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Although the penetration of the disease is almost 100% in adults, there is good genotype-phenotype correlation in only a very few cases, and such correlation is not usually seen even in the same family or identical twins.5760 The exceptions are cases of complete microdeletion of the NF1 gene of 1.4 Mb (patients with such mutations have a severe form of the disease, with numerous and early-onset neurofibromas, cognitive impairment, dysmorphic features, and a tendency to develop malignancies),58,61 deletions of 3 base pairs in exon 17 affecting a single amino acid, p.Met992del (cases present CaLS and freckling without neurofibromas),60 and mutations in codon 1809 of exon 29, which presents with pulmonary stenosis and short stature (phenotypic characteristics of Noonan syndrome).59 Problems with the genetic study have led some authors to consider routine genetic studies unnecessary in small children who still do not meet the criteria for the disease, as: 1) 95% of children will meet the clinical criteria at the age of 8 years

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