750 research outputs found
Multidisciplinary Treatment of Patients With Noonan Syndrome: A Consensus Statement
No full textImportance: Noonan syndrome (NS) is a rare developmental disorder and the most common condition among the RASopathies. Diagnosis and treatment of NS can be challenging due to the wide phenotypic variability of its manifestations. A multidisciplinary approach is essential, with continuous care required from infancy through adulthood; however, there is a lack of updated and widely shared guidelines for treating this condition. Objective: To develop consensus statements on the diagnosis of NS, patient transition from pediatric to adult care, follow-up, and treatment of short stature with recombinant human growth hormone (rhGH). Evidence review: Consensus was achieved through a modified Delphi process involving a multidisciplinary steering committee comprising 3 pediatric endocrinologists, 1 pediatric cardiologist, 1 molecular geneticist, along with a 25-member expert panel who had expertise in treating NS at clinical reference centers in Italy. In December 2023, the steering committee drafted 47 statements based on published evidence and clinical experience. These statements were then submitted to the expert panel, which provided anonymous feedback on their level of agreement or disagreement between January and March 2024. Findings: All 25 members of the expert panel completed the Delphi survey and consensus was achieved on all statements after the first round of voting. Full agreement (100%) was reached on several key points: importance of molecular characterization for diagnosis, prognosis, and treatment decisions; necessity of a multidisciplinary approach to NS treatment; need for improved transition from pediatric to adult care; increased risk in patients with hypertrophic cardiomyopathy (HCM); importance of monitoring adherence to rhGH therapy; acknowledgment that partial GH insensitivity should not exclude rhGH therapy; and safety concerns regarding rhGH therapy, particularly related to HCM and the risk of malignant neoplasms. Conclusions and relevance: Effective treatment of NS requires a multidisciplinary and personalized approach from infancy through adulthood. This comprehensive set of consensus statements is intended for clinicians to implement more effective care of patients with NS
Clinical manifestations of Noonan syndrome
No full textNoonan syndrome is a common genetic disorder characterized by facial anomalies,
congenital heart defect, short stature, webbed neck, chest deformities and
undescended testes. The phenotypic expression of Noonan syndrome is extremely
variable, with some affected subjects showing only minor features of the syndrome.
Cardiac malformations are also heterogeneous. Pulmonary stenosis, with or without
dysplastic pulmonary valve and hypertrophic cardiomyopathy, are the “classic”
cardiac defects reported in Noonan syndrome. However, atrial septal defect,
atrioventricular septal defect, left-sided obstructive lesions, tetralogy of Fallot and
patent ductus arteriosus have also been described. Autosomal dominant inheritance
has been documented in some families, although many cases appear to be sporadic.
The diagnosis of Noonan syndrome is at present purely clinical, because a
“diagnostic” test is not available. Indeed, although a gene for Noonan syndrome has
been recently mapped by linkage analysis to chromosome 12q, the gene or genes of
the syndrome have not been yet cloned.peer-reviewe
Study of PTPN11 and KRAS genes in patients with Noonan and Noonan-like syndromes
