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Jones KL, McNamara EA, Longoni M, Miller DE, Rohanizadegan M, Newman LA, Hayes F, Levitsky LL, Herrington BL, Lin AE. Dual diagnoses in 152 patients with Turner syndrome: Knowledge of the second condition may lead to modification of treatment and/or surveillance. Am J Med Genet A 2018; 176:2435-2445. [PMID: 30079495 DOI: 10.1002/ajmg.a.40470] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2018] [Revised: 05/10/2018] [Accepted: 06/21/2018] [Indexed: 02/06/2023]
Abstract
Turner syndrome is a sex chromosome abnormality in which a female has a single X chromosome or structurally deficient second sex chromosome. The phenotypic spectrum is broad, and atypical features prompt discussion of whether the known features of Turner syndrome should be further expanded. With the advent of clinical whole exome sequencing, there has been increased realization that some patients with genetic disorders carry a second genetic disorder, leading us to hypothesize that a "dual diagnosis" may be more common than suspected for Turner syndrome. We report five new patients with Turner syndrome and a co-occurring genetic disorder including one patient with Li-Fraumeni syndrome, Li-Fraumeni and Noonan syndrome, mosaic trisomy 8, pathogenic variant in RERE, and blepharophimosis-ptosis-epicanthanus inversus syndrome. We also undertook an extensive literature review of 147 reports of patients with Turner syndrome and a second genetic condition. A total of 47 patients (31%) had trisomy 21, followed by 36 patients (24%) had one of 11 X-linked disorders. Notably, 80% of the 147 reported patients with a dual diagnosis had mosaicism for Turner syndrome, approximately twice the frequency in the general Turner syndrome population. This article demonstrates the potential for co-occurring syndromes in patients with Turner syndrome, prompting us to recommend a search for an additional genetic disorder in Turner patients with unusual features. Knowledge of the second condition may lead to modification of treatment and/or surveillance. We anticipate that increased awareness and improved diagnostic technologies will lead to the identification of more cases of Turner syndrome with a co-occurring genetic syndrome.
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Affiliation(s)
- Kelly L Jones
- Division of Medical Genetics and Metabolism, Children's Hospital of The King's Daughters, Norfolk, Virginia.,Department of Pediatrics, Eastern Virginia Medical School, Norfolk, Virginia
| | - Erin A McNamara
- Genetics Unit, MassGeneral Hospital for Children, Boston, Massachusetts
| | - Mauro Longoni
- Pediatric Surgical Research Laboratories, Massachusetts General Hospital, Boston, Massachusetts
| | - Danny E Miller
- Department of Pediatrics, Seattle Children's Hospital, University of Washington, Seattle, Washington
| | - Mersedeh Rohanizadegan
- Division of Genetics and Genomics, Boston Children's Hospital, Harvard Medical School, Boston, Massachusetts
| | - Laura A Newman
- Division of Pediatric Hematology/Oncology, Department of Pediatrics, University of Mississippi, Jackson, Mississippi
| | - Frances Hayes
- Department of Medicine, Reproductive Endocrinology, Massachusetts General Hospital, Boston, Massachusetts
| | - Lynne L Levitsky
- Pediatric Endocrinology, MassGeneral Hospital for Children, Boston, Massachusetts
| | - Betty L Herrington
- Division of Pediatric Hematology/Oncology, Department of Pediatrics, University of Mississippi, Jackson, Mississippi
| | - Angela E Lin
- Genetics Unit, MassGeneral Hospital for Children, Boston, Massachusetts
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Pierpont ME, Richards M, Engel WK, Mendelsohn NJ, Summers CG. Retinal dystrophy in two boys with Costello syndrome due to the HRAS p.Gly13Cys mutation. Am J Med Genet A 2017; 173:1342-1347. [PMID: 28337834 DOI: 10.1002/ajmg.a.38110] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2016] [Revised: 11/17/2016] [Accepted: 12/05/2016] [Indexed: 11/12/2022]
Abstract
Features of Costello Syndrome, a systemic disorder caused by germline mutations in the proto-oncogene HRAS from the RAS/MAPK pathway, include failure-to-thrive, short stature, coarse facial features, cardiac defects including hypertrophic cardiomyopathy, intellectual disability, and predisposition to neoplasia. Two unrelated boys with Costello syndrome and an HRAS mutation (p.Gly13Cys) are presented with their ophthalmologic findings. Both had early symptoms of nystagmus, photophobia, and vision abnormalities. Fundus examination findings of retinal dystrophy were present at age 3 years. Both boys have abnormal electroretinograms with reduced or undetectable rod responses along with reduced cone responses consistent with rod-cone dystrophy. Our observations suggest that early ophthalmic examination and re-evaluations are indicated in children with Costello syndrome.
