Pulmonary Hypertension in Patients With Neurofibromatosis Type I
- 1 May 2011
- journal article
- case report
- Published by Ovid Technologies (Wolters Kluwer Health) in Medicine
- Vol. 90 (3), 201-211
- https://doi.org/10.1097/md.0b013e31821be2b7
Abstract
Neurofibromatosis type I (NF1) is a rare genetic disease caused by mutations in the NF1 gene, which codes for tumor suppressor neurofibromin. NF1 is transmitted as an autosomal dominant and fully penetrant trait with no sex predominance. Precapillary pulmonary hypertension (PH) is a severe complication of NF1, initially described in patients with advanced parenchymal lung disease, which may complicate the course of NF1. We conducted this study to describe clinical, functional, radiologic, and hemodynamic characteristics and outcome of patients with NF1-associated PH. We identified 8 new cases of NF1-associated PH in patients carrying a NF1 gene mutation. No bone morphogenic protein receptor 2 (BMPR2) point mutation or large size rearrangements were identified. Seven female patients and 1 male patient were reported, suggesting a possible female predominance. PH occurred late in the course of the disease (median age, 62 yr; range, 53-68 yr). Dyspnea and signs of right heart failure were the major symptoms leading to the diagnosis of PH. At diagnosis, patients had severe hemodynamic impairment with low cardiac index (median, 2.3 L/min per m2; range, 1.9-4.7) and elevated indexed pulmonary vascular resistance (median, 15.1 mm Hg/L/min per m2; range, 4.5-25.9). All patients were in New York Heart Association functional class III with severe exercise limitation (median 6-min walk distance, 180 m; range, 60-375 m). Most patients had associated parenchymal lung disease, but some had no or mild lung involvement with disproportionate pulmonary vascular disease. Overall, the impact of PH therapy was limited and outcomes were poor. In conclusion, PH represents a rare but severe complication of NF1, characterized by female predominance, late onset in the course of NF1, and severe functional and hemodynamic impairment. Because of poor outcome and limited impact of specific PH therapy, eligible patients require early referral for lung transplantation. Further studies are needed to better understand the pathophysiology and the role, if any, of neurofibromin in NF1-associated PH.Keywords
This publication has 46 references indexed in Scilit:
- The Neurofibromatosis Type 1 Tumor Suppressor Controls Cell Growth by Regulating Signal Transducer and Activator of Transcription-3 Activity In vitro and In vivoCancer Research, 2010
- Alterations in oestrogen metabolism: implications for higher penetrance of familial pulmonary arterial hypertension in femalesEuropean Respiratory Journal, 2009
- A Perivascular Origin for Mesenchymal Stem Cells in Multiple Human OrgansCell Stem Cell, 2008
- Endoglin germline mutation in a patient with hereditary haemorrhagic telangiectasia and dexfenfluramine associated pulmonary arterial hypertensionThorax, 2004
- TSC2 regulates VEGF through mTOR-dependent and -independent pathwaysCancer Cell, 2003
- Use of the National Institutes of Health Criteria for Diagnosis of Neurofibromatosis 1 in ChildrenPEDIATRICS, 2000
- Aberrant regulation of ras proteins in malignant tumour cells from type 1 neurofibromatosis patientsNature, 1992
- The NF1 locus encodes a protein functionally related to mammalian GAP and yeast IRA proteinsCell, 1990
- NeurofibromatosisArchives of Neurology, 1988
- Primary pulmonary hypertension in leopard syndrome.Heart, 1981