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Neurofibromatosis-Noonan syndrome(NFNS)

MedGen UID:
419089
Concept ID:
C2931482
Disease or Syndrome
Synonyms: Neurofibromatosis with Noonan phenotype; NFNS
SNOMED CT: Neurofibromatosis Noonan syndrome (715344006); NFNS - Neurofibromatosis Noonan syndrome (715344006); Neurofibromatosis type 1 Noonan syndrome (715344006); Neurofibromatosis with Noonan phenotype (715344006)
Modes of inheritance:
Autosomal dominant inheritance
MedGen UID:
141047
Concept ID:
C0443147
Intellectual Product
Source: Orphanet
A mode of inheritance that is observed for traits related to a gene encoded on one of the autosomes (i.e., the human chromosomes 1-22) in which a trait manifests in heterozygotes. In the context of medical genetics, an autosomal dominant disorder is caused when a single copy of the mutant allele is present. Males and females are affected equally, and can both transmit the disorder with a risk of 50% for each child of inheriting the mutant allele.
 
Gene (location): NF1 (17q11.2)
 
Monarch Initiative: MONDO:0011035
OMIM®: 601321
Orphanet: ORPHA638

Definition

A variant of neurofibromatosis type 1 characterized by the combination of features of neurofibromatosis type 1, such as café-au-lait spots, iris Lisch nodules, axillary and inguinal freckling, optic nerve glioma and multiple neurofibromas; and Noonan syndrome, with features such as short stature, typical facial features, congenital heart defects and unusual pectus deformity. [from SNOMEDCT_US]

