title: Hormonal versus genetic factors in limb and heart anomalies.
abstract: Three men, aged 18, 21 and 27 years, underwent surgery for atrial septal defect of the ostium secundum. All had bilateral absence of the forearm and thumb, with the rest of the hand directly attached to the upper arm. The patients had been exposed to synthetic progestogens during early intrauterine development. The oldest patient is described, together with a 6-year-old boy with limb reduction and Fallot's tetralogy who was exposed to the contraceptive pill during the first 2 months of gestation. During surgery he was found to have atrial septal defect of the ostium secundum. The most plausible diagnosis in such cases is the Holt-Oram syndrome, but the teratogenic effect of the synthetic hormones may be an important aetiological factor. Both hypotheses are discussed.
authors.affiliation: Department of Human Genetics, National Research Center, Cairo, Egypt.
authors.forename: E
authors.initials: E
authors.lastname: el-Gindi
authors.forename: M
authors.initials: M
authors.lastname: Ahmed-Nasr
mesh_terms: D000014:Abnormalities, Drug-Induced / Q000175:diagnosis / Q000209:etiology*; D000026:Abortion, Habitual / Q000517:prevention & control; D000293:Adolescent; D000328:Adult; D002648:Child; D003278:Contraceptives, Oral, Hormonal / Q000008:administration & dosage / Q000009:adverse effects*; D004480:Ectromelia / Q000139:chemically induced* / Q000175:diagnosis / Q000235:genetics*; D005260:Female; D006330:Heart Defects, Congenital / Q000139:chemically induced / Q000175:diagnosis / Q000235:genetics*; D006344:Heart Septal Defects, Atrial / Q000139:chemically induced / Q000175:diagnosis / Q000235:genetics; D006801:Humans; D008297:Male; D011247:Pregnancy; D011261:Pregnancy Trimester, First; D045167:Progesterone Congeners / Q000008:administration & dosage / Q000009:adverse effects*; D011884:Radius / Q000002:abnormalities; D012307:Risk Factors; D013771:Tetralogy of Fallot / Q000139:chemically induced / Q000175:diagnosis / Q000235:genetics; D013933:Thumb / Q000002:abnormalities; D014457:Ulna / Q000002:abnormalities
chemical_list: D003278:Contraceptives, Oral, Hormonal; D045167:Progesterone Congeners