No full textINTRODUÇÃO: a síndrome de Noonan apresenta herança autossômica dominante e é considerada uma doença relativamente frequente na população, com uma incidência estimada entre 1/1000 e 1/2500 nascidos vivos. Dentre os seus acometimentos destacam-se: dismorfismos faciais, baixa estatura, alterações cardíacas e criptorquia. A síndrome de Noonan é muito confundida com as síndromes Noonan-like devido à sobreposição dos achados clínicos. Estas, mais raras que a síndrome de Noonan, incluem as síndromes de LEOPARD, neurofibromatose-Noonan, cardiofaciocutânea e Costello. Atualmente sabe-se que tanto a síndrome de Noonan como as síndromes Noonan-like envolvem mutações em genes pertencentes à via de sinalização RAS-MAPK. Na síndrome de Noonan, pelo menos quatro genes desta via são responsáveis pelo fenótipo: PTPN11, SOS1, RAF1 e KRAS. Mutações no gene PTPN11, o primeiro gene descrito em associação com a síndrome, são encontradas em aproximadamente 40% dos casos. O segundo gene descrito, o gene KRAS, é responsável por cerca de 2% dos casos que não apresentam mutações no gene PTPN11. Mutações no gene KRAS estão presentes em pacientes com síndrome de Noonan com retardo mental e/ou atraso no desenvolvimento mais acentuados e em pacientes com a síndrome cardiofaciocutânea cujo envolvimento ectodérmico é mais sutil. OBJETIVO: devido à recente associação do gene KRAS com a síndrome de Noonan e outras síndromes Noonan-like é importante: (1) testar a frequência de mutação neste gene em pacientes que apresentam ou não mutações no gene PTPN11 e (2) tentar estabelecer uma correlação genótipo-fenótipo mais precisa, o que permitirá a realização de um aconselhamento genético mais adequado. MÉTODOS: foram avaliados 95 probandos com síndrome de Noonan e 30 com síndromes Noonan-like. O estudo molecular foi realizado através da reação em cadeia de polimerase, seguida das reações de purificação e sequenciamento bidirecional. RESULTADOS: foram encontradas mutações no gene PTPN11 em 20/46 (43%) pacientes com síndrome de Noonan, duas delas não descritas anteriormente. Relacionando o quadro clínico dos pacientes com síndrome de Noonan deste estudo, com e sem mutação no gene PTPN11, nota-se que os pacientes com mutação apresentam incidência significativamente maior de baixa estatura, de estenose pulmonar valvar e menor frequência de miocardiopatia hipertrófica. Uma mutação no gene KRAS foi encontrada em um paciente com síndrome de Costello, mutação esta ainda não relatada. Alterações gênicas em mais de um gene da via RAS-MAPK foram observadas em dois pacientes, sendo que uma delas em cada paciente não predizia um efeito fenotípico importante. Foram também encontrados três polimorfismos no gene KRAS, porém com mesma frequência no grupo controle. A fim de verificar a influência destes polimorfismos, as principais características da síndrome de Noonan foram relacionadas entre os pacientes com esta síndrome que apresentavam mutação no gene PTPN11 e comparadas quanto à presença ou ausência desses polimorfismos. Nenhuma diferença estatisticamente significante foi encontrada. CONCLUSÃO: Pacientes com síndrome de Noonan e mutações no gene PTPN11 apresentaram uma maior incidência de baixa estatura e de estenose pulmonar valvar e uma menor incidência de miocardiopatia hipertrófica. O gene KRAS, até então relacionado às síndromes de Noonan e cardiofaciocutânea, mostrou-se também responsável pela síndrome de Costello. Tanto as alterações gênicas consideradas não patogênicas como os polimorfismos encontrados no gene KRAS parecem não ter uma grande influência sobre a variabilidade fenotípica na síndrome de Noonan. Contudo, não é possível afastar totalmente que estas alterações apresentem um efeito sutil e que, em conjunto com outras variações genéticas e/ou ambientais, tenham um efeito moduladorINTRODUCTION: Noonan syndrome shows autosomal dominant inheritance, and is a relatively frequent disease in the population, with an estimated incidence between 1/1000 and 1/2500 live births. The main clinical features are: facial dysmorphisms, short stature, cryptorchidism and cardiac abnormalities. The differential diagnosis between Noonan syndrome and Noonan-like syndromes is not always easy, due to the overlap of the their clinicla findings. The Noonan-like syndromes, more rare that the Noonan syndrome, include the LEOPARD syndrome, neurofibromatosis-Noonan, cardiofaciocutaneous and Costello. Currently it is known that Noonan syndrome and Noonan-like syndromes involve mutations in genes belonging to the RAS-MAPK signaling pathway. In Noonan syndrome, at least four genes of this pathway are responsible for the phenotype: PTPN11, SOS1, RAF1 and KRAS. Mutations in PTPN11, the first gene described in association with this syndrome, are found