTHER
snippet: "HP:0000085 | Horseshoe kidney | Very frequent (99-80%)"
explanation: Orphanet records horseshoe kidney as very frequent.
- name: Crossed fused renal ectopia
category: Renal
subtype: Acro-renal-ocular overlap
frequency: VERY_FREQUENT
description: Crossed fused renal ectopia is a frequent renal positional anomaly in the overlap phenotype.
phenotype_term:
preferred_term: Crossed fused renal ectopia
term:
id: HP:0004736
label: Crossed fused renal ectopia
evidence:
- reference: ORPHA:959
reference_title: Acro-renal-ocular syndrome
supports: SUPPORT
evidence_source: OTHER
snippet: "HP:0004736 | Crossed fused renal ectopia | Very frequent (99-80%)"
explanation: Orphanet records crossed fused renal ectopia as very frequent.
- name: Renal hypoplasia/aplasia
category: Renal
subtype: Acro-renal-ocular overlap
frequency: FREQUENT
description: Kidney underdevelopment or absence can occur as part of the renal anomaly spectrum.
phenotype_term:
preferred_term: Renal hypoplasia/aplasia
term:
id: HP:0008678
label: Renal hypoplasia/aplasia
evidence:
- reference: ORPHA:959
reference_title: Acro-renal-ocular syndrome
supports: SUPPORT
evidence_source: OTHER
snippet: "HP:0008678 | Renal hypoplasia/aplasia | Frequent (79-30%)"
explanation: Orphanet records renal hypoplasia/aplasia as frequent.
- name: Bladder diverticulum
category: Renal
subtype: Acro-renal-ocular overlap
frequency: FREQUENT
description: Bladder diverticula are included among urinary tract abnormalities in the overlap phenotype.
phenotype_term:
preferred_term: Bladder diverticulum
term:
id: HP:0000015
label: Bladder diverticulum
evidence:
- reference: ORPHA:959
reference_title: Acro-renal-ocular syndrome
supports: SUPPORT
evidence_source: OTHER
snippet: "HP:0000015 | Bladder diverticulum | Frequent (79-30%)"
explanation: Orphanet records bladder diverticulum as frequent.
- name: Sensorineural hearing impairment
category: Auditory
frequency: FREQUENT
description: Sensorineural hearing loss is part of the congenital ear/hearing phenotype.
phenotype_term:
preferred_term: Sensorineural hearing impairment
term:
id: HP:0000407
label: Sensorineural hearing impairment
evidence:
- reference: ORPHA:93293
reference_title: Okihiro syndrome
supports: SUPPORT
evidence_source: OTHER
snippet: "sensorineural and/or conductive hearing loss"
explanation: Orphanet lists sensorineural and/or conductive hearing loss.
- reference: ORPHA:959
reference_title: Acro-renal-ocular syndrome
supports: SUPPORT
evidence_source: OTHER
snippet: "HP:0000407 | Sensorineural hearing impairment | Frequent (79-30%)"
explanation: Orphanet records sensorineural hearing impairment as frequent.
- name: Conductive hearing impairment
category: Auditory
subtype: Acro-renal-ocular overlap
frequency: FREQUENT
description: Conductive hearing loss may also occur in the SALL4-related spectrum.
phenotype_term:
preferred_term: Conductive hearing impairment
term:
id: HP:0000405
label: Conductive hearing impairment
evidence:
- reference: ORPHA:959
reference_title: Acro-renal-ocular syndrome
supports: SUPPORT
evidence_source: OTHER
snippet: "HP:0000405 | Conductive hearing impairment | Frequent (79-30%)"
explanation: Orphanet records conductive hearing impairment as frequent.
- name: Optic disc coloboma
category: Ophthalmologic
subtype: Acro-renal-ocular overlap
frequency: FREQUENT
description: Optic disc coloboma is a common structural ocular feature in acro-renal-ocular syndrome.
phenotype_term:
preferred_term: Optic disc coloboma
term:
id: HP:0000588
label: Optic disc coloboma
evidence:
- reference: ORPHA:959
reference_title: Acro-renal-ocular syndrome
supports: SUPPORT
evidence_source: OTHER
snippet: "HP:0000588 | Optic disc coloboma | Frequent (79-30%)"
explanation: Orphanet records optic disc coloboma as frequent.
- name: Optic disc hypoplasia
category: Ophthalmologic
subtype: Acro-renal-ocular overlap
frequency: FREQUENT
description: Optic disc hypoplasia can contribute to visual impairment.
phenotype_term:
preferred_term: Optic disc hypoplasia
term:
id: HP:0007766
label: Optic disc hypoplasia
evidence:
- reference: ORPHA:959
reference_title: Acro-renal-ocular syndrome
supports: SUPPORT
evidence_source: OTHER
snippet: "HP:0007766 | Optic disc hypoplasia | Frequent (79-30%)"
explanation: Orphanet records optic disc hypoplasia as frequent.
