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Costello syndrome is a disorder that affects many parts of the body. This condition is characterized by delayed development and intellectual disability, loose folds of skin (which are especially noticeable on the hands and feet), unusually flexible joints, and distinctive facial features including a large mouth with full lips. Heart problems are common, including an abnormal heartbeat (arrhythmia), structural heart defects, and a type of heart disease that enlarges and weakens the heart muscle (hypertrophic cardiomyopathy). Infants with Costello syndrome may be larger than average at birth, but most have difficulty feeding and grow more slowly than other children. People with this condition have relatively short stature and may have reduced growth hormone levels. Other signs and symptoms of Costello syndrome can include tight Achilles tendons (which connect the calf muscles to the heel), weak muscle tone (hypotonia), a structural abnormality of the brain called a Chiari I malformation, skeletal abnormalities, dental problems, and problems with vision.

genetic conditions
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1. Introduction

Beginning in early childhood, people with Costello syndrome are at an increased risk of developing certain cancerous and noncancerous tumors. The most common noncancerous tumors associated with this condition are papillomas, which are small, wart-like growths that usually develop around the nose and mouth or near the anus. The most common cancerous tumor associated with Costello syndrome is a childhood cancer called rhabdomyosarcoma, which begins in muscle tissue. Neuroblastoma, a tumor that arises in developing nerve cells, also has been reported in children and adolescents with this syndrome. In addition, some teenagers with Costello syndrome have developed transitional cell carcinoma, a form of bladder cancer that is usually seen in older adults.

The signs and symptoms of Costello syndrome overlap significantly with those of two other genetic conditions, cardiofaciocutaneous syndrome (CFC syndrome) and Noonan syndrome. In affected infants, it can be difficult to tell the three conditions apart based on their physical features. However, the conditions can be distinguished by their genetic cause and by specific patterns of signs and symptoms that develop later in childhood.

2. Frequency

This condition is very rare; it probably affects 200 to 300 people worldwide. Reported estimates of Costello syndrome prevalence range from 1 in 300,000 to 1 in 1.25 million people.

3. Causes

Mutations in the HRAS gene cause Costello syndrome. This gene provides instructions for making a protein called H-Ras, which is part of a pathway that helps control cell growth and division. Mutations that cause Costello syndrome lead to the production of an H-Ras protein that is abnormally turned on (active). The overactive protein directs cells to grow and divide constantly, which can lead to the development of cancerous and noncancerous tumors. It is unclear how mutations in the HRAS gene cause the other features of Costello syndrome, but many of the signs and symptoms probably result from cell overgrowth and abnormal cell division.

Some people with signs and symptoms like those of Costello syndrome do not have an identified mutation in the HRAS gene. These individuals may actually have CFC syndrome or Noonan syndrome, which are caused by mutations in related genes. The proteins produced from these genes interact with one another and with the H-Ras protein as part of the same cell growth and division pathway. These interactions help explain why mutations in different genes can cause conditions with overlapping signs and symptoms.

4. Inheritance

Costello syndrome is considered to be an autosomal dominant condition, which means one copy of the altered gene in each cell is sufficient to cause the disorder. Almost all reported cases have resulted from new gene mutations and have occurred in people with no history of the disorder in their family.