in approximately 40% of cases. The second gene described, the KRAS gene, is responsible for about 2% of the cases that dont have mutations in the PTPN11 gene. Mutations in the KRAS gene are present in patients with Noonan syndrome with mental retardation and/or developmental delay more pronounced and in patients with cardiofaciocutaneous syndrome whose ectodermal involvement is more subtle. OBJECTIVE: Due to the recent association of the KRAS gene with Noonan and Noonan-like syndromes is important: (1) to test the frequency of mutation in this gene in patients with or without mutations in PTPN11 and (2) to estabilish a more precise genotype-phenotype correlation, allowing the realization of a more appropriate genetic counseling. METHODS: 95 probands with Noonan syndrome and 30 with Noonan-like syndromes were evaluated. The molecular analysis was performed by the polymerase chain reaction, followed by purification and bidirectional sequencing. RESULTS: PTPN11 gene mutation was found in 20/46 (43%) patients with Noonan syndrome, two of them not previously described. By correlating the clinical features of patients with Noonan syndrome in this study, with or without mutations in the PTPN11 gene, it was noted that patients with mutations have significantly higher incidence of short stature, pulmonary stenosis and lower incidence of hypertrophic cardiomyopathy. Mutations in KRAS gene were found in two patients a patient with Noonan syndrome ant the other with Costello syndrome. Gene alterations in more than one gene at the RASMAPK patway were observed in two patients, but one of the mutations in each patient didnt predict a significant phenotypic effect. Were also foud three polymorphisms in the KRAS gene, but with the same frequency in the control group. To check the influence of these polymorphisms, the main features of Noonan syndrome were related among patients with this syndrome who had mutations in the PTPN11 gene and compared of the presence or absence of these polymorphisms. No statistically significant difference was found. CONCLUSION: Patients with Noonan syndrome and PTPN11 gene mutation had a higher incidence of short stature and pulmonary valve stenosis and a lower incidence of hypertrophic cardiomyopathy. The KRAS gene, previously related to Noonan and cardiofaciocutaneous syndrome, was also responsible for Costello syndrome. Gene alterations considered as nonpathogenic and polymorphisms found in the KRAS gene seem to have a not great influence on the phenotypic variability in Noonan syndrome. However, it is not possible to completely rule out that these changes have a subtle effect and that, together with other genetic variations and/or environmental factors, may have a modulating effec
Grammar writing for a grammar-reading audience
No full textThis paper will be concerned primarily with the problem of establishment of higher standards for grammar writing. The text includes a list of 28 points for grammar writers suggested by the Michael Noonan. About another issue, the evaluation of grammar writing within the profession and the professional support provided to grammar writers, the author makes some few comments at the end of this essay
A Novel Homozygous Loss-of-Function Variant in SPRED2 Causes Autosomal Recessive Noonan-like Syndrome
No full text: Noonan syndrome is an autosomal dominant developmental disorder characterized by peculiar facial dysmorphisms, short stature, congenital heart defects, and hypertrophic cardiomyopathy. In 2001, PTPN11 was identified as the first Noonan syndrome gene and is responsible for the majority of Noonan syndrome cases. Over the years, several other genes involved in Noonan syndrome (KRAS, SOS1, RAF1, MAP2K1, BRAF, NRAS, RIT1, and LZTR1) have been identified, acting at different levels of the RAS-mitogen-activated protein kinase pathway. Recently, SPRED2 was recognized as a novel Noonan syndrome gene with autosomal recessive inheritance, and only four families have been described to date. Here, we report the first Italian case, a one-year-old child with left ventricular hypertrophy, moderate pulmonary valve stenosis, and atrial septal defect, with a clinical