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Russell-Silver syndrome

Silver-Russell syndrome; Silver syndrome; RSS; Russell-Silver syndrome


Russell-Silver syndrome (RSS) is a disorder present at birth involving poor growth. One side of the body may also appear to be larger than the other.



One in 10 children with this syndrome has a problem involving chromosome 7. In other people with the syndrome, it may affect chromosome 11.

Most of the time, it occurs in people with no family history of the disease.

The estimated number of people who develop this condition varies greatly. Males and females are equally affected.




Symptoms can include:

  • Birthmarks that are the color of coffee with milk ( cafe-au-lait  marks)
  • Large head for body size, wide forehead with a small triangle-shaped face and small, narrow chin 
  • Curving of the pinky toward the ring finger
  • Failure to thrive , including delayed bone age
  • Low birth weight
  • Short height, short arms, stubby fingers and toes
  • Stomach and intestine problems such as acid reflux and constipation


Exams and Tests


The condition is usually diagnosed by early childhood. The health care provider will perform a physical exam.

There are no specific laboratory tests to diagnose RSS. Diagnosis is usually based on the judgment of your child's health care provider. However, the following tests may be done:

  • Blood sugar (some children may have low blood sugar)
  • Bone age testing (bone age is often younger than the child's actual age)
  • Chromosome testing (may detect a chromosomal problem)
  • Growth hormone (some children may have a deficiency)
  • Skeletal survey (to rule out other conditions that may mimic RSS)




Growth hormone replacement may help if this hormone is lacking. Other treatments include:

  • Making sure the person gets enough calories, to prevent low blood sugar and promote growth
  • Physical therapy, to improve muscle tone
  • Special education, to address learning disabilities and attention deficit problems the child may have 

Many specialists may be involved in treating a person with this condition. They include:

  • A doctor specializing in genetics to help diagnose RSS
  • A gastroenterologist or dietician to help develop the proper diet to enhance growth
  • An endocrinologist to prescribe growth hormone
  • A genetic counselor and psychologist


Support Groups


These organizations can provide support and more information:


Outlook (Prognosis)


Older children and adults do not show typical features as clearly as infants or younger children. Intelligence may be normal, although the person may have a learning disability. Birth defects of the urinary tract may be present.


Possible Complications


People with RSS may have these problems:

  • Chewing or speaking difficulty if jaw is very small
  • Learning disabilities


When to Contact a Medical Professional


Call your child's health care provider if signs of RSS develop. Make sure your child's height and weight are measured during each well-child visit. The provider may refer you to:

  • A genetic professional for a full evaluation and chromosome studies
  • A pediatric endocrinologist for management of your child's growth problems




Backeljauw PF, Dattani MT, Cohen P, Rosenfeld RG. Disorders of growth hormone/insulin-like growth factor secretion and action. In: Sperling MA, ed. Pediatric Endocrinology . 4th ed. Philadelphia, PA: Elsevier Saunders; 2014:chap 10.

Wakeling EL, Brioude F, Lokulo-Sodipe O, et al. Diagnosis and management of Silver-Russell syndrome: first international consensus statement. Nat Rev Endocrinol. 2017;13(2):105-124. PMID: 27585961 www.ncbi.nlm.nih.gov/pubmed/27585961 .


        A Closer Look


          Talking to your MD


            Self Care


              Tests for Russell-Silver syndrome



                Review Date: 10/30/2016

                Reviewed By: Anna C. Edens Hurst, MD, MS, Assistant Professor in Medical Genetics, The University of Alabama at Birmingham, Birmingham, AL. Review provided by VeriMed Healthcare Network. Also reviewed by David Zieve, MD, MHA, Isla Ogilvie, PhD, and the A.D.A.M. Editorial team.

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