Core clinical symptoms and heterogeneous manifestations of NS / LAH: three case reports and review of the literature

Abstract Background Noonan-like syndrome with loose anagen hair-a rare autosomal dominant disease with very clinical heterogeneity, is difficult to make clinical diagnosis in the earlier period. We identified the cause of disease with severely short stature by WES on three pediatric cases. Meanwhile, we summarized the clinical manifestations of these three patients and reviewed the literature of the syndrome. Case presentations We finally confirmed three cases of Noonan-like syndrome with loose anagen hair (NS / LAH) (OMIM # 607721) and hotspot mutation in SHOC2 gene (OMIM# 602775), which both involved in the RAS-MAPK signaling pathway. The mutation located in chr10: 112724120, NM_007373.3, c.4A>G (p.Ser2Gly) is de-novo heterozygous in all patients. NS / LAH show some core clinical symptoms, such as craniofacial anomalies, short stature, weight loss, abnormal hair, growth retardation and heterogeneous manifestations (macrocephaly, GH deficiency, congenital heart disease, skin pigmentation, mental retardation, etc.). In the study, we have also proved that it is safe and feasible to apply rhGH treatent on Noonan-like syndrome with loose anagen hair. Conclusions Through our effort, we have identified a rare disease in China. The molecular characteristics, clinical manifestations, and therapeutic measure were summarized so that it can help to clinicians a better understanding of the disease and offer patients effective and timely assistance.