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Pirtea P, Heggarty E, Hagege E, Tran C, de Ziegler D, Farabet C, Filali M, Poulain M, Ayoubi JM. Successful ART outcome in a woman with McCune-Albright syndrome: a case report and literature review. J Assist Reprod Genet 2023; 40:1669-1675. [PMID: 37278881 PMCID: PMC10352189 DOI: 10.1007/s10815-023-02844-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2023] [Accepted: 05/29/2023] [Indexed: 06/07/2023] Open
Abstract
McCune-Albright syndrome (MAS) is a rare genetic disease affecting multiple organs, including endocrine tissues. This endocrinopathy is sometimes responsible for infertility, as it may induce an independent functioning of the ovaries leading to anovulatory cycles. This case report describes the infertility journey of a 22-year-old female who had early puberty and irregular periods with high estrogen and progesterone levels, low FSH and LH (on day 3 of her menstrual cycle), and a multi-cystic right ovary. She received several infertility treatments: initially in vitro oocyte maturation (IVM) followed by cyst transvaginal ultrasound-guided aspiration, all unsuccessful. A right hemi-ovariectomy was performed that eventually restored regular cycles and made it possible to perform ovarian stimulation (OS) and in vitro fertilization (IVF). Live birth was obtained after the first embryo transfer.
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Affiliation(s)
- Paul Pirtea
- Department of Obstetrics, Gynecology and Reproductive Medicine, Foch Hospital, 92150, Suresnes, France.
| | - Estelle Heggarty
- Department of Obstetrics, Gynecology and Reproductive Medicine, Foch Hospital, 92150, Suresnes, France
| | - Estelle Hagege
- Department of Obstetrics, Gynecology and Reproductive Medicine, Foch Hospital, 92150, Suresnes, France
| | - Chloe Tran
- Department of Obstetrics, Gynecology and Reproductive Medicine, Foch Hospital, 92150, Suresnes, France
| | - Dominique de Ziegler
- Department of Obstetrics, Gynecology and Reproductive Medicine, Foch Hospital, 92150, Suresnes, France
| | - Clemence Farabet
- Department of Obstetrics, Gynecology and Reproductive Medicine, Foch Hospital, 92150, Suresnes, France
| | - Meryem Filali
- Department of Obstetrics, Gynecology and Reproductive Medicine, Foch Hospital, 92150, Suresnes, France
| | - Marine Poulain
- Department of Obstetrics, Gynecology and Reproductive Medicine, Foch Hospital, 92150, Suresnes, France
| | - Jean Marc Ayoubi
- Department of Obstetrics, Gynecology and Reproductive Medicine, Foch Hospital, 92150, Suresnes, France
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Treatment of primary infertility in McCune-Albright syndrome: a case report of a successful in vitro fertilization cycle. F S Rep 2021; 2:352-356. [PMID: 34553163 PMCID: PMC8441555 DOI: 10.1016/j.xfre.2021.05.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2021] [Revised: 05/13/2021] [Accepted: 05/14/2021] [Indexed: 11/22/2022] Open
Abstract
Objective To report a case in which pregnancy and live birth were achieved in an infertile patient with McCune-Albright syndrome via in vitro fertilization (IVF). Design Case report. Setting University hospital. Patient(s) A 29-year-old woman with McCune-Albright syndrome who presented with primary infertility due to ovulatory dysfunction and bilateral tubal blockage. Intervention(s) In vitro fertilization without unilateral oophorectomy. Main Outcome Measure(s) Live birth after IVF treatment. Result(s) Fresh IVF stimulation and bilateral oocyte retrieval yielded 12 oocytes and 4 top quality embryos. Fresh single embryo transfer did not result in pregnancy. Live birth occurred after the second frozen embryo transfer cycle. Conclusion(s) In vitro fertilization can lead to ongoing pregnancy in infertile patients with McCune-Albright syndrome without requiring unilateral oophorectomy.
