“…The mutation of this gene alters RAS-mitogen activated protein kinase (MAPK) pathway, thereby affecting extracellular ligands like growth factors, cytokines, and hormones on their cellular functions. 9 Van der Burg et al 10 developed a scoring system where presence of one major/ two minor and two major/ one minor sign is required for the diagnosis of Noonan syndrome (Table 2). In the present case, patients birth record revelaved normal height and weight, but his growth pattern had decreased to the 3 rd percentile over years which in consistent with the findings of Athota et al 11 and Kouz et al 12 The distinguishing features evident in this case include, short stature, chest deformity, congenital cardiac abnormalities, hypertelorism, ptosis, facial deformity, low set ears, deep grooved philtrum and low posterior hair line.…”