Clinical features

From HPO
Neuroblastoma
MedGen UID:
18012
Concept ID:
C0027819
Neoplastic Process
ALK-related neuroblastic tumor susceptibility is characterized by increased risk for neuroblastic tumors including neuroblastoma, ganglioneuroblastoma, and ganglioneuroma. Neuroblastoma is a more malignant tumor and ganglioneuroma a more benign tumor. Depending on the histologic findings, ganglioneuroblastoma can behave in a more aggressive fashion, like neuroblastoma, or in a benign fashion, like ganglioneuroma. Preliminary data from the ten reported families with ALK-related neuroblastic tumor susceptibility suggest an overall penetrance of approximately 57% with the risk for neuroblastic tumor development highest in infancy and decreasing by late childhood.
Cryptorchidism
MedGen UID:
8192
Concept ID:
C0010417
Congenital Abnormality
Cryptorchidism, or failure of testicular descent, is a common human congenital abnormality with a multifactorial etiology that likely reflects the involvement of endocrine, environmental, and hereditary factors. Cryptorchidism can result in infertility and increases risk for testicular tumors. Testicular descent from abdomen to scrotum occurs in 2 distinct phases: the transabdominal phase and the inguinoscrotal phase (summary by Gorlov et al., 2002).
Cubitus valgus
MedGen UID:
490152
Concept ID:
C0158465
Acquired Abnormality
Abnormal positioning in which the elbows are turned out.
Atrial septal defect, ostium secundum type
MedGen UID:
91034
Concept ID:
C0344724
Congenital Abnormality
A kind of atrial septum defect arising from an enlarged foramen ovale, inadequate growth of the septum secundum, or excessive absorption of the septum primum.
Pulmonic stenosis
MedGen UID:
408291
Concept ID:
C1956257
Disease or Syndrome
A narrowing of the right ventricular outflow tract that can occur at the pulmonary valve (valvular stenosis), below the pulmonary valve (infundibular stenosis), or above the pulmonary valve (supravalvar stenosis).
Short stature
MedGen UID:
87607
Concept ID:
C0349588
Finding
A height below that which is expected according to age and gender norms. Although there is no universally accepted definition of short stature, many refer to "short stature" as height more than 2 standard deviations below the mean for age and gender (or below the 3rd percentile for age and gender dependent norms).
Low-set ears
MedGen UID:
65980
Concept ID:
C0239234
Congenital Abnormality
Upper insertion of the ear to the scalp below an imaginary horizontal line drawn between the inner canthi of the eye and extending posteriorly to the ear.
Posteriorly rotated ears
MedGen UID:
96566
Concept ID:
C0431478
Congenital Abnormality
A type of abnormal location of the ears in which the position of the ears is characterized by posterior rotation (the superior part of the ears is rotated towards the back of the head, and the inferior part of the ears towards the front).
Neurofibroma
MedGen UID:
45058
Concept ID:
C0027830
Neoplastic Process
A benign peripheral nerve sheath tumor that generally appears as a soft, skin-colored papule or small subcutaneous nodule. Individuals with neurofibromatosis can have numerous neurofibromas.
Plexiform neurofibroma
MedGen UID:
64640
Concept ID:
C0206728
Neoplastic Process
A neurofibroma in which Schwann cells proliferate inside the nerve sheath, producing an irregularly thickened, distorted, tortuous structure.
Optic nerve glioma
MedGen UID:
138056
Concept ID:
C0346326
Neoplastic Process
A glioma originating in the optic nerve or optic chiasm.
Delayed speech and language development
MedGen UID:
105318
Concept ID:
C0454644
Finding
A degree of language development that is significantly below the norm for a child of a specified age.
Global developmental delay
MedGen UID:
107838
Concept ID:
C0557874
Finding
A delay in the achievement of motor or mental milestones in the domains of development of a child, including motor skills, speech and language, cognitive skills, and social and emotional skills. This term should only be used to describe children younger than five years of age.
Intellectual disability
MedGen UID:
811461
Concept ID:
C3714756
Mental or Behavioral Dysfunction
Intellectual disability, previously referred to as mental retardation, is characterized by subnormal intellectual functioning that occurs during the developmental period. It is defined by an IQ score below 70.
Specific learning disability
MedGen UID:
871302
Concept ID:
C4025790
Mental or Behavioral Dysfunction
Impairment of certain skills such as reading or writing, coordination, self-control, or attention that interfere with the ability to learn. The impairment is not related to a global deficiency of intelligence.
Scoliosis
MedGen UID:
11348
Concept ID:
C0036439
Disease or Syndrome
The presence of an abnormal lateral curvature of the spine.
Muscle weakness
MedGen UID:
57735
Concept ID:
C0151786
Finding
Reduced strength of muscles.
Malar flattening
MedGen UID:
347616
Concept ID:
C1858085
Finding
Underdevelopment of the malar prominence of the jugal bone (zygomatic bone in mammals), appreciated in profile, frontal view, and/or by palpation.
Superior pectus carinatum
MedGen UID:
351219
Concept ID:
C1864795
Finding
Pectus carinatum affecting primarily the superior part of the sternum.
Pectus excavatum of inferior sternum
MedGen UID:
400614
Concept ID:
C1864796
Finding
Pectus excavatum (defect of the chest wall characterized by depression of the sternum) affecting primarily the inferior region of the sternum.
Pectus excavatum
MedGen UID:
781174
Concept ID:
C2051831
Finding
A defect of the chest wall characterized by a depression of the sternum, giving the chest ("pectus") a caved-in ("excavatum") appearance.
Macrocephaly
MedGen UID:
745757
Concept ID:
C2243051
Finding
Occipitofrontal (head) circumference greater than 97th centile compared to appropriate, age matched, sex-matched normal standards. Alternatively, a apparently increased size of the cranium.
Webbed neck
MedGen UID:
113154
Concept ID:
C0221217
Congenital Abnormality
Pterygium colli is a congenital skin fold that runs along the sides of the neck down to the shoulders. It involves an ectopic fibrotic facial band superficial to the trapezius muscle. Excess hair-bearing skin is also present and extends down the cervical region well beyond the normal hairline.
Downslanted palpebral fissures
MedGen UID:
98391
Concept ID:
C0423110
Finding
The palpebral fissure inclination is more than two standard deviations below the mean.
Short neck
MedGen UID:
99267
Concept ID:
C0521525
Finding
Diminished length of the neck.
Epicanthus
MedGen UID:
151862
Concept ID:
C0678230
Congenital Abnormality
Epicanthus is a condition in which a fold of skin stretches from the upper to the lower eyelid, partially covering the inner canthus. Usher (1935) noted that epicanthus is a normal finding in the fetus of all races. Epicanthus also occurs in association with hereditary ptosis (110100).
Depressed nasal bridge
MedGen UID:
373112
Concept ID:
C1836542
Finding
Posterior positioning of the nasal root in relation to the overall facial profile for age.
Thick vermilion border
MedGen UID:
332232
Concept ID:
C1836543
Finding
Increased width of the skin of vermilion border region of upper lip.
Midface retrusion
MedGen UID:
339938
Concept ID:
C1853242
Anatomical Abnormality
Posterior positions and/or vertical shortening of the infraorbital and perialar regions, or increased concavity of the face and/or reduced nasolabial angle.
Low posterior hairline
MedGen UID:
383755
Concept ID:
C1855728
Finding
Hair on the neck extends more inferiorly than usual.
Prominent nasolabial fold
MedGen UID:
355725
Concept ID:
C1866487
Finding
Exaggerated bulkiness of the crease or fold of skin running from the lateral margin of the nose, where nasal base meets the skin of the face, to a point just lateral to the corner of the mouth (cheilion, or commissure).
Inguinal freckling
MedGen UID:
320315
Concept ID:
C1834297
Finding
The presence in the inguinal region (groin) of an increased number of freckles, small circular spots on the skin that are darker than the surrounding skin because of deposits of melanin.
Axillary freckling
MedGen UID:
348082
Concept ID:
C1860335
Finding
The presence in the axillary region (armpit) of an increased number of freckles, small circular spots on the skin that are darker than the surrounding skin because of deposits of melanin.
Cafe au lait spots, multiple
MedGen UID:
396266
Concept ID:
C1861975
Disease or Syndrome
The presence of six or more cafe-au-lait spots.
Ptosis
MedGen UID:
2287
Concept ID:
C0005745
Disease or Syndrome
The upper eyelid margin is positioned 3 mm or more lower than usual and covers the superior portion of the iris (objective); or, the upper lid margin obscures at least part of the pupil (subjective).
Hypertelorism
MedGen UID:
9373
Concept ID:
C0020534
Finding
Although hypertelorism means an excessive distance between any paired organs (e.g., the nipples), the use of the word has come to be confined to ocular hypertelorism. Hypertelorism occurs as an isolated feature and is also a feature of many syndromes, e.g., Opitz G syndrome (see 300000), Greig cephalopolysyndactyly (175700), and Noonan syndrome (163950) (summary by Cohen et al., 1995).
Lisch nodules
MedGen UID:
395461
Concept ID:
C1860334
Finding
The presence of pigmented, oval and dome-shaped raised hamartomatous nevi of the iris..

