Information on the following diseases can be found in the Related Disorders section of this report:

• Ribbing Disease
• Paget’s Disease
• Van Buchem Disease
• Craniodiaphyseal Dysplasia

The symptoms associated with Camurati-Engelmann disease vary greatly from case to case even among affected family members. Some affected individuals may exhibit few or no symptoms of the disorder (asymptomatic); others may exhibit significant disability.


The age of onset of Camurati-Engelmann disease also varies greatly from case to case. Most cases become apparent during early childhood. However, symptoms may become apparent as early as three months of age or as late as the sixth decade of life.

Camurati-Engelmann disease is characterized by bone pain, especially in the long bones of the upper legs (femurs). In many cases, muscle weakness and pain in the legs may result in an unusual “waddling” walk (gait). In some cases, bone pain is even severe enough to prevent walking. In about half of the affected individuals, hardening (sclerosis) of the bones at the base of the skull occurs, possibly leading to vision and hearing impairment and facial paralysis.

In some cases, fatigue, headaches, poor appetite, exophthalmos (abnormal protrusion of the eyeball), reduced subcutaneous fat, and/or swelling of the lower legs may also be associated with Camurati-Engelmann disease. In rare cases, the liver and spleen may be enlarged (hepatosplenomegaly).
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Camurati-Engelmann disease is inherited as an autosomal dominant trait. Some cases of Camurati-Engelmann disease occur without a previous family history of the disorder, resulting instead from a spontaneous genetic change (i.e., new mutation). The inheritance of this mutation is autosomal dominant.

Human traits, including the classic genetic diseases, are the product of the interaction of two genes, one received from the father and one from the mother. In dominant disorders, a single copy of the disease gene (received from either the mother or father) will be expressed "dominating" the other normal gene and resulting in the appearance of the disease. The risk of transmitting the disorder from affected parent to offspring is 50 percent for each pregnancy regardless of the sex of the resulting child. The risk is the same for each pregnancy.

Investigators have determined that most cases of Camurati-Engelmann disease are caused by disruption or changes (mutations) in the transforming growth factor-beta-1 (TGFB1) gene.

The TGFB1 gene is located on the long arm (q) of chromosome 19 (19q13.1). Chromosomes are found in the nucleus of all body cells. They carry the genetic characteristics of each individual. Pairs of human chromosomes are numbered from 1 through 22, with an unequal 23rd pair of X and Y chromosomes for males and two X chromosomes for females. Each chromosome has a short arm designated as "p" and a long arm identified by the letter "q." Chromosomes are further subdivided into bands that are numbered. For example, "chromosome 19q13.1" refers to band 13.1 on the long arm of chromosome 19.
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Camurati-Engelmann disease is a rare disorder affecting males and females in equal numbers. The disorder usually becomes apparent before 30 years of age; in many cases, onset is before 10 years of age. More than 100 cases have been reported in the medical literature.
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Symptoms of the following disorders can be similar to those of Camurati-Engelmann disease. Comparisons may be useful for a differential diagnosis:

Ribbing disease is an extremely rare genetic disorder characterized by abnormal hardening of the shafts of the long bones (diaphyseal sclerosis). In most cases, onset occurs after puberty. Some affected individuals may not display symptoms of the disorder (asymptomatic); others may experience pain and swelling in affected areas. The relationship between Ribbing disease and Camurati-Engelmann disease is not fully understood. Some researchers believe that they are separate, although similar, disorders. Other researchers believe that they represent different expressions of the same disorder.

Paget's disease is a slowly progressive disease of the skeletal system characterized by abnormally rapid bone breakdown and formation, leading to the development of bones that are dense but fragile. The major symptom is bone pain. It usually affects middle-aged and elderly people and most frequently occurs in the spine, skull, pelvis, thighs and lower legs. Most cases are asymptomatic or mild. Symptoms are often vague and may be hard to distinguish from those of many other bone diseases. Bowed bones and frequent fractures are caused by abnormally soft bones. Enlargement of the head, headaches, sensation of heat, deep dull pain in the bones and hearing loss may also occur. (For more information on this disorder, choose "Paget" as your search term in the Rare Disease Database.)

Van Buchem Disease is an osteoscleorotic disease involving the skull, mandible, clavicles, ribs and diaphyses of long bones that usually presents during adolescence. This disease has an autosomal recessive inheritance pattern.


Craniodiaphyseal Dysplasia , in its severe form, involves massive growth (hyperostosis) of the bones of the head and face, accompanied by intensive hardening (sclerosis) of the connective tissue. Compression of cranial nerves may have severe consequences, and progressive mental retardation is not uncommon. The severe form of the disorder is often present at birth and is most likely transmitted as an autosomal recessive characteristic. There is a less severe form, which is probably transmitted as an autosomal dominant trait.

