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Features include always present findings: Calvarial hyperostosis, Inner ear hearing loss (sensorineural hearing impairment), and Osteosclerosis of the base of the skull; and common findings: Facial palsy, Abnormal vestibular function, Anosmia, and Headache. 18 total HPO annotations.
Organ System | Phenotype Count | Example Features |
|---|---|---|
Ears | 3 | Abnormal vestibular function, Tinnitus, Inner ear hearing loss (sensorineural hearing impairment) |
SLC39A14 function has not been fully characterized.
Hyperostosis cranialis interna is associated with mutations in the SLC39A14 gene on chromosome 8.
SLC39A14 deficiency should be suspected in probands with typical clinical, neuroimaging, and laboratory findings : Clinical findings. Infantile or early-childhood onset of the following:
Delay in acquisition of developmental motor milestones or loss of developmental motor milestones
Progressive pharmaco-resistant dystonia
No approved treatments are currently available for hyperostosis cranialis interna. The disease remains an area of unmet medical need.
Evaluations Following Initial Diagnosis To establish the extent of disease and needs in an individual diagnosed with SLC39A14 deficiency, the evaluations summarized (if not performed as part of the evaluation that led to the diagnosis) are recommended. Table 3. Recommended Evaluations Following Initial Diagnosis in Individuals with SLC39A14 Deficiency
To monitor existing manifestations, the individual's response to supportive care, and the emergence of new manifestations, the following evaluations are recommended.
Table 4.
Recommended Surveillance for Individuals with SLC39A14 Deficiency
System/Concern | Evaluation | Frequency
| • Measurement of growth parameters
No clinical trials have been registered for hyperostosis cranialis interna.
1 publication has been identified in PubMed for hyperostosis cranialis interna. Research spans Case Report / Case Series (100%).
Alsaleh AS (2025). [PMID: 40091967](https://pubmed.ncbi.nlm.nih.gov/40091967/). *Cureus*. [Case Report / Case Series]
Data assembled from 7 of 12 sources · Last updated Sep 19, 2026, 6:42 AM UTC
Online Mendelian Inheritance in Man
European rare disease database
Genetic and Rare Diseases Info Center
Eyes | 3 | Ocular hypertension, Ocular pain, Damage to the optic nerve (optic atrophy) |
Head and neck | 1 | Facial palsy |
Heart and blood vessels | 1 | Ocular hypertension |
Muscles | 1 | Damage to the optic nerve (optic atrophy) |
Brain and nerves | 1 | Headache |
Bones and joints | 1 | Osteosclerosis of the base of the skull |
Age of onset: adulthood.
SLC39A14 deficiency has only recently been identified in 30 individuals from 23 families [, , , , , , , , ]; therefore, information on the phenotypic spectrum and disease progression is limited. Onset occurs typically between ages six months and three years. Affected children present with delay or loss of motor developmental milestones (e.g., delayed walking, gait disturbance) . Early in the disease course, children show axial hypotonia followed by dystonia, spasticity, dysarthria, bulbar dysfunction, and signs of parkinsonism including bradykinesia, hypomimia, and tremor. By the end of the first decade, children develop severe, generalized, pharmaco-resistant dystonia, limb contractures, scoliosis, and loss of independent ambulation.
Source: GeneReviews — "SLC39A14 Deficiency"
Bulbar dysfunction
Dysarthria
Note: One individual with onset of dystonia during the second decade has been reported, suggesting that milder presentations with juvenile or adult onset may also occur . Neuroimaging. Brain MRI findings characteristic of manganese deposition including T1-weighted hyperintensity of the following:
Source: GeneReviews — "SLC39A14 Deficiency"
Table 2. Hereditary Disorders of Interest in the Differential Diagnosis of SLC39A14 Deficiency
Gene | Differential Disorder | MOI | Features of Differential Disorder |
|---|---|---|---|
SLC30A10 | Hypermanganesemia with dystonia 1 (HMNDYT1) | AR | Dystonia-parkinsonism; hypermanganesemia; brain MRI features consistent w/manganese deposition |
ATP13A2 | Kufor-Rakeb syndrome | AR | Parkinsonism-dystonia; T2-weighted hypointensity of the globus pallidus on brain MRI |
Wilson disease | AR | Parkinsonism-dystonia | Liver disease, psychiatric symptoms, low serum ceruloplasmin high non-ceruloplasmin-bound serum copper; no Mn deposition on brain MRI Inherited forms of dystonia (See Dystonia Overview.) KMT2B |
KMT2B-related dystonia | AD | Early-onset generalized dystonia | No features consistent w/Mn deposition on brain MRI; absence of hypermanganesemia MECR |
MECR-related neurologic disorder | AR | Optic atrophy; no features consistent w/Mn deposition on brain MRI TOR1A | — |
DYT1 early-onset isolated dystonia | AD | No features consistent w/Mn deposition on brain MRI; absence of hypermanganesemia GCH1 | — |
GTPCH1-deficient DRD | AD | Parkinsonism-dystonia | No features consistent w/Mn deposition on brain MRI SLC6A3 |
Source: GeneReviews — "SLC39A14 Deficiency"
Genetic testing for SLC39A14 is available. Testing is considered confirmatory for diagnosis.
System/Concern | Evaluation | Comment |
|---|
Development | Developmental assessment | To incl motor, adaptive, cognitive, speech/language eval; Eval for early intervention/ special education |
Musculoskeletal | Orthopedics/ physical medicine rehab/ PT OT eval | To incl assessment of:; Gross motor fine motor skills; Contractures, clubfoot, kyphoscoliosis; Mobility, ADL, need for adaptive devices; Need for PT (to improve gross motor skills) /or OT (to improve fine motor skills) Gastrointestinal/ |
Feeding | Gastroenterology/ nutrition/ feeding team eval | To incl eval of aspiration risk nutritional status; Consider eval for gastric tube placement in those w/dysphagia /or aspiration risk. Genetic |
counseling | By genetics professionals 1 | To inform affected persons their families re nature, MOI, implications of SLC39A14 deficiency to facilitate medical personal decision making Family support resources |
Source: GeneReviews — "SLC39A14 Deficiency"
View trials for hyperostosis cranialis interna
Eval of nutritional status safety of oral intake
| At each visit
| • Monitor development incl ambulation speech.
Neurologic exam (scoring of mvmt disorder severity)
To assess treatment response disease progression:
Whole-blood manganese levels
Brain MRI
| To be considered on an individual basis based on available resources
Source: GeneReviews — "SLC39A14 Deficiency"
Phenotype severity distribution: 3 always present features, 4 common features.
Estimated prevalence: <1 in 1,000,000 (VERY_RARE).