Malan syndrome

Malan syndrome
Malan syndrome
Other names	Malan overgrowth syndrome, MALNS, Sotos-like syndrome, Sotos syndrome 2
Specialty	Medical genetics
Symptoms	Intellectual disability, overgrowth, Marfanoid habitus, visual problems
Usual onset	Present at birth
Causes	NFIX mutation
Diagnostic method	Molecular genetic testing
Differential diagnosis	Marfan syndrome, Sotos syndrome, Weaver syndrome
Management	Based on symptoms
Frequency	80 reported cases
Named after	Valérie Malan

Malan syndrome (MALNS) is a rare overgrowth syndrome caused by autosomal dominant mutations in the NFIX gene.^[1] The syndrome is characterized by overgrowth, craniofacial dysmorphia, intellectual disability, and behavioral issues. It was formerly diagnosed as Sotos syndrome 2.^[2]^[3]

Signs and symptoms

Malan syndrome is defined by initial overgrowth and mild-to-severe intellectual disability. Almost all individuals with Malan syndrome display above-average height, weight, and head circumference in early life, but only one-third of adults with Malan syndrome are >2 standard deviations above the mean. Most individuals display advanced bone age. Hypotonia and seizures may be observed.

All individuals display some degree of global developmental delay and intellectual disability which typically ranges from moderate to severe, though mild cases have been observed. Cognitive function, adaptive function, and language skills are impaired.^[4] Anxiety and noise hypersensitivity are frequently reported. Autism spectrum features are observed in 31% of individuals.^[2]

The facial gestalt of Malan syndrome includes dolichocephaly, a long or triangular face, prominent forehead, depressed nasal bridge, deep-set eyes, downslanting palpebral fissures, short nose with anteverted nares, long philtrum, everted lower lip, and prominent chin. Marfanoid features are extremely common, including scoliosis, hyperkyphosis or hyperlordosis, pectus excavatum or carinatum, slender habitus, and long hands.^[3]

Ophthalmological features are common in Malan syndrome and can be used to distinguish it from Sotos syndrome. Vision impairments may include strabismus, myopia, hypermetropia, astigmatism, and nystagmus. Blue sclerae are often observed.^[3]

Cause

Malan syndrome is caused by autosomal dominant mutations in the NFIX gene. Both variants and deletions have been reported. In some cases, the deletion also affects CACNA1A, which is associated with episodic ataxia type 2 or familial hemiplegic migraine.^[5] Nearly all cases are caused by de novo mutations, though familial cases have been observed due to gonadal or parental mosaicism.^[3]

Management

Individuals with Malan syndrome should receive comprehensive evaluation of all major body systems at diagnosis. Height, weight, head circumference, BMI, and food intake should be evaluated regularly. Orthopedic and visual evaluations are recommended annually until puberty. Risk of pathologic bone fracture is increased in Malan syndrome; bone integrity can be assessed via DXA. Neurological features such as epilepsy and vegetative symptoms should receive standard treatment. Neuropsychiatric and behavioral issues should be evaluated at diagnosis and managed as appropriate.^[3]

References

^ ^a ^b "Malan overgrowth syndrome". Orphanet. December 2020. Retrieved 2024-01-11.
^ ^a ^b Priolo M, Schanze D, Tatton-Brown K, Mulder PA, Tenorio J, Kooblall K; et al. (2018). "Further delineation of Malan syndrome". Hum Mutat. 39 (9): 1226–1237. doi:10.1002/humu.23563. PMC 6175110. PMID 29897170.{{cite journal}}: CS1 maint: multiple names: authors list (link)
^ ^a ^b ^c ^d ^e Macchiaiolo M, Panfili FM, Vecchio D, Gonfiantini MV, Cortellessa F, Caciolo C; et al. (2022). "A deep phenotyping experience: up to date in management and diagnosis of Malan syndrome in a single center surveillance report". Orphanet J Rare Dis. 17 (1): 235. doi:10.1186/s13023-022-02384-9. PMC 9206304. PMID 35717370.{{cite journal}}: CS1 maint: multiple names: authors list (link)
^ Alfieri P, Macchiaiolo M, Collotta M, Montanaro FAM, Caciolo C, Cumbo F; et al. (2022). "Characterization of Cognitive, Language and Adaptive Profiles of Children and Adolescents with Malan Syndrome". J Clin Med. 11 (14): 4078. doi:10.3390/jcm11144078. PMC 9316998. PMID 35887841.{{cite journal}}: CS1 maint: multiple names: authors list (link)
^ Klaassens M, Morrogh D, Rosser EM, Jaffer F, Vreeburg M, Bok LA; et al. (2015). "Malan syndrome: Sotos-like overgrowth with de novo NFIX sequence variants and deletions in six new patients and a review of the literature". Eur J Hum Genet. 23 (5): 610–5. doi:10.1038/ejhg.2014.162. PMC 4402637. PMID 25118028.{{cite journal}}: CS1 maint: multiple names: authors list (link)

External links

[orphanet-1] "Malan overgrowth syndrome". Orphanet. December 2020. Retrieved 2024-01-11.