Term Hierarchy

CClinical test,  RResearch test,  OOMIM,  GGeneReviews,  VClinVar  
  • CROGVNeurofibromatosis-Noonan syndrome

Recent clinical studies

Etiology

Witkowski L, Dillon MW, Murphy E, S Lebo M, Mason-Suares H
Mol Genet Genomic Med 2020 Apr;8(4):e1180. Epub 2020 Feb 27 doi: 10.1002/mgg3.1180. PMID: 32107864Free PMC Article
Cizmarova M, Kostalova L, Pribilincova Z, Lasabova Z, Hlavata A, Kovacs L, Ilencikova D
Endocr Regul 2013 Oct;47(4):217-22. doi: 10.4149/endo_2013_04_217. PMID: 24156711
Zenker M
Horm Res 2009 Dec;72 Suppl 2:57-63. Epub 2009 Dec 22 doi: 10.1159/000243782. PMID: 20029240
Nyström AM, Ekvall S, Allanson J, Edeby C, Elinder M, Holmström G, Bondeson ML, Annerén G
Clin Genet 2009 Dec;76(6):524-34. Epub 2009 Oct 21 doi: 10.1111/j.1399-0004.2009.01233.x. PMID: 19845691
Klopfenstein KJ, Sommer A, Ruymann FB
J Pediatr Hematol Oncol 1999 Mar-Apr;21(2):158-60. doi: 10.1097/00043426-199903000-00014. PMID: 10206464

