Denouement and Discussion
(Syndrome of Congenital Asymmetry, Short Stature, and Variations in the Pattern of Sexual Development)
The principal features of Silver's syndrome are shortness of stature, significant asymmetry, and variations in the pattern of sexual development. At birth, the children are usually small for gestational age and continue to be short. Growth usually parallels, but is below the third percentile. The face has a triangular shape with a broad forehead and narrow jaw. The lips are thin and the corners of the mouth downturned. Café-au-lait spots (areas of pigmentation) are common. The asymmetry usually involves the entire half of the body but in some cases may be segmental, affecting only the skull, the spine, or an extremity. The fifth fingers are short and in-curved, and syndactyly, particularly of the second and third toes, has been described. Variations in the pattern of sexual development, including precocious development in girls, may occur.