Talla baja y enfermedades raras

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Abstract

La baja talla constituye el primer motivo de consulta en endocrinología pediátrica. En un alto porcentaje su etiología es clara y obedece fundamentalmente a variantes de normalidad. Sin embargo, en aproximadamente un 20% esta baja talla es patológica y obliga a estudios exhaustivos. La asociación de enfermedades raras (ER) con talla baja es altamente frecuente. En este trabajo repasamos las etiologías de la baja talla en enfermedades raras, describiendo: - las formas genéticas de la hormona de crecimiento (GH) bien sean aisladas o asociadas a malformaciones de la línea media u otras. - aquellas de gran importancia por su repercusión clínica como el Síndrome de Turner, Síndrome de Noonan y el Síndrome de Willi-Prader. - Las frecuentes displasias óseas, con alteración genética en algunos casos para el gen SHOX, situado en el brazo corto del cromosoma Xp. La importancia de estos diagnósticos radica en la posibilidad de hacer un tratamiento precoz y eficaz, en algunos de ellos, con GH. En conclusión, el diagnóstico de enfermedades raras con baja talla es un reto actual y habitual en endocrinología pediátrica por los grandes avances de la genética molecular y la posibilidad de tratamiento en algunas de ellas. Implica siempre un abordaje multidisciplinario por la asociación frecuente de patología que presenta y a su vez, ofrece la posibilidad de realizar el oportuno consejo genético.

Translated abstract

Low stature is the main reason of consultation in paediatric endocrinology. In a high percentage of cases, its etiology is clear and fundamentally answers to variants of normality. However, in approximately 20% of cases low stature is pathological and requires exhaustive studies. The association of rare diseases (RD) with low height is very frequent. In this article we review the etiology of low height, describing: - The genetic forms of the growth hormone (GH), whether isolated or associated with malformations of the average line or others. - Those which are of great importance due to their clinical repercussion, such as Turner’s Syndrome, Noonan’s Syndrome and Willi-Prader’s Syndrome. - The frequent osseous dysplasias, in some cases with genetic alterations of the SHOX gene, situated in the short arm of the Xp chromosome. The importance of these diagnoses lies in the possibility of carrying out early and efficient treatment, in some of them, with GH. In conclusion, the diagnosis of rare diseases with low height is a current and normal challenge in paediatric endocrinology due to the great advances in molecular genetics and the possibility of treatment in some of them. It always involves a multidisciplinary approach due to the frequent association of pathology it presents, and, in its turn, it offers the possibility of carrying out timely genetic counselling.

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Mutations in PTPN11, encoding the protein tyrosine phosphatase SHP-2, cause Noonan syndrome.

M. Tartaglia, E. L. Mehler, R. Goldberg … (2001)

Noonan syndrome (MIM 163950) is an autosomal dominant disorder characterized by dysmorphic facial features, proportionate short stature and heart disease (most commonly pulmonic stenosis and hypertrophic cardiomyopathy). Webbed neck, chest deformity, cryptorchidism, mental retardation and bleeding diatheses also are frequently associated with this disease. This syndrome is relatively common, with an estimated incidence of 1 in 1,000-2,500 live births. It has been mapped to a 5-cM region (NS1) [corrected] on chromosome 12q24.1, and genetic heterogeneity has also been documented. Here we show that missense mutations in PTPN11 (MIM 176876)-a gene encoding the nonreceptor protein tyrosine phosphatase SHP-2, which contains two Src homology 2 (SH2) domains-cause Noonan syndrome and account for more than 50% of the cases that we examined. All PTPN11 missense mutations cluster in interacting portions of the amino N-SH2 domain and the phosphotyrosine phosphatase domains, which are involved in switching the protein between its inactive and active conformations. An energetics-based structural analysis of two N-SH2 mutants indicates that in these mutants there may be a significant shift of the equilibrium favoring the active conformation. This implies that they are gain-of-function changes and that the pathogenesis of Noonan syndrome arises from excessive SHP-2 activity.