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Abstract
A case of Ullrich-Noonan syndrome with pulmonary stenosis, epicanthus, ptosis, small stature, curved tibia, positive sex chromatin, and a diploid chromosome number is presented. A detailed chromosomal banding analysis with the G-staining, C-staining and Ag-I-staining techniques revealed no significant anomalies. The literature is reviewed and the criteria for diagnosing Ullrich-Noonan syndrome are presented.
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Nielsen J, Friedrich U, Holm V, Petersen GB, Stabell I, Simonsen H, Johansen K. Turner-phenotype in males. Clin Genet 2008; 4:58-63. [PMID: 4144179 DOI: 10.1111/j.1399-0004.1973.tb01123.x] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
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Au YK, Collins WP, Patel JS, Asamoah A. Spontaneous corneal rupture in Noonan syndrome. A case report. Ophthalmic Genet 1997; 18:39-41. [PMID: 9134549 DOI: 10.3109/13816819709057882] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
PURPOSE/METHODS A variety of ocular and periocular manifestations have been described in Noonan syndrome. Collagen abnormalities have been described; however, to our knowledge spontaneous corneal rupture has not been reported. A forty-three-year-old female who presented with spontaneous corneal rupture was later diagnosed as having Noonan syndrome. RESULTS/CONCLUSIONS Collagen abnormalities have been described with Noonan syndrome and this is likely the cause of corneal rupture in this patient.
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Affiliation(s)
- Y K Au
- Department of Ophthalmology, Louisiana State University Medical School- Shreveport 71130-3932, USA
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Abstract
The Noonan syndrome is a rare disease characterized by dysmorphic facies, short stature, ear abnormalities, cryptorchidism, ocular abnormalities, cardiovascular anomalies, cubitus valgus, webbed neck, and cutaneous and hair abnormalities. Some 25% to 40% of patients have dermatologic abnormalities. Diagnosis is purely clinical, and intrauterine diagnosis is very important based on the presence of cystic hygroma and evidence of myocardial abnormalities. Treatment is symptomatic. Genetic counseling is necessary.
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Affiliation(s)
- M S Daoud
- Department of Dermatology, Mayo Clinic, Rochester, MN 55905, USA
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Hara T, Sasaki T, Miyauchi H, Takakura K. Noonan phenotype associated with intracerebral hemorrhage and cerebral vascular anomalies: case report. SURGICAL NEUROLOGY 1993; 39:31-6. [PMID: 8451716 DOI: 10.1016/0090-3019(93)90106-b] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/30/2023]
Abstract
A case of a 19-year-old man with multiple characteristics of the Noonan phenotype and a massive intracerebral hemorrhage in the left putaminal region is presented. The hemorrhage was removed surgically, and the patient made a good recovery and was finally able to walk unassisted. Postoperative cerebral angiograms revealed various vascular anomalies, including a small aneurysm. To the best of our knowledge, this is the second detailed case report of an association of the Noonan phenotype with cerebral vascular anomalies presenting intracerebral hemorrhage. The etiology of this syndrome remains unknown but the possible causes of this rare association are discussed.
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Affiliation(s)
- T Hara
- Department of Neurosurgery, Faculty of Medicine, University of Tokyo, Japan
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Abstract
A report is presented on a man of Turkish origin, with Noonan Syndrome and unilateral conductive hearing loss since early childhood. There was no history of otitis media. At the age of 23, exploratory tympanotomy revealed a total absence of the long process of the incus and a normal-looking tympanic membrane. The position of the normal-shaped mobile stapes was just medial, and not posteromedial, to the malleus. A congenital ossicular chain anomaly was diagnosed. An allograft malleus head was interposed between the stapes and the malleus. The resulting air-bone gap was less than 10 dB. A review of the literature is given on hearing loss in Noonan Syndrome.
