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No HPO annotations are available for this condition.
To date, at least 75 individuals have been identified with a pathogenic variant in HNRNPK [, , , , ]. The following description of the phenotypic features associated with this condition is based on these reports. Table 2. Select Features of Au-Kline Syndrome
Clinical diagnostic criteria for Au-Kline syndrome (AKS) have been proposed .
AKS should be suspected in individuals with at least four of the following six characteristic facial features :
Long palpebral fissures
Ptosis
Shallow orbits
No approved treatments are currently available for neurodevelopmental disorder-craniofacial dysmorphism-cardiac defect-hip dysplasia syndrome. The disease remains an area of unmet medical need.
No clinical practice guidelines for Au-Kline syndrome (AKS) have been published.
To establish the extent of disease and needs in an individual diagnosed with AKS, the evaluations summarized (if not performed as part of the evaluation that led to diagnosis) are recommended.
To monitor existing manifestations, the individual's response to supportive care, and the emergence of new manifestations, the evaluations summarized in are recommended. Table 6. Au-Kline Syndrome: Recommended Surveillance
Data assembled from 3 of 12 sources · Last updated Sep 20, 2026, 5:41 PM UTC
European rare disease database
Genetic and Rare Diseases Info Center
Feature |
|---|
% of Persons w/Feature |
|---|
Comment |
|---|
Hypotonia | 32/32 (100%) | — |
Developmental delay/ intellectual disability | 32/32 (100%) | — |
Central nervous system malformations | 15/30 (50%) | Findings are generally nonspecific. |
Hyporeflexia or areflexia | 12/31 (39%) | See . High pain tolerance |
Craniosynostosis | 7/31 (23%) | The most commonly affected sutures are metopic sagittal; other sutures have also been reported. |
Cleft palate | 8/21 (38%) | High-arched palate bifid uvula have also been reported. See . |
Congenital heart defects | 20/32 (63%) | 3 persons have been found to have aortic dilatation. |
Cryptorchidism (in males) | 13/17 (76%) | — |
Hydronephrosis | 16/31 (52%) | — |
Feeding difficulties | ~40% | 2 persons have required longer-term support w/G-tube. |
Muscle weakness | ~40% | — |
Growth deficiency | ~30% | The incidence of short stature in later life is complicated by the presence of scoliosis. |
Scoliosis | 12/31 (39%) | — |
Hearing loss | 5/22 (23%) | Typically due to middle ear effusion, but sensorineural hearing loss is also present in some persons. Developmental delay (DD) and intellectual disability (ID). All affected individuals to date have been found to have developmental delay and/or intellectual disability. |
Source: GeneReviews — "Au-Kline Syndrome"
Deeply grooved tongue
Broad nose with wide nasal bridge and thick alae nasi
Downturned mouth, often described as an M-shaped Cupid's bow
AND
Global developmental delay or intellectual disability (defined as a DQ or IQ score below 70)
Hypotonia
A diagnosis is considered highly likely in an individual with at least five of the six characteristic facial features in addition to global developmental delay/ intellectual disability and hypotonia ; however, molecular genetic testing is still recommended. Further supportive features may include:
Source: GeneReviews — "Au-Kline Syndrome"
Table 3.
Disorders to Consider in the Differential Diagnosis of Au-Kline Syndrome
Gene(s) | Disorder | MOI | Clinical Features of Disorder
Overlapping w/AKS | Distinguishing from AKS
KDM6A
| Kabuki syndrome | ADXL1 | • Postnatal growth deficiency
Congenital heart defects
Genitourinary anomalies
Elongated palpebral fissures, large, prominent ears, cleft palate, dental anomalies
ID (mild to moderate)
Skeletal anomalies
| • Arched broad eyebrows; short columella w/depressed nasal tip2
Cleft lip or lip pits
Immunodeficiency
Craniosynostosis is rare.
BRAF
KRAS
LZTR1
MAP2K1
MRAS
NRAS
PTPN11
RAF1
RASA2
RIT1
RRAS2
SOS1
SOS2 | Noonan syndrome | ADAR3 | • Short stature
Genitourinary anomalies; cryptorchidism in males
Coarse facial features
Ptosis
Prenatal cystic hygroma or nuchal translucency
Source: GeneReviews — "Au-Kline Syndrome"
Table 4.
Au-Kline Syndrome: Recommended Evaluations Following Initial Diagnosis
System/Concern | Evaluation | Comment
| Measure weight, length/height, head circumference. | To assess for growth restriction microcephaly
| Developmental assessment | • To incl motor, adaptive, cognitive, speech-language eval
Eval for early intervention/ special education
Neurobehavioral/
| Neuropsychiatric eval | For persons age 12 mos: screening for concerns incl ADHD, anxiety, /or findings suggestive of ASD
| Neurologic eval to incl assessment for seizures dysautonomia | • Brain MRI could be considered if neurologic symptoms (e.g., seizure) are present.
Consider EEG if seizures are a concern.
Consider referral to neurologist.
| In infants, evaluate for craniosynostosis w/clinical exam imaging as needed. | Referral to neurosurgeon if craniosynostosis is suspected
ENT eval | To identify palate anomalies malocclusion
| Cardiac eval w/echocardiography | To evaluate for structural defects, dilatation of aorta, cardiomyopathy
| Renal ultrasound | To evaluate for hydronephrosis
Source: GeneReviews — "Au-Kline Syndrome"
Search ClinicalTrials.gov in the US and EU Clinical Trials Register in Europe for access to information on clinical studies for a wide range of diseases and conditions. Note: There may not be clinical trials for this disorder.
Source: GeneReviews — "Au-Kline Syndrome"
View trials for neurodevelopmental disorder-craniofacial dysmorphism-cardiac defect-hip dysplasia syndrome
Evaluation |
|---|
Frequency |
|---|
Craniofacial | Screen for craniosynostosis. | In infants, at all health visits during 1st few mos of life |
Cardiovascular | Echocardiography to monitor for aortic dilatation (in all persons, w/ or w/out congenital heart defect) cardiomyopathy | Per cardiologist; Frequency of eval may depend on size of aortic root arch. |
Skeletal | Clinical exam for scoliosis | At all health visits; at least annually until skeletal maturity1 |
Hearing | Audiologic eval | Annually, or as clinically indicated |
Eyes | Ophthalmologic eval | Frequency per ophthalmologist |
Dental | Eval by dentist /or orthodontist | At least every 6 mos |
Endocrine | TSH free T4 | Annually Bone densitometry |
Source: GeneReviews — "Au-Kline Syndrome"
Estimated prevalence: <1 in 1,000,000 (VERY_RARE).