Is McCune-Albright syndrome overlooked in subjects with fibrous dysplasia of bone?
OBJECTIVE
McCune-Albright syndrome (MAS) is characterized by a clinical triad of endocrinopathies, café au lait pigmentation, and polyostotic fibrous dysplasia of bone. We hypothesized that children diagnosed with fibrous dysplasia are not routinely being evaluated for coexisting endocrine dysfunction or MAS. Our objective was to prospectively screen subjects with fibrous dysplasia for endocrine disease and G(s)alpha gene (GNAS1 )-activating mutations.


METHODS
Nine subjects who presented with fibrous dysplasia and were followed in orthopedic clinics were evaluated for other manifestations of MAS. Genomic DNA was isolated from blood, and mutation analysis of GNAS1 was performed.


RESULTS
On physical examination, 5 of 9 subjects were found to have café au lait pigmentation. Three of 9 subjects had TSH levels below the normal range. One of these subjects was found to have hyperthyroidism and was treated by total thyroidectomy. GNAS1 mutations were identified in 5 of 9 subjects with either monostotic or polyostotic fibrous dysplasia of bone.


CONCLUSIONS
We conclude that a substantial proportion of children being followed for fibrous dysplasia of bone have unrecognized clinical and laboratory features of MAS. These children are at risk for endocrinopathy and should be screened accordingly.
Hannon
Tamara S
TS
Department of Pediatrics, Section of Pediatric Endocrinology/Diabetology, James Whitcomb Riley Hospital for Children, Indianapolis, Indiana 46202, USA. tshannon@iupui.edu
Noonan
Ken
K
Steinmetz
Rosemary
R
Eugster
Erica A
EA
Levine
Michael A
MA
Pescovitz
Ora Hirsch
OH
D000293:Adolescent; D002648:Child; D002675:Child, Preschool; D004252:DNA Mutational Analysis; D017931:DNA Primers / Q000235:genetics; D004262:DNA Restriction Enzymes / Q000235:genetics; D004958:Estradiol / Q000097:blood; D005260:Female; D005357:Fibrous Dysplasia of Bone / Q000150:complications* / Q000235:genetics / Q000378:metabolism; D005359:Fibrous Dysplasia, Polyostotic / Q000150:complications* / Q000175:diagnosis / Q000453:epidemiology; D019205:GTP-Binding Protein alpha Subunits, Gs / Q000235:genetics; D019382:Human Growth Hormone / Q000097:blood; D006801:Humans; D006854:Hydrocortisone / Q000097:blood; D006980:Hyperthyroidism / Q000453:epidemiology; D015994:Incidence; D007334:Insulin-Like Growth Factor I / Q000378:metabolism; D008297:Male; D016133:Polymerase Chain Reaction; D011388:Prolactin / Q000097:blood; D011446:Prospective Studies; D011629:Puberty, Precocious / Q000453:epidemiology; D013739:Testosterone / Q000097:blood; D013963:Thyroid Hormones / Q000097:blood
D017931:DNA Primers; D013963:Thyroid Hormones; D019382:Human Growth Hormone; D013739:Testosterone; D004958:Estradiol; D007334:Insulin-Like Growth Factor I; D011388:Prolactin; D004262:DNA Restriction Enzymes; D019205:GTP-Binding Protein alpha Subunits, Gs; D006854:Hydrocortisone