Health Library

What is 22q11.2 deletion syndrome?

22q11.2 deletion syndrome is a genetic disorder. In this syndrome, a tiny piece of
chromosome 22 is missing. This can cause many medical problems. These problems may
range from heart defects and developmental delays to seizures and effects on facial
appearance. These might include cleft palate (an opening in the roof of the mouth).

In 22q11.2 deletion syndrome, a tiny piece of chromosome 22 is missing from the long
arm of chromosome 22, at a location called q11.2. 

Most people affected by the syndrome do not experience all the health problems that
are associated with it. In general, health problems that are present due to 22q11.2
deletion syndrome can be managed with treatment, especially if they are detected early. 

In the mid-1960s, an endocrinologist named Dr. Angelo DiGeorge recognized that a particular
group of clinical features frequently occurred together, including the following: 

• Hypoparathyroidism (underactive parathyroid gland), which results in hypocalcemia
  (low blood calcium levels) 

• Hypoplastic (underdeveloped) thymus or absent thymus, which results in problems with
  the immune system 

• Conotruncal heart defects (such as tetralogy of Fallot, interrupted aortic arch, ventricular
  septal defects, vascular rings) 

• Cleft lip and/or palate

The signs and symptoms of 22q11.2 deletion syndrome can vary from one affected person
to another. For that reason, several disorders and collections of symptoms caused
by this syndrome have had other names in the past. These names, some of which are
still used occasionally, include: 

• DiGeorge syndrome

• Velocardiofacial syndrome (VCFS)

• Shprintzen syndrome

• Conotruncal anomaly face syndrome (CTAF)

• Sedlackova syndrome

In addition, some children with the syndrome were previously diagnosed with Opitz
G/BBB syndrome or Cayler cardiofacial syndrome. Doctors now understand that these
disorders all share the same genetic cause as 22q11.2 deletion syndrome. 

Who is affected by 22q11.2 deletion syndrome?

About one in 4,000 people have 22q11.2 deletion syndrome. Some medical experts believe
this number should be higher; some people with the chromosome defect have less severe
symptoms that may not be diagnosed as 22q11.2 deletion syndrome. Thus, they are unaware
they have the syndrome. 

What causes 22q11.2 deletion syndrome?

Most people with 22q11.2 deletion syndrome are missing about 30 to 40 genes. The exact
function of many of these genes remains a mystery. But one gene, TBX1, probably accounts
for the syndrome’s most common physical symptoms. These include heart problems and
cleft palate. Another nearby gene, called COMT, may also help explain the increased
risk for behavior problems and mental illness in people with the syndrome. 

About 90 percent of 22q11.2 deletion syndrome cases occur randomly at fertilization
or early in fetal development. So most people affected with the disorder have no previous
family history of it. However, they may pass the condition on to their children. The
remaining 10 percent of cases are inherited from either the mother or the father.
When the condition is inherited, other family members could also be affected. Because
a person who has this chromosome deletion has a 50 percent chance of passing the deletion
to a child, both parents are generally offered the opportunity to have their blood
studied to look for the deletion. 

What are the signs and symptoms of 22q11.2 deletion syndrome?

The signs and symptoms of 22q11.2 deletion syndrome may vary widely, even among family
members. At least 30 different signs or symptoms have been associated with this disorder,
but most affected people only have some symptoms.  

The most common symptoms include: 

• Heart defects, which are usually present from birth 

• Palate abnormalities, such as cleft palate and speech difficulties 

• Middle ear infections or hearing loss 

• Feeding difficulties 

• Low levels of calcium in the blood, due to problems with the parathyroid glands, which
  can trigger seizures 

• Immune system problems that can increase risk for infections 

• Kidney abnormalities 

• Spine problems, such as scoliosis (curvature in the spine) and abnormalities in the
  bones of  the neck or upper back 

• Learning difficulties, especially with nonverbal material, and developmental delays 

• Communication and social interaction problems, including autism 

• An increased risk for mental illness, such as anxiety, depression, or schizophrenia
  in adulthood

Facial features of children with 22q11.2 deletion syndrome may include the following: 

• Small ears with squared upper ear

• Hooded eyelids

• Cleft lip and/or palate

• Asymmetric (uneven) facial appearance when crying

• Small mouth, chin, and side areas of the tip of the nose  

The symptoms of 22q11.2 deletion syndrome may resemble other problems or medical conditions.
Always consult your child’s doctor for a diagnosis. 

How is 22q11.2 deletion syndrome diagnosed?