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Agopiantz M, Sorlin A, Vabres P, Leheup B, Carmignac V, Malaplate-Armand C, Diligent C, Bonnet C, Gauchotte G. Fertility in McCune Albright syndrome female: A case study focusing on AMH as a marker of ovarian dysfunction and a literature review. J Gynecol Obstet Hum Reprod 2021; 50:102171. [PMID: 34048958 DOI: 10.1016/j.jogoh.2021.102171] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2021] [Revised: 05/19/2021] [Accepted: 05/23/2021] [Indexed: 11/17/2022]
Abstract
BACKGROUND The molecular basis of McCune Albright syndrome (MAS) is a recurrent GNAS Postzygotic gain of function sporadic mutation, resulting in a mosaic disease. Most of girls present precocious puberty, caused by the development of recurrent ovarian cysts with autonomous Hyperestrogenic stimulation. After menarche, the majority of patients with ovarian GNAS mutation have menstrual disturbances and infertility. OBJECTIVES We wanted to focus on the fertility of MAS females and propose an appropriate management, by a detailed case report and an exhaustive review of the literature on fertility and pregnancy in MAS females. RESULTS We present the case of a 29-year-old MAS female, who had previously undergone a unilateral ovariectomy and was managed by in vitro fertilization (IVF). Eight oocytes with many morphological abnormalities were retrieved. The GNAS mutation was found at a low frequency in follicular cells. The ovarian histopathological examination showed developing follicles of all stages, strongly expressing AMH by immunohistochemistry. In addition, AMH was high (45.5 pmol/L) and the AMH / AFC ratio (5.69 pmol/L per follicle) was much higher than in PCOS and control groups (2.16, and 1.34 respectively). CONCLUSIONS Ovarian and endometrial involvement can be responsible for infertility in MAS women. IVF and oophorectomy may be useful in management. The genetic characterization of the different tissues may have a prognostic utility. Moreover, we suggest that the AMH could be a marker of the ovarian activity in MAS. Further studies are needed to clarify the potential oocyte abnormalities and the risk of miscarriages in order to guide genetic counseling.
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Affiliation(s)
- Mikaël Agopiantz
- Department of Reproductive Medicine, CHRU de Nancy, Université de Lorraine, Nancy, France; INSERM U1256, Université de Lorraine, Vandœuvre-lès-Nancy, France.
| | - Arthur Sorlin
- Department of Genetics, CHRU de Nancy, Université de Lorraine, Vandœuvre-lès-Nancy, France; EA 4271, Université de Bourgogne Franche-Comté, Dijon, France
| | - Pierre Vabres
- EA 4271, Université de Bourgogne Franche-Comté, Dijon, France; Department of Dermatology, CHU de Dijon, Université de Bourgogne Franche-Comté, Dijon, France
| | - Bruno Leheup
- INSERM U1256, Université de Lorraine, Vandœuvre-lès-Nancy, France; Department of Medical Genetics, CHRU de Nancy, Université de Lorraine, Vandœuvre-lès-Nancy, France
| | | | | | - Catherine Diligent
- Department of Biology of Reproduction, CHRU de Nancy, Université de Lorraine, Nancy, France
| | - Céline Bonnet
- INSERM U1256, Université de Lorraine, Vandœuvre-lès-Nancy, France; Department of Genetics, CHRU de Nancy, Université de Lorraine, Vandœuvre-lès-Nancy, France
| | - Guillaume Gauchotte
- INSERM U1256, Université de Lorraine, Vandœuvre-lès-Nancy, France; Department of Pathology, CHRU de Nancy, Université de Lorraine, Nancy, France
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Abstract
Pituitary adenomas are common intracranial neoplasms, with diverse phenotypes. Most of these tumors occur sporadically and are not part of genetic disorders. Over the last decades numerous genetic studies have led to identification of somatic and germline mutations associated with pituitary tumors, which has advanced the understanding of pituitary tumorigenesis. Exploring the genetic background of pituitary neuroendocrine tumors can lead to early diagnosis associated with better outcomes, and their molecular mechanisms should lead to novel targeted therapies even for sporadic tumors. This article summarizes the genes and the syndromes associated with pituitary tumors.
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Affiliation(s)
- Sayka Barry
- Centre for Endocrinology, William Harvey Research Institute, Barts and The London School of Medicine, Queen Mary University of London, Charterhouse Square, London EC1M 6BQ, UK
| | - Márta Korbonits
- Centre for Endocrinology, William Harvey Research Institute, Barts and The London School of Medicine, Queen Mary University of London, Charterhouse Square, London EC1M 6BQ, UK.