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Affiliation(s)
- C W Cremers
- Institute of Otorhinolaryngology, University Hospital of Nijmegen, The Netherlands
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Witt DR, Hoyme HE, Zonana J, Manchester DK, Fryns JP, Stevenson JG, Curry CJ, Hall JG. Lymphedema in Noonan syndrome: clues to pathogenesis and prenatal diagnosis and review of the literature. AMERICAN JOURNAL OF MEDICAL GENETICS 1987; 27:841-56. [PMID: 3321992 DOI: 10.1002/ajmg.1320270412] [Citation(s) in RCA: 115] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Abstract
The Noonan syndrome (NS) is a true multiple congenital anomalies (MCA) syndrome with numerous manifestations. An association with lymphedema has been noted, but its pathogenesis is not fully understood. Nine new cases and a review of the literature explore the role of lymphedema in NS, including its pathogenesis, presentations, and phenotypic effects. Consideration is given to developmental stage at time of onset, chronicity, resolution, and anatomic site. It appears likely that lymphedema is a much more frequent concomitant in NS than previously realized. The major source of lymphedema in NS appears to be a presently undefined dysplasia of lymphatic vessels of unknown cause. Further study of lymphedema may provide an understanding of its role in shaping the NS phenotype. Comparison with other MCA syndromes and animal models is made in this regard. Relevance to prenatal diagnosis and treatment is discussed.
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Affiliation(s)
- D R Witt
- Genetics Department, Kaiser Permanente, San Jose, California
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Abstract
Noonan's syndrome is a clinically recognisable short stature syndrome with autosomal dominant inheritance. The diagnosis can be difficult as the phenotypic expression is very variable. There has been an attempt to divide this syndrome into type I (in which the facial features, especially ptosis, antimongoloid eye slant, and hypertelorism are prominent) and type II (where cardiological abnormalities are more to the fore), but this has not yet been confirmed by other studies.
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Abstract
After an introduction dealing with the "historical evolution" of the Noonan syndrome (NS), we try to define the NS phenotype based on clinical descriptions published since 1883. The theories concerning the cause of the NS are discussed fully. The peculiar cardiac involvement deserves special attention and raises the question of whether the Watson and LEOPARD syndromes are indistinguishable from NS. Finally, the recent contributions to the variability of the NS phenotype (reports on lymphatic dysplasia, partial deficiency of factor XI, malignant hyperthermia, perceptual-motor disabilities, and endocrine evaluation) are also described.
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Opitz JM, Pallister PD. Brief historical note: the concept of "gonadal dysgenesis". AMERICAN JOURNAL OF MEDICAL GENETICS 1979; 4:333-43. [PMID: 395846 DOI: 10.1002/ajmg.1320040404] [Citation(s) in RCA: 26] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
The history of gonadal by dysgenesis cautions against overinterpretation of data: The streak gonads are neither the result of dysgenesis nor of embryonic origin but represent late fetal/neonatal degeneration; the X-chromatin-negative character of the buccal smear and the frequency of color vision defects did not indicate male sex in the Ullrich-Turner syndrome but rather an XO constitution; severity of dysgenesis did not correlate with risk of gonadal neoplasia but with genotype; the gonadal lesion in the Ullrich-Turner syndrome was not due to a pituitary defect but a primary ovarian lesion; patients with the Noonan syndrome do not have the Turner phenotype. The concept of gonadal dysgenesis, introduced to Kermauner in 1912, has outlived its usefulness. Improved methods of phenotype analysis, family studies, and endocrine and cytogenetic methods have showen it to be causally and pathogenetically heterogeneous and have contributed to a better identification and delineation of the several different genetic entities which it formerly comprised.