[pmid29897170-2] Priolo M, Schanze D, Tatton-Brown K, Mulder PA, Tenorio J, Kooblall K; et al. (2018). "Further delineation of Malan syndrome". Hum Mutat. 39 (9): 1226–1237. doi:10.1002/humu.23563. PMC 6175110. PMID 29897170.{{cite journal}}: CS1 maint: multiple names: authors list (link)

[pmid35717370-3] Macchiaiolo M, Panfili FM, Vecchio D, Gonfiantini MV, Cortellessa F, Caciolo C; et al. (2022). "A deep phenotyping experience: up to date in management and diagnosis of Malan syndrome in a single center surveillance report". Orphanet J Rare Dis. 17 (1): 235. doi:10.1186/s13023-022-02384-9. PMC 9206304. PMID 35717370.{{cite journal}}: CS1 maint: multiple names: authors list (link)

[pmid35887841-4] Alfieri P, Macchiaiolo M, Collotta M, Montanaro FAM, Caciolo C, Cumbo F; et al. (2022). "Characterization of Cognitive, Language and Adaptive Profiles of Children and Adolescents with Malan Syndrome". J Clin Med. 11 (14): 4078. doi:10.3390/jcm11144078. PMC 9316998. PMID 35887841.{{cite journal}}: CS1 maint: multiple names: authors list (link)

[pmid25118028-5] Klaassens M, Morrogh D, Rosser EM, Jaffer F, Vreeburg M, Bok LA; et al. (2015). "Malan syndrome: Sotos-like overgrowth with de novo NFIX sequence variants and deletions in six new patients and a review of the literature". Eur J Hum Genet. 23 (5): 610–5. doi:10.1038/ejhg.2014.162. PMC 4402637. PMID 25118028.{{cite journal}}: CS1 maint: multiple names: authors list (link)

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Classification	D ICD-11: LD2C ICD-10: Q87.3 OMIM: 614753
External resources	Orphanet: 420179

v t e Congenital abnormality syndromes
Craniofacial	Acrocephalosyndactyly Apert syndrome Carpenter syndrome Pfeiffer syndrome Saethre–Chotzen syndrome Sakati–Nyhan–Tisdale syndrome Bonnet–Dechaume–Blanc syndrome Other Baller–Gerold syndrome Cyclopia Goldenhar syndrome Moebius syndrome Pierre Robin sequence
Short stature	1q21.1 deletion syndrome Aarskog–Scott syndrome Cockayne syndrome Cornelia de Lange syndrome Dubowitz syndrome Noonan syndrome Robinow syndrome Silver–Russell syndrome Seckel syndrome Smith–Lemli–Opitz syndrome Snyder–Robinson syndrome Turner syndrome
Limbs	Adducted thumb syndrome Holt–Oram syndrome Klippel–Trénaunay syndrome Nail–patella syndrome Rubinstein–Taybi syndrome Gastrulation/mesoderm: Caudal regression syndrome Ectromelia Sirenomelia VACTERL association
Overgrowth syndromes	Bannayan–Riley–Ruvalcaba syndrome Beckwith–Wiedemann syndrome Benign symmetric lipomatosis Klippel–Trénaunay syndrome Neurofibromatosis type I Perlman syndrome Proteus syndrome Sotos syndrome Tatton-Brown–Rahman syndrome Weaver syndrome
Laurence–Moon–Bardet–Biedl	Bardet–Biedl syndrome Laurence–Moon syndrome
Combined/other, known locus	2 (Feingold syndrome) 3 (Zimmermann–Laband syndrome) 4/13 (Fraser syndrome) 8 (Branchio-oto-renal syndrome, CHARGE syndrome) 12 (Keutel syndrome, Timothy syndrome) 15 (Marfan syndrome) 19 (Donohue syndrome) Multiple Fryns syndrome