- name: Visual impairment
category: Ophthalmologic
subtype: Acro-renal-ocular overlap
frequency: FREQUENT
description: Structural ocular anomalies and optic disc abnormalities can cause impaired vision.
phenotype_term:
preferred_term: Visual impairment
term:
id: HP:0000505
label: Visual impairment
evidence:
- reference: ORPHA:959
reference_title: Acro-renal-ocular syndrome
supports: SUPPORT
evidence_source: OTHER
snippet: "HP:0000505 | Visual impairment | Frequent (79-30%)"
explanation: Orphanet records visual impairment as frequent.
- name: Strabismus
category: Ophthalmologic
subtype: Acro-renal-ocular overlap
frequency: FREQUENT
description: Strabismus is part of the ocular motility phenotype and may overlap with Duane anomaly.
phenotype_term:
preferred_term: Strabismus
term:
id: HP:0000486
label: Strabismus
evidence:
- reference: ORPHA:959
reference_title: Acro-renal-ocular syndrome
supports: SUPPORT
evidence_source: OTHER
snippet: "HP:0000486 | Strabismus | Frequent (79-30%)"
explanation: Orphanet records strabismus as frequent.
- name: Short palpebral fissure
category: Ophthalmologic
subtype: Acro-renal-ocular overlap
frequency: FREQUENT
description: Short palpebral fissures are a frequent periocular feature in acro-renal-ocular syndrome.
phenotype_term:
preferred_term: Short palpebral fissure
term:
id: HP:0012745
label: Short palpebral fissure
evidence:
- reference: ORPHA:959
reference_title: Acro-renal-ocular syndrome
supports: SUPPORT
evidence_source: OTHER
snippet: "HP:0012745 | Short palpebral fissure | Frequent (79-30%)"
explanation: Orphanet records short palpebral fissure as frequent.
- name: Anal atresia
category: Gastrointestinal
description: Imperforate anus and related anorectal malformations are less frequent associated features.
phenotype_term:
preferred_term: Imperforate anus
term:
id: HP:0002023
label: Anal atresia
evidence:
- reference: ORPHA:93293
reference_title: Okihiro syndrome
supports: SUPPORT
evidence_source: OTHER
snippet: "imperforate anus and scoliosis"
explanation: Orphanet lists imperforate anus among less frequent features.
- reference: PMID:16086360
reference_title: >-
SALL4 mutations in Okihiro syndrome (Duane-radial ray syndrome),
acro-renal-ocular syndrome, and related disorders.
supports: SUPPORT
evidence_source: OTHER
snippet: "Other abnormalities reported in this condition are anal, renal, cardiac, ear,"
explanation: The review includes anal malformations among associated abnormalities.
- name: Scoliosis
category: Musculoskeletal
description: Scoliosis is a less frequent spinal feature.
phenotype_term:
preferred_term: Scoliosis
term:
id: HP:0002650
label: Scoliosis
evidence:
- reference: ORPHA:93293
reference_title: Okihiro syndrome
supports: SUPPORT
evidence_source: OTHER
snippet: "imperforate anus and scoliosis"
explanation: Orphanet lists scoliosis among less frequent features.
- name: Congenital heart defects
category: Cardiovascular
description: Cardiac malformations may occur, including Holt-Oram-like SALL4-related presentations.
phenotype_term:
preferred_term: Congenital heart defects
term:
id: HP:0001627
label: Abnormal heart morphology
evidence:
- reference: PMID:16086360
reference_title: >-
SALL4 mutations in Okihiro syndrome (Duane-radial ray syndrome),
acro-renal-ocular syndrome, and related disorders.
supports: SUPPORT
evidence_source: OTHER
snippet: "Other abnormalities reported in this condition are anal, renal, cardiac, ear,"
explanation: The review includes cardiac malformations among associated abnormalities.
- name: Sandal gap
category: Musculoskeletal
subtype: Acro-renal-ocular overlap
frequency: FREQUENT
description: Sandal gap is a common foot feature in acro-renal-ocular syndrome.
phenotype_term:
preferred_term: Sandal gap
term:
id: HP:0001852
label: Sandal gap
evidence:
- reference: ORPHA:959
reference_title: Acro-renal-ocular syndrome
supports: SUPPORT
evidence_source: OTHER
snippet: "HP:0001852 | Sandal gap | Frequent (79-30%)"
explanation: Orphanet records sandal gap as frequent.
