title: GH Therapy and first final height data in Noonan-like syndrome with loose anagen hair (Mazzanti syndrome).
abstract: Noonan-like syndrome with loose anagen hair (NS/LAH or Mazzanti Syndrome) is caused by a single missense mutation in SHOC2 promoting tN-myristoylation of the encoded protein. Cardinal features include facial features resembling NS, short stature often associated with proven growth hormone deficiency (GHD), typical ectodermal anomalies, and distinctive behavior. Overall, the clinical features are more severe than those generally observed in NS, even though the phenotype improves with age. We report on growth and pubertal trend in seven patients heterozygous for a mutated SHOC2 allele, treated with long-term GH-therapy, and final height (FH) in three of them. They were approximately -3 SDS below the Italian general population standards, they had very low IGF1 levels at baseline and GHD at pharmacological tests. All patients were treated with GH (0.035 mg/kg/day) for a mean period of 8.49 ± 5.72 years. After the 1st year of GH-therapy, IGF1 level and height velocity had increased. Three of 7 patients reached the FH (-2.34 ± 0.12 SDS) at 18.25 ± 0.73 years, after GH administration for 12.39 ± 2.12 years. Pubertal development was variable, showing a prolonged and delayed puberty or rapid pubertal progression that could impair the FH. Overall, our data in this small cohort suggest that NS/LAH patients benefit from long-term GH-therapy, although they do not show the characteristic catch-up growth of isolated GHD. While the observed growth and pubertal behavior is consistent with a dysfunction of the hypothalamic-pituitary-gonadal axis, the functional link between SHOC2 and the GH/IGF signaling pathways remains to be clarified.
authors.affiliation: Pediatric Endocrinology and Rare Diseases, Department of Pediatrics, S.Orsola-Malpighi University Hospital - University of Bologna, Bologna, Italy.
authors.forename: Laura
authors.initials: L
authors.lastname: Mazzanti
authors.forename: Federica
authors.initials: F
authors.lastname: Tamburrino
authors.forename: Emanuela
authors.initials: E
authors.lastname: Scarano
authors.forename: Annamaria
authors.initials: A
authors.lastname: Perri
authors.forename: Benedetta
authors.initials: B
authors.lastname: Vestrucci
authors.forename: Monica
authors.initials: M
authors.lastname: Guidetti
authors.forename: Cesare
authors.initials: C
authors.lastname: Rossi
authors.forename: Marco
authors.initials: M
authors.lastname: Tartaglia
mesh_terms: D001827:Body Height; D002648:Child; D002675:Child, Preschool; D005260:Female; D057238:Growth Charts; D020249:Hormone Replacement Therapy; D019382:Human Growth Hormone / Q000627:therapeutic use*; D006801:Humans; D007223:Infant; D047908:Intracellular Signaling Peptides and Proteins / Q000235:genetics; D058247:Loose Anagen Hair Syndrome / Q000188:drug therapy* / Q000235:genetics; D008297:Male; D009154:Mutation; D009634:Noonan Syndrome / Q000188:drug therapy* / Q000235:genetics; D010641:Phenotype; D011627:Puberty
chemical_list: D047908:Intracellular Signaling Peptides and Proteins; C112913:SHOC2 protein, human; D019382:Human Growth Hormone
keywords: NS/LAH; SHOC2; growth hormone; noonan syndrome; rasopathies