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Boyce AM, Casey RK, Ovejero Crespo D, Murdock CM, Estrada A, Guthrie LC, Brillante BA, Gomez-Lobo V, Nieman LK, Collins MT. Gynecologic and reproductive outcomes in fibrous dysplasia/McCune-Albright syndrome. Orphanet J Rare Dis 2019; 14:90. [PMID: 31036049 PMCID: PMC6489337 DOI: 10.1186/s13023-019-1057-x] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2018] [Accepted: 04/08/2019] [Indexed: 01/19/2023] Open
Abstract
Background Autonomous ovarian activation with recurrent estrogen-producing cysts is a hallmark feature of the rare bone and endocrine disorder fibrous dysplasia/McCune-Albright syndrome. Precocious puberty in girls with McCune-Albright syndrome has been well-described, however long-term effects on gynecologic and reproductive function are unknown. Concerningly, case reports have described poor skeletal outcomes associated with pregnancy in women with fibrous dysplasia. Methods Thirty-nine women with fibrous dysplasia/McCune-Albright syndrome were evaluated as part of a natural history study. Clinical, radiographic, and biochemical data were reviewed. Women were contacted to obtain detailed menstrual and reproductive histories. Results Abnormal uterine bleeding affected 77% of women (30/39), and was associated with severe anemia requiring blood transfusion in 3 cases. Nine women underwent hysterectomy for management of bleeding, including 67% (6/9) at the unusually young age of less than age 35 years. Infertility affected 43% of women (9/21), including 2 women who developed primary ovarian insufficiency after undergoing surgical treatment of ovarian cysts. Of 25 spontaneous pregnancies in 14 women, 35% (8) were unplanned. Among the 14 pregnancies, pregnancy was associated with no change in bone pain in 7 subjects (53%), increased bone pain in 4 subjects (31%), and decreased bone pain in 2 subjects (15%). No additional skeletal complications were reported during pregnancies. Conclusions Women with fibrous dysplasia/McCune-Albright syndrome report a high prevalence of gynecologic morbidity and reduced fertility. There is no clear association between pregnancy and poor skeletal outcomes in this population.
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Affiliation(s)
- Alison M Boyce
- Skeletal Disorders & Mineral Homeostasis Section, National Institute of Dental and Craniofacial Research, National Institutes of Health, 30 Convent Drive Room 218 MSC 4320, Bethesda, MD, USA.
| | - Rachel K Casey
- Division of Pediatric and Adolescent Gynecology, Department of Obstetrics and Gynecology, MedStar Washington Hospital Center, Children's National Health System, Washington, D.C., USA.,Pediatric and Adolescent Gynecology, Inova Health System, Pediatric Specialists of Virginia, Fairfax, VA, USA
| | - Diana Ovejero Crespo
- Skeletal Disorders & Mineral Homeostasis Section, National Institute of Dental and Craniofacial Research, National Institutes of Health, 30 Convent Drive Room 218 MSC 4320, Bethesda, MD, USA.,Musculoskeletal Research Unit, Hospital del Mar Institute of Medical Investigation (IMIM), Barcelona, Spain.,National Research Council, Institute of Clinical Physiology, Lecce, Italy
| | - Cynthia M Murdock
- Program in Reproductive and Adult Endocrinology, The Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health, Bethesda, MD, USA.,Reproductive Medicine Associates of Connecticut, Norwalk, CT, USA
| | - Andrea Estrada
- Skeletal Disorders & Mineral Homeostasis Section, National Institute of Dental and Craniofacial Research, National Institutes of Health, 30 Convent Drive Room 218 MSC 4320, Bethesda, MD, USA.,Division of Endocrinology & Diabetes, Children's National Health System, 111 Michigan Ave NW, Washington, D.C, USA
| | - Lori C Guthrie
- Skeletal Disorders & Mineral Homeostasis Section, National Institute of Dental and Craniofacial Research, National Institutes of Health, 30 Convent Drive Room 218 MSC 4320, Bethesda, MD, USA
| | - Beth A Brillante
- Skeletal Disorders & Mineral Homeostasis Section, National Institute of Dental and Craniofacial Research, National Institutes of Health, 30 Convent Drive Room 218 MSC 4320, Bethesda, MD, USA
| | - Veronica Gomez-Lobo