- name: Broad hallux phalanx
category: Musculoskeletal
subtype: Acro-renal-ocular overlap
frequency: FREQUENT
description: Broad hallux phalanges are frequent foot findings in the overlap phenotype.
phenotype_term:
preferred_term: Broad hallux phalanx
term:
id: HP:0010059
label: Broad hallux phalanx
evidence:
- reference: ORPHA:959
reference_title: Acro-renal-ocular syndrome
supports: SUPPORT
evidence_source: OTHER
snippet: "HP:0010059 | Broad hallux phalanx | Frequent (79-30%)"
explanation: Orphanet records broad hallux phalanx as frequent.
- name: Short hallux
category: Musculoskeletal
subtype: Acro-renal-ocular overlap
frequency: FREQUENT
description: Short hallux is a frequent foot finding in the overlap phenotype.
phenotype_term:
preferred_term: Short hallux
term:
id: HP:0010109
label: Short hallux
evidence:
- reference: ORPHA:959
reference_title: Acro-renal-ocular syndrome
supports: SUPPORT
evidence_source: OTHER
snippet: "HP:0010109 | Short hallux | Frequent (79-30%)"
explanation: Orphanet records short hallux as frequent.
genetic:
- name: SALL4
association: Causal heterozygous pathogenic variant
relationship_type: CAUSATIVE
variant_origin: GERMLINE
gene_term:
preferred_term: SALL4
term:
id: hgnc:15924
label: SALL4
notes: >-
Reported pathogenic mechanisms include nonsense, frameshift, deletion, and
selected missense variants that reduce SALL4 function. The phenotype is
highly variable, even within families.
evidence:
- reference: ORPHA:959
reference_title: Acro-renal-ocular syndrome
supports: SUPPORT
evidence_source: OTHER
snippet: "SALL4 | spalt like transcription factor 4 | hgnc:15924 | Disease-causing germline mutation(s) in"
explanation: Orphanet links SALL4 disease-causing germline variants to the overlapping acro-renal-ocular phenotype.
- reference: PMID:16086360
reference_title: >-
SALL4 mutations in Okihiro syndrome (Duane-radial ray syndrome),
acro-renal-ocular syndrome, and related disorders.
supports: SUPPORT
evidence_source: OTHER
snippet: "mutation in the SALL4 gene, a human gene related to the developmental regulator"
explanation: The review identifies SALL4 mutations as the molecular cause.
- reference: PMID:35179219
reference_title: A de novo mutation of SALL4 in a Chinese family with Okihiro syndrome.
supports: SUPPORT
evidence_source: HUMAN_CLINICAL
snippet: "pathogenic heterozygous c.3060delG variant was identified in exon 4 of"
explanation: This case report supports causal heterozygous SALL4 variants.
- reference: PMID:36829172
reference_title: "A novel de novo nonsense mutation in SALL4 causing duane radial ray syndrome: a case report and expanding the phenotypic spectrum."
supports: SUPPORT
evidence_source: HUMAN_CLINICAL
snippet: "novel de novo heterozygous nonsense mutation in exon 2 of SALL4 gene"
explanation: >-
This case report provides additional human clinical support for de novo
heterozygous SALL4 pathogenic variants causing Duane-radial ray syndrome.
diagnosis:
- name: Molecular genetic testing
description: >-
Diagnosis is established when suggestive clinical findings are paired with
a heterozygous pathogenic SALL4 variant identified by molecular genetic
testing.
diagnosis_term:
preferred_term: molecular genetic testing
term:
id: MAXO:0000533
label: molecular genetic testing
results: Genetic testing identifies a heterozygous pathogenic SALL4 sequence or copy-number variant.
evidence:
- reference: PMID:20301547
reference_title: SALL4-Related Disorders.
supports: SUPPORT
evidence_source: OTHER
snippet: "proband with suggestive findings and a heterozygous pathogenic variant in SALL4"
explanation: GeneReviews directly states the molecular diagnostic criterion.
- name: Multisystem clinical assessment
description: >-
Clinical assessment includes ophthalmologic examination, renal function and
renal ultrasound surveillance when indicated, cardiac surveillance, hearing
evaluation, and growth or pituitary assessment as clinically appropriate.
diagnosis_term:
preferred_term: clinical assessment
term:
id: MAXO:0000487
label: clinical assessment
results: Assessment defines the ocular, limb, renal, auditory, cardiac, and endocrine manifestations that require management.
evidence:
- reference: PMID:20301547
reference_title: SALL4-Related Disorders.
supports: SUPPORT
evidence_source: OTHER
snippet: "Ophthalmologic exam with frequency as recommended by ophthalmologist"
explanation: GeneReviews recommends ophthalmologic surveillance.