suspicion of RASopathy supported by the presence of typical Noonan-like facial features and short stature. Exome sequencing identified a novel homozygous loss-of-function variant in the exon 3 of SPRED2 (NM_181784.3:c.325del; p.Arg109Glufs*7), likely causing nonsense-mediated decay. Our results and the presented clinical data may help us to further understand and dissect the genetic heterogeneity of Noonan syndrome.Noonan syndrome is an autosomal dominant developmental disorder characterized by peculiar facial dysmorphisms, short stature, congenital heart defects, and hypertrophic cardiomyopathy. In 2001, PTPN11 was identified as the first Noonan syndrome gene and is responsible for the majority of Noonan syndrome cases. Over the years, several other genes involved in Noonan syndrome (KRAS, SOS1, RAF1, MAP2K1, BRAF, NRAS, RIT1, and LZTR1) have been identified, acting at different levels of the RAS-mitogen-activated protein kinase pathway. Recently, SPRED2 was recognized as a novel Noonan syndrome gene with autosomal recessive inheritance, and only four families have been described to date. Here, we report the first Italian case, a one-year-old child with left ventricular hypertrophy, moderate pulmonary valve stenosis, and atrial septal defect, with a clinical suspicion of RASopathy supported by the presence of typical Noonan-like facial features and short stature. Exome sequencing identified a novel homozygous loss-of-function variant in the exon 3 of SPRED2 (NM_181784.3:c.325del; p.Arg109Glufs*7), likely causing nonsense-mediated decay. Our results and the presented clinical data may help us to further understand and dissect the genetic heterogeneity of Noonan syndrome
Thomas Noonan, (1839-1912), purchased by Mrs. A. A. Snyder on August 15, 1950.
No full textDocuments regarding the double headstone for Thomas Noonan, (1839-1912), buried with Maria Noonan, (1850-1906), purchased by Mrs. A. A. Snyder. The marker was placed at Calvary Cemetery, Lot 215, Section 8 in Toledo, Ohio. The stone is made of Barre with Sandblast letters
The PTPN11 gene analysis in Noonan syndrome patients
No full textINTRODUÇÃO: A síndrome de Noonan é uma doença autossômica dominante caracterizada por baixa estatura, dismorfismos faciais (hipertelorismo ocular, inclinação para baixo das fendas palpebrais, ptose palpebral, palato alto e má-oclusão dentária), pescoço curto e/ou alado, defeitos cardíacos, principalmente a estenose pulmonar valvar, deformidade esternal e criptorquia nos pacientes do sexo masculino. O gene PTPN11, localizado no braço longo do cromossomo 12 (12q24.1), é responsável por aproximadamente 50% dos casos de síndrome de Noonan. OBJETIVO: Detectar a freqüência de mutações no gene PTPN11 em uma amostra de pacientes os quais preenchiam os critérios clínicos para a síndrome de Noonan e síndromes Noonan-like e estabelecer uma correlação genótipo-fenótipo. MÉTODOS: Cinqüenta probandos com síndrome de Noonan, 3 com síndrome de LEOPARD, 3 com síndrome de Noonan-like/lesões múltiplas de células gigantes e 2 com neurofibromatose-Noonan foram incluídos nesse estudo. O estudo molecular foi realizado através da técnica da cromatografia líquida de alta precisão desnaturante e, naqueles com um perfil anormal, a técnica do seqüenciamento do éxon em questão foi concretizada. RESULTADOS: Mutações missense no gene PTPN11 foram identificadas em 21 probandos com síndrome de Noonan (42%), em todos os três pacientes com a síndrome de LEOPARD, em um caso com síndrome de Noonan-like/lesões múltiplas de células gigantes e em um paciente com síndrome da neurofibromatose-Noonan. Este último probando também apresentava uma mutação no gene NF1. A única anomalia que atingiu uma diferença estatisticamente significante quando comparados os grupos de pacientes com e sem mutação foi o grupo de distúrbios hematológicos. Um paciente com síndrome de Noonan que apresentou uma doença mieloproliferativa possuía a mutação T73I. CONCLUSÃO: A síndrome de Noonan é uma doença heterogênea, uma vez que mutações no gene PTPN11 são responsáveis por 42% dos casos. Uma correlação genótipo-fenótipo definitiva não foi estabelecida, mas a mutação T73I parece