Growth standards of patients with Noonan and Noonan-like syndromes with mutations in the RAS/MAPK pathway

Authors

  • Alexsandra C. Malaquias,

    Corresponding author
    1. Unidade de Endocrinologia-Genetica, LIM/25, Disciplina de Endocrinologia da Faculdade de Medicina da Universidade de Sao Paulo (FMUSP), Sao Paulo, Brazil
    2. Unidade de Endocrinologia do Desenvolvimento, Laboratorio de Hormonios e Genética Molecular, LIM/42, Disciplina de Endocrinologia da FMUSP, Sao Paulo, Brazil
    • Av. Dr. Arnaldo, 455 5° andar sala 5340, Faculdade de Medicina da USP (LIM-25), CEP 01246-903, Sao Paulo, SP, Brazil.
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  • Amanda S. Brasil,

    1. Unidade de Genetica, Instituto da Crianca, FMUSP, Sao Paulo, Brazil
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  • Alexandre C. Pereira,

    1. Laboratorio de Genetica e Cardiologia Molecular, Instituto do Coraçao (InCor), FMUSP, Sao Paulo, Brazil
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  • Ivo J.P. Arnhold,

    1. Unidade de Endocrinologia do Desenvolvimento, Laboratorio de Hormonios e Genética Molecular, LIM/42, Disciplina de Endocrinologia da FMUSP, Sao Paulo, Brazil
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  • Berenice B. Mendonca,

    1. Unidade de Endocrinologia do Desenvolvimento, Laboratorio de Hormonios e Genética Molecular, LIM/42, Disciplina de Endocrinologia da FMUSP, Sao Paulo, Brazil
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  • Debora R. Bertola,

    1. Unidade de Genetica, Instituto da Crianca, FMUSP, Sao Paulo, Brazil
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  • Alexander A.L. Jorge

    Corresponding author
    1. Unidade de Endocrinologia-Genetica, LIM/25, Disciplina de Endocrinologia da Faculdade de Medicina da Universidade de Sao Paulo (FMUSP), Sao Paulo, Brazil
    2. Unidade de Endocrinologia do Desenvolvimento, Laboratorio de Hormonios e Genética Molecular, LIM/42, Disciplina de Endocrinologia da FMUSP, Sao Paulo, Brazil
    • Av. Dr. Arnaldo, 455 5° andar sala 5340, Faculdade de Medicina da USP (LIM-25), CEP 01246-903, Sao Paulo, SP, Brazil.
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  • How to Cite this Article: Malaquias AC, Brasil AS, Pereira AC, Arnhold IJP, Mendonca BB, Bertola DR, Jorge AAL. 2012. Growth standards of patients with Noonan and Noonan-like syndromes with mutations in the RAS/MAPK pathway. Am J Med Genet Part A 158A: 2700–2706.

Abstract

Noonan syndrome (NS) and Noonan-like syndromes (NLS) are autosomal dominant disorders caused by heterozygous mutations in genes of the RAS/MAPK pathway. The aim of the study was to construct specific growth charts for patients with NS and NLS. Anthropometric measurements (mean of 4.3 measurements per patient) were obtained in a mixed cross-sectional and longitudinal mode from 127 NS and 10 NLS patients with mutations identified in PTPN11 (n = 90), SOS1 (n = 14), RAF1 (n = 10), KRAS (n = 8), BRAF (n = 11), and SHOC2 (n = 4) genes. Height, weight, and body mass index (BMI) references were constructed using the lambda, mu, sigma (LMS) method. Patients had birth weight and length within normal ranges for gestational age although a higher preterm frequency (16%) was observed. Mean final heights were 157.4 cm [−2.4 standard deviation score (SDS)] and 148.4 cm (−2.2 SDS) for adult males and females, respectively. BMI SDS was lower when compared to Brazilian standards (BMI SDS of −0.9 and −0.5 SDS for males and females, respectively). Patients harboring mutations in RAF1 and SHOC2 gene were shorter than other genotypes, whereas patients with SOS1 and BRAF mutations had more preserved postnatal growth. In addition, patients with RAF1 and BRAF had the highest BMI whereas patients with SHOC2 and KRAS mutations had the lowest BMI. The present study established the first height, weight, and BMI reference curves for NS and NLS patients, based only on patients with a proven molecular cause. These charts can be useful for the clinical follow-up of patients with NS and NLS. © 2012 Wiley Periodicals, Inc.

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