Genotype–phenotype discordance in Noonan syndrome: prenatal diagnosis in an asymptomatic mother
DOI:
https://doi.org/10.18203/2320-1770.ijrcog20262142Keywords:
Noonan syndrome, RASopathy, Prenatal diagnosis, Nuchal fold, MAPK1 mutation, PsoriasisAbstract
Noonan syndrome is a RASopathy with variable clinical expression. Prenatal suspicion is often based on ultrasound findings such as increased nuchal fold. Increased nuchal fold on prenatal ultrasound led to genetic evaluation and identification of a pathogenic MAPK1 variant in the foetus. Segregation analysis revealed the same mutation in the phenotypically normal mother also. The neonate after birth was clinically normal with no structural abnormalities. This case highlights the importance of prenatal markers and demonstrates that Noonan syndrome may be present without classical phenotypic features.
References
Roberts AE, Allanson JE, Tartaglia M, Gelb BD. Noonan syndrome. Lancet. 2013;381(9863):333-42.
Tangshewinsirikul C, Wattanasirichaigoon D, Tim-Aroon T, Promsonthi P, Katanyuwong P, Diawtipsukon S, et al. Prenatal Sonographic Features of Noonan Syndrome: Case Series and Literature Review. J Clin Med. 2024;13(19):5735.
Romano AA, Allanson JE, Dahlgren J, Gelb BD, Hall B, Pierpont ME, et al. Noonan syndrome: clinical features, diagnosis, and management guidelines. Pediatrics. 2010;126(4):746-59.
Tartaglia M, Mehler EL, Goldberg R, Zampino G, Brunner HG, Kremer H, et al. Mutations in PTPN11, encoding the protein tyrosine phosphatase SHP-2, cause Noonan syndrome. Nat Genet. 2001;29(4):465-8.
Malone FD, Ball RH, Nyberg DA, Comstock CH, Saade GR, Berkowitz RL, et al. First-trimester septated cystic hygroma: prevalence, natural history, and pediatric outcome. Obstet Gynecol. 2005;106(2):288-94.
Pierpont ME, Digilio MC. Cardiovascular disease in Noonan syndrome. Curr Opin Pediatr. 2018;30(5):601-8.
Lowes MA, Suárez-Fariñas M, Krueger JG. Immunology of psoriasis. Annu Rev Immunol. 2014;32:227-55.
Hawkes JE, Yan BY, Chan TC, Krueger JG. Discovery of the IL-23/IL-17 signaling pathway and the treatment of psoriasis. J Immunol. 2018;201(6):1605-13.
Murase JE, Chan KK, Garite TJ, Cooper DM, Weinstein GD. Hormonal effect on psoriasis in pregnancy and postpartum. Arch Dermatol. 2005;141(5):601-6.