Document Detail

Pulmonary hypertension in patients with neurofibromatosis type I.
MedLine Citation:
PMID:  21512413     Owner:  NLM     Status:  MEDLINE    
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.
David Montani; Florence Coulet; Barbara Girerd; Mélanie Eyries; Emmanuel Bergot; Hervé Mal; Giuseppina Biondi; Claire Dromer; Thomas Hugues; Charles Marquette; Caroline O'Connell; Dermot S O'Callaghan; Laurent Savale; Xavier Jaïs; Peter Dorfmüller; Hugues Begueret; Laurent Bertoletti; Olivier Sitbon; Christine Bellanné-Chantelot; Gérard Zalcman; Gérald Simonneau; Marc Humbert; Florent Soubrier
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Publication Detail:
Type:  Case Reports; Journal Article    
Journal Detail:
Title:  Medicine     Volume:  90     ISSN:  1536-5964     ISO Abbreviation:  Medicine (Baltimore)     Publication Date:  2011 May 
Date Detail:
Created Date:  2011-05-04     Completed Date:  2011-07-07     Revised Date:  2012-06-25    
Medline Journal Info:
Nlm Unique ID:  2985248R     Medline TA:  Medicine (Baltimore)     Country:  United States    
Other Details:
Languages:  eng     Pagination:  201-11     Citation Subset:  AIM; IM    
Faculté de Médecine, Université Paris-Sud, Kremlin-Bicêtre, France.
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MeSH Terms
Bone Morphogenetic Protein Receptors, Type II / genetics,  metabolism
Endothelium, Vascular / metabolism
Hypertension, Pulmonary / diagnosis,  etiology*
Middle Aged
Mutation / genetics
Myocytes, Smooth Muscle / metabolism
Neurofibromatosis 1 / complications*,  diagnosis,  genetics*
Neurofibromin 1 / genetics,  metabolism
Reg. No./Substance:
0/Neurofibromin 1; EC protein, human; EC Morphogenetic Protein Receptors, Type II

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