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Affiliation(s)
- Mary Ella Pierpont
- Department of Pediatrics, University of Minnesota, Minneapolis, Minnesota.,Department of Ophthalmology and Visual Neurosciences, University of Minnesota, Minneapolis, Minnesota.,Children's Hospitals and Clinics of Minnesota, Minneapolis, Minnesota
| | - Mary Richards
- Department of Pediatrics, University of Minnesota, Minneapolis, Minnesota
| | - W Keith Engel
- Department of Ophthalmology and Visual Neurosciences, University of Minnesota, Minneapolis, Minnesota.,Children's Hospitals and Clinics of Minnesota, Minneapolis, Minnesota
| | - Nancy J Mendelsohn
- Department of Pediatrics, University of Minnesota, Minneapolis, Minnesota.,Genomic Medicine, Children's Hospitals and Clinics of Minnesota, Minneapolis, Minnesota
| | - C Gail Summers
- Department of Pediatrics, University of Minnesota, Minneapolis, Minnesota.,Department of Ophthalmology and Visual Neurosciences, University of Minnesota, Minneapolis, Minnesota
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Los E, Baines H, Guttmann-Bauman I. Concurrent Van der Woude syndrome and Turner syndrome: A case report. SAGE Open Med Case Rep 2017; 5:2050313X16687916. [PMID: 28228961 PMCID: PMC5308529 DOI: 10.1177/2050313x16687916] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2016] [Accepted: 12/13/2016] [Indexed: 11/15/2022] Open
Abstract
Most cases of Van der Woude syndrome are caused by a mutation to interferon regulatory factor 6 on chromosome 1. Turner syndrome is caused by complete or partial absence of the second sex chromosome in girls. We describe a unique case of the two syndromes occurring concurrently though apparently independently in a girl with Van der Woude syndrome diagnosed at birth and Turner syndrome at 14 years 9 months. Short stature was initially misattributed to Van der Woude syndrome and pituitary insufficiency associated with clefts before correctly diagnosing Turner syndrome. We discuss the prevalence of delayed diagnosis of Turner syndrome, the rarity of reports of concurrent autosomal chromosome mutation and sex chromosome deletion, as well as the need to consider the diagnosis of Turner syndrome in all girls with short stature regardless of prior medical history.
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Affiliation(s)
- Evan Los
- Pediatric Endocrinology, James H. Quillen College of Medicine, East Tennessee State University, Johnson City, TN, USA
| | - Hayley Baines
- Pediatric Endocrinology, Oregon Health & Science University, Portland, OR, USA
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Novel pathogenic variant in the HRAS gene with lethal outcome and a broad phenotypic spectrum among Polish patients with Costello syndrome. Clin Dysmorphol 2016; 26:83-90. [PMID: 28027064 DOI: 10.1097/mcd.0000000000000165] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
Abstract
Costello syndrome (CS) is a rare congenital disorder from the group of RASopathies, characterized by a distinctive facial appearance, failure to thrive, cardiac and skin anomalies, intellectual disability, and a predisposition to neoplasia. CS is associated with germline mutations in the proto-oncogene HRAS, a small GTPase from the Ras family. In this study, a molecular and clinical analysis was carried out in eight Polish patients with the Costello phenotype. A molecular test showed two known heterozygous mutations in the first coding exon of the gene in seven patients: p.G12S (n=4) and p.G12A (n=3), and a novel pathogenic variant p.G60V in one child with an unusually severe, lethal course of the syndrome. In addition, a fatal course of CS was present in one patient with the p.G12A mutation and in another with p.G12S, there was a co-occurrence of Turner syndrome because of the distal Xp deletion. A severe clinical manifestation with a lethal outcome in an individual with p.G60V in HRAS and contrary observations of an attenuated phenotype in CS patients with other mutations at glycine-60 residue may suggest that the nature of the substituted amino acid plays a significant role in the clinical variability observed in some CS cases.
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