In addition to a prenatal history, complete medical and family history, and a physical
examination, diagnostic procedures for 22q11.2 deletion may include: 

• Blood tests and tests to examine for immune system problems

• X-ray. A diagnostic test that uses invisible electromagnetic energy beams to produce images
  of internal tissues, bones, and organs onto film 

• Echocardiography. A procedure that evaluates the structure and function of the heart, by using sound
  waves recorded on an electronic sensor that produce a moving picture of the heart
  and heart valves 

• Fluorescent in situ hybridization (FISH) studies. When features of conotruncal heart defects, clefting, other facial features, hypocalcemia,
  and absent thymus are identified, a blood test is usually ordered to look for a deletion
  in the chromosome 22q11.2 region. FISH is specifically designed to look for small
  groups of genes that are deleted. If the FISH test finds no deletion in the 22q11.2
  region and the features of VCFS are still strongly suggestive, then a full chromosome
  study is usually performed to look for other chromosome defects that have been associated
  with this syndrome. 

If a 22q11.2 deletion is detected in a child, then both parents are offered the FISH
test to see if this deletion is inherited. In approximately 10 percent of families,
the deletion has been inherited from one of the parents. Any individual who has this
22q11.2 deletion has a 50 percent chance, with each pregnancy, of passing it on to
a child.           

How is 22q11.2 deletion syndrome treated?

There is no cure for 22q11.2 deletion syndrome, but many of its related health problems
can be treated. Parents can help their child by seeking early, competent care.  

Specific treatment for 22q11.2 deletion syndrome will be determined by your child’s doctor
based on the following: 

• Your child’s age, overall health, and medical history

• The extent of the disease

• The type of disease

• Your child’s tolerance for specific medications, procedures, or therapies

• Expectations for the course of the disease

• Your opinion or preference 

Treatment will also depend on the particular features in any given child and may include
the following: 

• A cardiologist will evaluate heart defects and may correct them with an interventional
  procedure or surgery. 

• A plastic surgeon and a speech pathologist will evaluate cleft lip and/or palate defects. 

• Speech and gastrointestinal specialists will evaluate feeding difficulties. Some children
  with the syndrome have severe feeding difficulties and need tube feedings in order
  to get adequate nutrition. Feeding difficulties are not usually related to heart or
  palate problems, but rather to intestinal problems caused by the syndrome. 

• Immunology evaluations should be performed in all children with this deletion. Patients
  with T-cell dysfunction are at risk for recurrent infections. Those with severe T-cell
  disorders should avoid live viral vaccines. All blood products for transfusions (if
  needed) should be irradiated unless cleared by an immunology doctor. 

Other common problems that may require treatment include: 

• Low calcium. This is common in children with the syndrome, especially right after birth. But it
  can also recur during stressful periods, such as during puberty or following surgery.
  A child may need to take calcium supplements as well as vitamin D to help absorb the
  calcium. A referral to an endocrinologist (doctor who specializes in treating conditions
  affecting the endocrine system) may be recommended.

• Developmental difficulties. Young children with 22q11.2 deletion syndrome may be slow to achieve developmental
  milestones, such as sitting, walking, and talking. The International 22q11.2 Deletion
  Syndrome Foundation recommends that parents consider physical therapy (PT), occupational
  therapy (OT), and speech therapy for their affected children. PT strengthens large
  muscles and helps children meet developmental milestones. OT focuses on small muscles
  used for skills, such as tying shoes and buttoning clothes. It can also help with
  feeding problems. Speech therapy can help address language delays that may become
  apparent after a child turns one year old. 

A child’s doctor or parents may request an evaluation to determine what services are
available to assist in the management of a child with 22q11.2 deletion syndrome. 

Long-term outlook for children with 22q11.2 deletion syndrome

A small percentage of children with severe heart defects and immune system problems
caused by 22q11.2 deletion syndrome will not survive the first year of life. However,
with the proper treatment of heart defects, immune system disorders, and other health
problems, the vast majority of children with a 22q11.2 deletion will survive and grow
into adulthood. These children will generally need extra help throughout school and
will need long-term care for their individual health needs. 

Although it is not common, some children with the syndrome may have behavioral conditions,
such as autism, attention deficit disorder (ADD/ADHD), obsessive compulsive disorder
(OCD), or anxiety. According to the Velo-Cardio-Facial Syndrome Educational Foundation,
most individuals with the syndrome have some behavioral problems. The occurrence of
psychiatric disorders is higher for adults with 22q11.2 deletion syndrome, but medical
researchers are still investigating the exact nature and risk of these disorders.