Noonan syndrome with multiple lentigines
Multiple lentigines syndrome; LEOPARD syndrome; NSMLNoonan syndrome with multiple lentigines (NSML) is a rare inherited disorder. People with this condition have problems with the skin, head and face, inner ear, and heart. The genitals may also be affected.
Noonan syndrome with multiple lentigines was formerly known as LEOPARD syndrome.
Causes
NSML is inherited as an autosomal dominant trait. This means the person only needs an abnormal gene from one parent in order to inherit the disorder.
Symptoms
The former name of NSML of LEOPARD stands for the different problems (signs and symptoms) of this disorder:
- Lentigines -- large number of brown or black freckle-like skin markings that mainly affect the neck and upper chest but can appear all over the body
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Electrocardiograph conduction abnormalities -- problems with the electrical and pumping functions of the heart
Electrocardiograph
An electrocardiogram (ECG) is a test that records the electrical activity of the heart.
Read Article Now Book Mark Article - Ocular hypertelorism -- eyes that are spaced wide apart
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Pulmonary valve stenosis -- narrowing of the pulmonary heart valve, resulting in less blood flow to the lungs and causing shortness of breath
Pulmonary valve stenosis
Pulmonic stenosis is a heart valve disorder that involves the pulmonary valve. This is the valve separating the right ventricle (one of the chambers ...
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Abnormalities of the genitals -- such as undescended testicles
Undescended testicles
Undescended testicle occurs when one or both testicles fail to move into the scrotum before birth.
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Retardation of growth (delayed growth) -- including bone growth problems of the chest and spine
Delayed growth
Delayed growth is poor or abnormally slow height or weight gains in a child younger than age 5. This may just be normal, and the child may outgrow i...
Read Article Now Book Mark Article - Deafness -- hearing loss may vary between mild and severe
NSML is similar to Noonan syndrome. However, the main symptom that tells apart the two conditions is that people with NSML have lentigines.
Noonan syndrome
Noonan syndrome is a disease present from birth (congenital) that causes many parts of the body to develop abnormally. In about 50% of cases, it is ...
Read Article Now Book Mark ArticleExams and Tests
Your health care provider will perform a physical exam and listen to the heart with a stethoscope.
Tests that may be done include:
- Electrocardiogram (ECG) and echocardiogram to check the heart
Echocardiogram
An echocardiogram is a test that uses sound waves to create pictures of the heart. The picture and information it produces is more detailed than a s...
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- CT scan of the brain
- Skull x-ray
- EEG to check the brain's function
- Blood tests to check certain hormone levels
- Removing a small amount of skin for examination (skin biopsy)
Skin biopsy
A skin lesion biopsy is when a small amount of skin is removed so it can be examined under a microscope. The skin is tested to look for skin conditi...
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Treatment
Symptoms are treated as appropriate. A hearing aid may be needed. Hormone treatment may be necessary at the expected time of puberty to cause the normal changes to occur.
Laser, cryosurgery (freezing), or bleaching creams may help lighten some of the brown spots on the skin.
Support Groups
More information and support for people with LEOPARD syndrome and their families can be found at:
- National Organization for Rare Disorders - rarediseases.org/rare-diseases/leopard-syndrome/
- Noonan Syndrome Foundation - www.teamnoonan.org/information
- Rasopathies Network - rasopathiesnet.org/
Possible Complications
Complications vary and include:
- Deafness
- Delayed puberty
- Heart problems
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Infertility
Infertility
Infertility means you cannot get pregnant (conceive). There are 2 types of infertility:Primary infertility refers to couples who have not become preg...
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When to Contact a Medical Professional
Contact your provider if there are symptoms of this disorder.
Contact your provider for an appointment if you have a family history of this disorder and plan to have children.
Prevention
Genetic counseling is recommended for people with a family history of NSLM who want to have children.
Genetic counseling
Genetics is the study of heredity, the process of a parent passing certain genes on to their children. A person's appearance, such as height, hair co...
Read Article Now Book Mark ArticleReferences
James WD, Elston DM, Treat JR, Rosenbach MA, Neuhaus IM. Melanocytic nevi and neoplasms. In: James WD, Elston DM, Treat JR, Rosenbach MA, Neuhaus IM, eds. Andrews' Diseases of the Skin: Clinical Dermatology. 13th ed. Philadelphia, PA: Elsevier; 2020:chap 30.
Paller AS, Mancini AJ. Disorders of pigmentation. In: Paller AS, Mancini AJ, eds. Paller and Mancini – Hurwitz Clinical Pediatric Dermatology. 6th ed. Philadelphia, PA: Elsevier; 2022:chap 11.
Review Date: 5/31/2023
Reviewed By: Ramin Fathi, MD, FAAD, Director, Phoenix Surgical Dermatology Group, Phoenix, AZ. Also reviewed by David C. Dugdale, MD, Medical Director, Brenda Conaway, Editorial Director, and the A.D.A.M. Editorial team.
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