Developmental Disorders of the Lymphatics

An information blog for disorders of the lymphatics. For all articles, please click on "Archives" - Due to spammers, I will no longer allow comments, sorry.

Tuesday, February 14, 2012

Noonan Syndrome.

Noonan Syndrome.

Update of Aug 2011


Allanson JE, Roberts AE.

Judith E Allanson, MD
Department of Genetics
Children's Hospital of Eastern Ontario
Ottawa, Ontario, Canada
Amy E Roberts, MD
Cardiovascular Genetics
Children’s Hospital Boston
Boston, Massachusetts


In: Pagon RA, Bird TD, Dolan CR, Stephens K, editors.


GeneReviews [Internet]. Seattle (WA): University of Washington, Seattle; 1993-.



Noonan syndrome (NS) is characterized by short stature, congenital heart defect, anddevelopmental delay of variable degree. Other findings can include broad or webbed neck, unusual chest shape with superior pectus carinatum and inferior pectus excavatum, cryptorchidism, characteristic facies, varied coagulation defects, lymphaticdysplasias, and ocular abnormalities. Although birth length is usually normal, final adult height approaches the lower limit of normal. Congenital heart disease occurs in 50%-80% of individuals. Pulmonary valve stenosis, often with dysplasia, is the most common heart defect and is found in 20%-50% of individuals. Hypertrophic cardiomyopathy, found in 20%-30% of individuals, may be present at birth or develop in infancy or childhood. Other structural defects include atrial and ventricular septal defects, branch pulmonary artery stenosis, and tetralogy of Fallot. Up to one third of affected individuals have mild intellectual disability.


NS is diagnosed on clinical grounds by observation of key features. Affected individuals have normal chromosome studies. Molecular genetic testing identifies a mutation in PTPN11 in 50% of affected individuals, SOS1 in approximately 13%, RAF1 in 3% to 17%, and KRAS in fewer than 5%. Other genes in which mutations have been reported to cause Noonan syndrome in fewer than 1% of cases include NRAS, BRAF, and MAP2K1.


Treatment of manifestations: Cardiovascular anomalies in NS are usually treated as in the general population. Developmental disabilities are addressed by early intervention programs and individualized education strategies. Treatment for serious bleeding is guided by knowledge of the specific factor deficiency or platelet aggregation anomaly. Growth hormone (GH) treatment increases growth velocity. Surveillance: Monitoring of anomalies found in any system, especially cardiovascular abnormalities.


NS is inherited in an autosomal dominant manner. Although many individuals with NS have a de novo mutation, an affected parent is recognized in 30%-75% of families. The risk to sibs of a proband depends on the genetic status of the parents. If a parent is affected, the risk is 50%. When the parents are clinically unaffected, the risk to the sibs of a proband appears to be low (<1%). Each child of an individual with Noonan syndrome has a 50% chance of inheriting the mutation. Prenatal testing is possible if the disease-causing allele has been identified in an affected family member.


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