predispor a distúrbios mieloproliferativos. Com relação às síndromes Noonan-like, o gene PTPN11 é o principal responsável pela síndrome de LEOPARD e também desempenha um papel na síndrome da neurofibromatose-Noonan. A síndrome de Noonan-like/lesões múltiplas de células gigantes, a qual faz parte do espectro da síndrome de Noonan, é também uma doença heterogênea.INTRODUCTION: Noonan syndrome is an autosomal dominant disorder comprising short stature, facial dysmorphisms (ocular hypertelorism, downslanting palpebral fissures, palpebral ptosis, high arched palate and dental malocclusion), short and/or webbed neck, heart defects, mainly valvar pulmonary stenosis, sternal deformity and cryptorchidism in males. The PTPN11 gene, localized in the long arm of chromosome 12 (12q24.1), is responsible for approximately 50% of the cases. OBJECTIVE: To detect the PTPN11 gene mutation rate in a cohort of clinically well-characterized patients with Noonan and Noonan-like syndromes and to study the genotype-phenotype correlation. METHODS: Fifty probands with Noonan syndrome ascertained according to well-established diagnostic criteria, 3 with LEOPARD syndrome, 3 with Noonan-like/multiple giant cell lesion syndrome and 2 with neurofibromatosis/Noonan were enrolled in this study. Mutational analysis was performed using denaturing high-performance liquid chromatography followed by sequencing of amplicons with an aberrant elution profile. RESULTS: Missense mutations in the PTPN11 gene were identified in 21 probands with Noonan syndrome (42%), in all three patients with LEOPARD syndrome, in one case with Noonan-like/multiple giant cell lesion syndrome and in one with neurofibromatosis-Noonan syndrome. This last patient also showed a NF1 gene mutation. The only anomaly that reached statistical significance when comparing probands with and without mutations was the hematological abnormalities. A Noonan syndrome patient presenting a myeloproliferative disorder showed a T73I mutation. CONCLUSION: Noonan syndrome is a heterogeneous disorder, once PTPN11 gene mutations is responsible for 42% of the cases. A definitive genotype-phenotype correlation is not established, but the T73I mutation seems to predispose to a myeloproliferative disorder. Regarding Noonan-like syndromes, the PTPN11 gene is the main one in LEOPARD syndrome and also plays a role in neurofibromatosis-Noonan syndrome. Noonan-like/multiple giant cell lesion syndrome, part of the spectrum of Noonan syndrome, is also heterogeneous
Zespół Noonan u 8-letniej pacjentki – opis przypadku = 8 - year - old patient with Noonan syndrome - case report
No full textGrabiec Aleksandra, Szczepkowska Aleksandra, Osica Piotr, Janas‑Naze Anna. Zespół Noonan u 8-letniej pacjentki – opis przypadku = 8 - year - old patient with Noonan syndrome - case report. Journal of Education, Health and Sport. 2016;6(12):575-581. eISSN 2391-8306. DOI http://dx.doi.org/10.5281/zenodo.216473
http://ojs.ukw.edu.pl/index.php/johs/article/view/4101
The journal has had 7 points in Ministry of Science and Higher Education parametric evaluation. Part B item 754 (09.12.2016).
754 Journal of Education, Health and Sport eISSN 2391-8306 7
© The Author (s) 2016;
This article is published with open access at Licensee Open Journal Systems of Kazimierz Wielki University in Bydgoszcz, Poland
Open Access. This article is distributed under the terms of the Creative Commons Attribution Noncommercial License which permits any noncommercial use, distribution, and reproduction in any medium,
provided the original author(s) and source are credited. This is an open access article licensed under the terms of the Creative Commons Attribution Non Commercial License
(http://creativecommons.org/licenses/by-nc/4.0/) which permits unrestricted, non commercial use, distribution and reproduction in any medium, provided the work is properly cited.
This is an open access article licensed under the terms of the Creative Commons Attribution Non Commercial License (http://creativecommons.org/licenses/by-nc/4.0/) which permits unrestricted, non commercial
use, distribution and reproduction in any medium, provided the work is properly cited.