Diagnosis

Işık E, Onay H, Atik T, Solmaz AE, Özen S, Çoğulu Ö, Darcan Ş, Özkınay F
J Clin Res Pediatr Endocrinol 2020 Mar 19;12(1):113-116. Epub 2019 May 15 doi: 10.4274/jcrpe.galenos.2019.2019.0023. PMID: 31088041Free PMC Article
Yapijakis C, Pachis N, Natsis S, Voumvourakis C
In Vivo 2016 May-Jun;30(3):315-20. PMID: 27107091
Prada CE, Zarate YA, Hagenbuch S, Lovell A, Schorry EK, Hopkin RJ
Am J Med Genet A 2011 Jun;155A(6):1360-6. Epub 2011 May 12 doi: 10.1002/ajmg.a.33996. PMID: 21567923
Fukushima Y
Acta Paediatr Jpn 1996 Feb;38(1):102-4. doi: 10.1111/j.1442-200x.1996.tb03447.x. PMID: 8992851
Buehning L, Curry CJ
Pediatr Dermatol 1995 Sep;12(3):267-71. doi: 10.1111/j.1525-1470.1995.tb00175.x. PMID: 7501563

Therapy

Vurallı D, Gönç N, Vidaud D, Özön A, Alikaşifoğlu A, Kandemir N
J Clin Res Pediatr Endocrinol 2016 Mar 5;8(1):96-100. Epub 2015 Dec 18 doi: 10.4274/jcrpe.2070. PMID: 26758488Free PMC Article
Klopfenstein KJ, Sommer A, Ruymann FB
J Pediatr Hematol Oncol 1999 Mar-Apr;21(2):158-60. doi: 10.1097/00043426-199903000-00014. PMID: 10206464

Prognosis

Dalili S, Hoseini Nouri SA, Bayat R, Koohmanaee S, Tabrizi M, Zarkesh M, Tarang A, Mahdieh N
Hum Genomics 2023 Feb 20;17(1):12. doi: 10.1186/s40246-023-00460-0. PMID: 36803953Free PMC Article
Vurallı D, Gönç N, Vidaud D, Özön A, Alikaşifoğlu A, Kandemir N
J Clin Res Pediatr Endocrinol 2016 Mar 5;8(1):96-100. Epub 2015 Dec 18 doi: 10.4274/jcrpe.2070. PMID: 26758488Free PMC Article
Santoro C, Pacileo G, Limongelli G, Scianguetta S, Giugliano T, Piluso G, Ragione FD, Cirillo M, Mirone G, Perrotta S
BMC Med Genet 2014 Apr 26;15:44. doi: 10.1186/1471-2350-15-44. PMID: 24767283Free PMC Article
Prada CE, Zarate YA, Hagenbuch S, Lovell A, Schorry EK, Hopkin RJ
Am J Med Genet A 2011 Jun;155A(6):1360-6. Epub 2011 May 12 doi: 10.1002/ajmg.a.33996. PMID: 21567923

Clinical prediction guides

Dalili S, Hoseini Nouri SA, Bayat R, Koohmanaee S, Tabrizi M, Zarkesh M, Tarang A, Mahdieh N
Hum Genomics 2023 Feb 20;17(1):12. doi: 10.1186/s40246-023-00460-0. PMID: 36803953Free PMC Article
Takenouchi T, Shimizu A, Torii C, Kosaki R, Takahashi T, Saya H, Kosaki K
Am J Med Genet A 2014 Feb;164A(2):392-6. Epub 2013 Dec 5 doi: 10.1002/ajmg.a.36288. PMID: 24311457
Nyström AM, Ekvall S, Allanson J, Edeby C, Elinder M, Holmström G, Bondeson ML, Annerén G
Clin Genet 2009 Dec;76(6):524-34. Epub 2009 Oct 21 doi: 10.1111/j.1399-0004.2009.01233.x. PMID: 19845691
De Luca A, Bottillo I, Sarkozy A, Carta C, Neri C, Bellacchio E, Schirinzi A, Conti E, Zampino G, Battaglia A, Majore S, Rinaldi MM, Carella M, Marino B, Pizzuti A, Digilio MC, Tartaglia M, Dallapiccola B
Am J Hum Genet 2005 Dec;77(6):1092-101. Epub 2005 Oct 26 doi: 10.1086/498454. PMID: 16380919Free PMC Article
Bahuau M, Flintoff W, Assouline B, Lyonnet S, Le Merrer M, Prieur M, Guilloud-Bataille M, Feingold N, Munnich A, Vidaud M, Vidaud D
Am J Med Genet 1996 Dec 18;66(3):347-55. doi: 10.1002/(SICI)1096-8628(19961218)66:3<347::AID-AJMG20>3.0.CO;2-L. PMID: 8985499

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