5. Other Names for This Condition

  • faciocutaneoskeletal syndrome
  • FCS syndrome

References

  1. Abe Y, Aoki Y, Kuriyama S, Kawame H, Okamoto N, Kurosawa K, Ohashi H, MizunoS, Ogata T, Kure S, Niihori T, Matsubara Y; Costello and CFC syndrome study groupin Japan. Prevalence and clinical features of Costello syndrome andcardio-facio-cutaneous syndrome in Japan: findings from a nationwideepidemiological survey. Am J Med Genet A. 2012 May;158A(5):1083-94. doi:10.1002/ajmg.a.35292.
  2. Aoki Y, Niihori T, Kawame H, Kurosawa K, Ohashi H, Tanaka Y, Filocamo M, Kato K, Suzuki Y, Kure S, Matsubara Y. Germline mutations in HRAS proto-oncogene causeCostello syndrome. Nat Genet. 2005 Oct;37(10):1038-40.
  3. Axelrad ME, Schwartz DD, Fehlis JE, Hopkins E, Stabley DL, Sol-Church K, GrippKW. Longitudinal course of cognitive, adaptive, and behavioral characteristics inCostello syndrome. Am J Med Genet A. 2009 Dec;149A(12):2666-72. doi:10.1002/ajmg.a.33126.
  4. Estep AL, Tidyman WE, Teitell MA, Cotter PD, Rauen KA. HRAS mutations inCostello syndrome: detection of constitutional activating mutations in codon 12and 13 and loss of wild-type allele in malignancy. Am J Med Genet A. 2006 Jan1;140(1):8-16.
  5. Gripp KW, Lin AE, Stabley DL, Nicholson L, Scott CI Jr, Doyle D, Aoki Y,Matsubara Y, Zackai EH, Lapunzina P, Gonzalez-Meneses A, Holbrook J, Agresta CA, Gonzalez IL, Sol-Church K. HRAS mutation analysis in Costello syndrome: genotype and phenotype correlation. Am J Med Genet A. 2006 Jan 1;140(1):1-7.
  6. Gripp KW, Lin AE. Costello syndrome: a Ras/mitogen activated protein kinasepathway syndrome (rasopathy) resulting from HRAS germline mutations. Genet Med.2012 Mar;14(3):285-92. doi: 10.1038/gim.0b013e31822dd91f. Review.
  7. Gripp KW, Morse LA, Axelrad M, Chatfield KC, Chidekel A, Dobyns W, Doyle D,Kerr B, Lin AE, Schwartz DD, Sibbles BJ, Siegel D, Shankar SP, Stevenson DA,Thacker MM, Weaver KN, White SM, Rauen KA. Costello syndrome: Clinical phenotype,genotype, and management guidelines. Am J Med Genet A. 2019 Sep;179(9):1725-1744.doi: 10.1002/ajmg.a.61270.
  8. Gripp KW, Rauen KA. Costello Syndrome. 2006 Aug 29 [updated 2019 Aug 29]. In: Adam MP, Ardinger HH, Pagon RA, Wallace SE, Bean LJH, Stephens K, Amemiya A,editors. GeneReviews® [Internet]. Seattle (WA): University of Washington,Seattle; 1993-2020. Available from http://www.ncbi.nlm.nih.gov/books/NBK1507/
  9. Gripp KW, Stabley DL, Nicholson L, Hoffman JD, Sol-Church K. Somatic mosaicismfor an HRAS mutation causes Costello syndrome. Am J Med Genet A. 2006 Oct15;140(20):2163-9.
  10. Kerr B, Delrue MA, Sigaudy S, Perveen R, Marche M, Burgelin I, Stef M, Tang B,Eden OB, O'Sullivan J, De Sandre-Giovannoli A, Reardon W, Brewer C, Bennett C,Quarell O, M'Cann E, Donnai D, Stewart F, Hennekam R, Cavé H, Verloes A, PhilipN, Lacombe D, Levy N, Arveiler B, Black G. Genotype-phenotype correlation inCostello syndrome: HRAS mutation analysis in 43 cases. J Med Genet. 2006May;43(5):401-5.
  11. Quezada E, Gripp KW. Costello syndrome and related disorders. Curr OpinPediatr. 2007 Dec;19(6):636-44.
  12. Rauen KA. Distinguishing Costello versus cardio-facio-cutaneous syndrome: BRAFmutations in patients with a Costello phenotype. Am J Med Genet A. 2006 Aug1;140(15):1681-3.
  13. Rauen KA. HRAS and the Costello syndrome. Clin Genet. 2007 Feb;71(2):101-8.Review.
  14. Stevenson DA, Yang FC. The musculoskeletal phenotype of the RASopathies. Am J Med Genet C Semin Med Genet. 2011 May 15;157C(2):90-103. doi:10.1002/ajmg.c.30296.
  15. White SM, Graham JM Jr, Kerr B, Gripp K, Weksberg R, Cytrynbaum C, Reeder JL, Stewart FJ, Edwards M, Wilson M, Bankier A. The adult phenotype in Costellosyndrome. Am J Med Genet A. 2005 Jul 15;136(2):128-35. Erratum in: Am J Med GenetA. 2005 Nov 15;139(1):55.
  16. Zampino G, Pantaleoni F, Carta C, Cobellis G, Vasta I, Neri C, Pogna EA, DeFeo E, Delogu A, Sarkozy A, Atzeri F, Selicorni A, Rauen KA, Cytrynbaum CS,Weksberg R, Dallapiccola B, Ballabio A, Gelb BD, Neri G, Tartaglia M. Diversity, parental germline origin, and phenotypic spectrum of de novo HRAS missensechanges in Costello syndrome. Hum Mutat. 2007 Mar;28(3):265-72.
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Update Time: 24 Dec 2020
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    Yin, N. Costello Syndrome. Encyclopedia. Available online: https://encyclopedia.pub/entry/5022 (accessed on 03 October 2022).
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