The authors declare that there is no conflict of interests regarding the publication of this paper.
Received: 01.12.2016. Revised 12.12.2016. Accepted: 20.12.2016.
Zespół Noonan u 8-letniej pacjentki – opis przypadku
8 - year - old patient with Noonan syndrome - case report
Aleksandra Grabiec1, Aleksandra Szczepkowska2, Piotr Osica2, Anna Janas‑Naze2
1 Studenckie Koło Naukowe przy Zakładzie Chirurgii Stomatologicznej Uniwersytetu Medycznego w Łodzi
2 Zakład Chirurgii Stomatologicznej UM w Łodzi
Kierownik: dr hab. n. med. prof. nadzw. Anna Janas-Naze
Adres do korespondencji:
Aleksandra Szczepkowska
Zakład Chirurgii Stomatologicznej UM w Łodzi
92-213 Łódź, ul. Pomorska 251
e-mail: [email protected]
tel. 42 675 75 71
Praca finansowana przez Uniwersytet Medyczny w Łodzi w ramach działalności statutowej nr 503/2-163-01/503-21-001
Streszczenie: W poniższej pracy opisano przypadek zespołu Noonan u 8- letniej dziewczynki.
Słowa kluczowe: zespół Noonan, rzadkie choroby genetyczne, znieczulenia ogólne
Abstract: The article presents the case of 7 year old girl with Noonan syndrome.
Key words: Noonan syndrome, rare genetic diseases, general anesthesi
Incongruity and Nostalgia in Sarah Binks
No full textIn Paul Hiebert's Sarah Binks, incongruity between what is real and what is perceived or fancied is sustained at all levels, thus maintaining throughout the contrast necessary for humour. Noonan extends the concept of incongruity to apply to the general states of mind of Sarah, the fictional "Author," Hiebert, and the reader
Achados hematológicos na síndrome de Noonan
No full textOBJECTIVE: Noonan syndrome is a multiple congenital anomaly syndrome, and bleeding diathesis is considered part of the clinical findings. The purpose of this study was to determine the frequency of hemostatic abnormalities in a group of Noonan syndrome patients. METHOD: We studied 30 patients with clinical diagnosis of Noonan syndrome regarding their hemostatic status consisting of bleeding time, prothrombin time, activated partial thromboplastin time and thrombin time tests, a platelet count, and a quantitative determination of factor XI. RESULTS: An abnormal laboratory result was observed in 9 patients (30%). Although coagulation-factor deficiencies, especially factor XI deficiency, were the most common hematological findings, we also observed abnormalities of platelet count and function in our screening. CONCLUSIONS: Hemostatic abnormalities are found with some frequency in Noonan syndrome patients (30% in our sample). Therefore, we emphasize the importance of a more extensive hematological investigation in these patients, especially prior to an invasive procedure, which is required with some frequency in this disorder.OBJETIVO: A síndrome de Noonan é uma patologia de múltiplas anomalias congênitas e, dentre os achados clínicos, a diátese hemorrágica está incluída. O propósito deste estudo é determinar a freqüência de anormalidades hemostáticas nos pacientes afetados. MÉTODO: Nós estudamos 30 pacientes afetados pela síndrome quanto aos aspectos hematológicos que consistiu de tempo de sangramento, tempo de protrombina, tempo de tromboplastina parcial ativada, tempo de trombina, contagem de plaquetas e dosagem do fator de coagulação XI. RESULTADOS: Um resultado laboratorial anormal foi observado em 9 desses pacientes (30%). Apesar dos achados mais comuns terem sido as deficiências dos fatores de coagulação, especialmente do fator XI, também observamos anormalidades no número e na função plaquetária. CONCLUSÕES: Anormalidades hemostáticas são observadas com certa freqüência em pacientes com síndrome de Noonan (30% em nossa amostra). Enfatizamos, portanto, a importância de uma investigação hematológica mais detalhada nesses pacientes, especialmente antes da realização de um procedimento invasivo, o qual é requerido com certa freqüência na síndrome
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