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A syndrome caused in the majority of cases by heterozygous mutation(s) in the KMT2D gene, encoding lysine-specific methyltransferase 2D, an enzyme involved in chromatin regulation; a minority of cases result from mutation(s) in the X-linked KDM6A gene, encoding lysine-specific demethylase 6A, an enzyme involved in regulation of histone methylation. The condition is characterized by distinctive facial features, including arched eyebrows, long eyelashes, long palpebral fissures with the lower lids turned out at the outside edges, a flat nose and large protruding earlobes, dermatoglyphic anomalies, hypotonia, short stature, developmental delay, and intellectual impairment. Some patients also manifest congenital hyperinsulinism, the molecular mechanism of which is unknown.
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