Treatment of Camurati-Engelmann disease usually involves the use of low-doses of steroid drugs such as cortisone, prednisone or deflazacort to relieve the symptoms. Surgical correction (osteotomy) of lower limb abnormalities has been performed in some cases. Eye surgery to decompress the optic nerves is usually ineffective and is usually not recommended.

Genetic counseling may be of benefit for affected individuals and their families. Other treatment is symptomatic and supportive.
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Information on current clinical trials is posted on the Internet at www.clinicaltrials.gov. All studies receiving U.S. government funding, and some supported by private industry, are posted on this government website.

For information about clinical trials being conducted at the National Institutes of Health (NIH) in Bethesda, MD, contact the NIH Patient Recruitment Office:

Tollfree: (800) 411-1222
TTY: (866) 411-1010
Email: prpl@cc.nih.gov

McKusick VA, ed. Online Mendelian Inheritance in Man (OMIM). Baltimore. MD: The Johns Hopkins University; Entry No:131300; Last Update:10/11/00.

McKusick VA, ed. Online Mendelian Inheritance in Man (OMIM). Baltimore. MD: The Johns Hopkins University; Entry No:601477; Last Update:4/24/00.

TEXTBOOKS
Jones KL, ed. Smith's Recognizable Patterns of Human Malformation. 5th ed. Philadelphia, PA: W. B. Saunders Co: 1997:480.

Gorlin RJ, et al., eds. Syndromes of the Head and Neck, 3rd ed. New York, NY: Oxford University Press; 1990:243.

Buyce ML, ed. Birth Defects Encyclopedia. Dover, MA: Blackwell Scientific Publications; For: The Center for Birth Defects Information Services Inc; 1990:531-32.

JOURNAL ARTICLES
Inaoka T, et al. Scintigraphic evaluation of pamidronate and corticosteroid therapy in a patient with progressive diaphyseal dysplasia (camurati-engelmann disease). Clin Nucl Med. 2001;26:680-82.

Janssens K, et al. Localisation of the gene causing diaphyseal dysplasia Camurati-Engelmann disease to chromosome 19q13. J of Med Genet. 2000;37:245-49.

Janssens K, et al. Mutations in the gene encoding the latency-associated peptide of TGF-beta1 cause camurati-engelmann disease. Nat Genet. 2000;26:273-73.

Saito T, et al. Domain-specific mutations of a transforming growth factor (TGF)-beta 1 latency-associated peptide cause Camurati-Engelmann disease because of the formation of a constitutively active form of TFG-bet 1. J Biol Chem. 2001;276:11469-72.

Vaugh SP, et al. Confirmation of the mapping of the Camurati-Engelmann locus to 19q13.2 and refinement to a 3.2-cM region. Genomics. 2000;66:119-21.

Makita Y, et al. Intrafamilial phenotypic variability in Engelmann disease (ED): are ED and Ribbing disease the same entity? Am J Med Genet. 2000;92:153-56.

Friedland DR, et al. Cochlear implantation for auditory rehabilitation in Camurati-Engelmann disease. Ann Otol Rhinol Laryngol. 2000;109:160-62.

Bas F, et al. Deflazacort treatment in progressive diaphyseal dysplasia (Camurati-Engelmann disease). J Paediatr Child Health. 1999;35:401-05.

Wright M, et al. Papilloedema, a complication of progressive diaphyseal dysplasia: a series of three case reports. Br J Ophthalmol. 1998;82:1042-48.

Heymans O, et al. Camurati-Engelmann disease. Effects of corticosteroids. Acta Clin Belg. 1998;53:189-92.

Kaftori JK, et al. Progressive diaphyseal dysplasia (Camurati-Engelmann): radiographic follow-up and CT findings. Radiology. 1987;164:777-82.

Naveh Y, et al. Progressive diaphyseal dysplasia: evaluation of corticosteroid therapy. Pediatrics. 1985;75:321-23.

Verbruggen LA, et al. Clinical and scintigraphic evaluation of corticosteroid treatment in a case of progressive diaphyseal dysplasia. J Rheumatol. 1985;12:809-13.

Sparkes RS, et al. Cumarati-Engelmann disease. Genetics and clinical manifestations with a review of the literature. J Med Genet. 1972;9:73-85.

Allen DT, et al. Corticosteroids in the treatment of engelmann's disease: progressive diaphyseal dysplasia. Pediatrics. 1970;46:523-31.

INTERNET
Wallace SE, Wilcox WR. Camurati-Engelmann Disease. GENEREVIEWS. Last Update: 16 August 2006. 18pp.
www.genetests.org
Accessed 6/6/2007

Engelmann disease. Encyclopedia of Genetic Disorders. eNotes.com. ©2007. 5pp.
www.eNotes.com
Accessed 6/6/2007

Camurati Engelmann disease. Orphanet. 2/2005.1p.
www.orpha.net
Accessed 6/6/2007