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Tejani A, Del Rosario C, Arulanantham K, Alpert LI. Noonan's syndrome associated with polycistic renal disease. J Urol 1976; 115:209-11. [PMID: 765504 DOI: 10.1016/s0022-5347(17)59134-x] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
Noonan's syndrome is an eponymic designation that has been used during the last 8 years to describe a variable constellation of somatic and visceral congenital anomalies, which includes groups of patients previously referred to as male Turner's, female pseudo-Turner's and Bonnevie-Ullrich syndromes. It is now recognized that both sexes may show the stigmas of this condition and, unlike Turner's syndrome, there is no karyotype abnormality although there is often a familial pattern. The most commonly observed anomalies include webbing of the neck, hypertelorism, a shield-shaped chest and short stature. Congenital heart disease, principally pulmonary stenosis, and sexual infantilism often with cryptorchidism in the male subject are additional associated anomalies in this syndrome. Renal anomalies have been described rarely and usually consist of rotational errors, duplications and hydronephrosis. We report the first case of an infant who displayed many of the stigmas of Noonan's syndrome and also showed early evidence of frank renal failure secondary to renal dysplasia with cystic disease.
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Ehlers KH, Engle MA, Levin AR, Deely WJ. Eccentric ventricular hypertrophy in familial and sporadic instances of 46 XX, XY Turner phenotype. Circulation 1972; 45:639-52. [PMID: 5012250 DOI: 10.1161/01.cir.45.3.639] [Citation(s) in RCA: 51] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
Abstract
This study of individuals with familial and sporadically occurring 46 XX or XY Turner phenotype documented a wide range of right- and left-sided cardiovascular abnormalities and a previously unreported eccentric hypertrophy of the left ventricle.
A mother and five of her seven children had abnormal cardiovascular findings. Five had an abnormal electrocardiogram with frontal ÂQRS of -60° to ±180° and rS or rsr' in V
1
and rS, qrS, or qRS in V
5
. Catheterization demonstrated the following anomalies: coarctation of the aorta in three, valvular aortic stenosis in one, pulmonary valvular insufficiency with atrial septal defect in one, and pulmonary arterial branch stenosis in one child. All six had a similar abnormality of the left ventricle on angiocardiography. During systole and also in diastole the cavity was encroached on in its superolateral and posteroinferior aspects. Septal hypertrophy altered right ventricular contour in two.
A similarly abnormal electrocardiogram and left ventricle were found in four unrelated individuals with the XX, XY Turner phenotype. Three had pulmonary stenosis; in two there was an associated septal defect. The fourth, with no associated cardiac defect, died in heart failure at 5 months of age. At necropsy she had marked eccentric biventricular hypertrophy, chiefly involving the left ventricle so that the chamber was reduced to a slitlike cavity. The hypertrophied septum bulged into the right ventricular outflow tract.
A number of cardiovascular anomalies occur in familial and sporadic instances of this syndrome; eccentric ventricular hypertrophy recognizable by an electrocardiographic abnormality seems to be a distinctive cardiac lesion in the XX, XY Turner phenotype. Except for the unusual and, we believe, characteristic ECG, there was no clinical clue on physical examination or cardiac series of chest roentgenograms to suggest the presence of eccentric left ventricular hypertrophy. We recommend that selective left ventricular angiocardiography be performed when patients with the Turner phenotype undergo diagnostic cardiac catheterization, especially when the frontal ÂQRS is superiorly directed.
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Nielsen J, Friedrich U, Christensen AL, Godt HH, Strömgren LS. A phenotypic male with karyotype 45,X:45,X,ace+(?Yg--). HUMANGENETIK 1972; 15:319-26. [PMID: 4634448 DOI: 10.1007/bf00281731] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
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Similä S, Kaski U. The turner phenotype in three brothers with ichtyosis vulgaris. ACTA PAEDIATRICA SCANDINAVICA 1967:Suppl 177:120+. [PMID: 5587685 DOI: 10.1111/j.1651-2227.1967.tb05258.x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/15/2023]
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Overzier C. [The so-called masculine Turner's syndrome]. ARCHIV FUR KLINISCHE UND EXPERIMENTELLE DERMATOLOGIE 1966; 227:666-73. [PMID: 5984812 DOI: 10.1007/bf00502916] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/17/2023]
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