- reference: PMID:20301547
reference_title: SALL4-Related Disorders.
supports: SUPPORT
evidence_source: OTHER
snippet: "renal function in those with renal anomalies, even if renal function is normal"
explanation: GeneReviews recommends renal-function monitoring for individuals with renal anomalies.
- reference: PMID:27941963
reference_title: Clinical and Genetic Findings in Mexican Patients with Duane Anomaly and Radial Ray Malformations/Okihiro Syndrome.
supports: SUPPORT
evidence_source: HUMAN_CLINICAL
snippet: "ophthalmologic and general physical examination was performed in all patients."
explanation: >-
This clinical cohort supports combined ophthalmologic and general
physical examination as part of evaluation.
treatments:
- name: Corrective surgery for strabismus, limb, and cardiac malformations
description: >-
Surgery is used as needed for Duane-associated strabismus, forearm or limb
malformations, and congenital heart defects; it treats manifestations
rather than the SALL4 transcriptional defect.
treatment_term:
preferred_term: surgical procedure
term:
id: MAXO:0000004
label: surgical procedure
target_mechanisms:
- target: SALL4-Related Congenital Anomaly Spectrum
treatment_effect: MODULATES
description: >-
Corrective procedures address structural manifestations produced by the
congenital anomaly spectrum.
evidence:
- reference: PMID:20301547
reference_title: SALL4-Related Disorders.
supports: SUPPORT
evidence_source: OTHER
snippet: "Duane anomaly, malformations of the forearms, and congenital heart defects;"
explanation: GeneReviews recommends surgery for these manifestations as needed.
- name: Renal and cardiac supportive specialist management
description: >-
Nephrology, urology, and cardiology management addresses renal anomalies,
conduction defects, heart block, and congenital heart defects without
correcting the primary SALL4 mechanism.
treatment_term:
preferred_term: supportive care
term:
id: MAXO:0000950
label: supportive care
target_mechanisms:
- target: SALL4-Related Congenital Anomaly Spectrum
treatment_effect: MODULATES
description: Specialist care monitors and treats renal and cardiovascular complications.
evidence:
- reference: PMID:20301547
reference_title: SALL4-Related Disorders.
supports: SUPPORT
evidence_source: OTHER
snippet: "management of renal anomalies per nephrologist and/or urologist"
explanation: GeneReviews recommends nephrology/urology management of renal anomalies.
- reference: PMID:20301547
reference_title: SALL4-Related Disorders.
supports: SUPPORT
evidence_source: OTHER
snippet: "medications or pacemaker for those with conduction defects or heart block;"
explanation: GeneReviews recommends standard cardiac management when conduction disease is present.
- name: Hearing support
description: >-
Hearing aids are used when hearing impairment is present.
treatment_term:
preferred_term: supportive care
term:
id: MAXO:0000950
label: supportive care
target_mechanisms:
- target: SALL4-Related Congenital Anomaly Spectrum
treatment_effect: MODULATES
description: Hearing support addresses auditory manifestations but not the congenital mechanism.
evidence:
- reference: PMID:20301547
reference_title: SALL4-Related Disorders.
supports: SUPPORT
evidence_source: OTHER
snippet: "hearing aids as needed"
explanation: GeneReviews recommends hearing aids when needed.
clinical_trials: []
datasets: []
notes: >-
ORPHA:959 also includes HP:0004059 "Radial club hand" as frequent, but the
local HPO cache marks HP:0004059 obsolete. This entry represents the same
radial-ray pattern with current radius and thumb phenotype bindings instead
of adding an obsolete term.
references:
- reference: PMID:20301547
title: SALL4-Related Disorders.
tags:
- GeneReviews
findings:
- statement: >-
GeneReviews summarizes the SALL4-related clinical spectrum, diagnostic
testing, inheritance, surveillance, and management.
- reference: PMID:16086360
title: >-
SALL4 mutations in Okihiro syndrome (Duane-radial ray syndrome),
acro-renal-ocular syndrome, and related disorders.
findings:
- statement: >-
SALL4 truncating mutations and deletions support haploinsufficiency as a
central disease mechanism.
- reference: PMID:36635047
title: Structure of SALL4 zinc finger domain reveals link between AT-rich DNA binding and Okihiro syndrome.
findings:
- statement: >-
Patient-associated C-terminal zinc-finger missense variants reduce SALL4
DNA binding.
This report is retrieval-only and is generated directly from Asta results.
search_papers_by_relevance with snippet_search.