- Division of Pediatric and Adolescent Gynecology, Department of Obstetrics and Gynecology, MedStar Washington Hospital Center, Children's National Health System, Washington, D.C., USA
| | - Lynette K Nieman
- Program in Reproductive and Adult Endocrinology, The Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health, Bethesda, MD, USA
| | - Michael T Collins
- Skeletal Disorders & Mineral Homeostasis Section, National Institute of Dental and Craniofacial Research, National Institutes of Health, 30 Convent Drive Room 218 MSC 4320, Bethesda, MD, USA
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Chevalier N, Paris F, Fontana S, Delotte J, Gaspari L, Ferrari P, Sultan C, Fénichel P. Postpubertal Persistent Hyperestrogenemia in McCune-Albright Syndrome: Unilateral Oophorectomy Improved Fertility but Detected an Unexpected Borderline Epithelial Ovarian Tumor. J Pediatr Adolesc Gynecol 2015; 28:e169-72. [PMID: 26321108 DOI: 10.1016/j.jpag.2015.04.001] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/03/2015] [Revised: 03/16/2015] [Accepted: 04/01/2015] [Indexed: 11/25/2022]
Abstract
BACKGROUND McCune-Albright syndrome (MAS), due to a somatic mutation of the GNAS1 gene, begins usually in girls with peripheral precocious puberty. Ovarian autonomy may persist in adulthood with acyclic hyperestrogenemia, infertility, and a potential risk of estrogen-dependent cancer. CASE A 22-year-old woman, with MAS, was referred for infertility with left macropolycystic ovary, hyperestrogenemia, and chronic anovulation unsuccessfully treated by controlled hyperstimulation. Once ovarian cyst punctures and cDNA analysis verified that GNAS1 mutation was restricted to the left ovary, unilateral ovariectomy was performed. It improved right ovarian function, allowed an in vitro fertilization-induced pregnancy, but revealed an unexpected borderline epithelial ovarian tumor. SUMMARY AND CONCLUSION Several breast cancers have already been reported in young MAS patients but not a borderline epithelial ovarian tumor. In this context, we would recommend that persistent hyperestrogenemia in an adult be corrected and gynecological follow-up of the breasts, ovaries, and endometrium be implemented.
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Affiliation(s)
- Nicolas Chevalier
- Department of Endocrinology and Reproductive Medicine, University Hospital of Nice, INSERM U1065/C3M, Nice, France
| | - Françoise Paris
- Department of Hormonology and Pediatric Endocrinology, University Hospital of Montpellier, Montpellier, France
| | - Sylvie Fontana
- Department of Endocrinology and Reproductive Medicine, University Hospital of Nice, INSERM U1065/C3M, Nice, France
| | - Jérôme Delotte
- Department of Obstetrics, Gynecology, Reproduction and Fetal Medicine, University Hospital of Nice, Nice, France
| | - Laura Gaspari
- Department of Hormonology and Pediatric Endocrinology, University Hospital of Montpellier, Montpellier, France
| | - Patricia Ferrari
- Biochemistry Department, University Hospital of Nice, Nice, France
| | - Charles Sultan
- Department of Obstetrics, Gynecology, Reproduction and Fetal Medicine, University Hospital of Nice, Nice, France
| | - Patrick Fénichel
- Department of Endocrinology and Reproductive Medicine, University Hospital of Nice, INSERM U1065/C3M, Nice, France.
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Boyce AM, Chong WH, Shawker TH, Pinto PA, Linehan WM, Bhattacharryya N, Merino MJ, Singer FR, Collins MT. Characterization and management of testicular pathology in McCune-Albright syndrome. J Clin Endocrinol Metab 2012; 97:E1782-90. [PMID: 22745241 PMCID: PMC3431566 DOI: 10.1210/jc.2012-1791] [Citation(s) in RCA: 47] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
CONTEXT The testicular phenotype in McCune-Albright syndrome (MAS) has not been well characterized. Boys present with a relatively low incidence of precocious puberty in comparison with girls. Radiographic and histological studies are limited to small series and case reports, which report testicular microlithiasis and Sertoli cell hyperplasia. OBJECTIVE Our objective was to characterize the biochemical, radiological, and histological spectrum and clinical management of testicular pathology in males with MAS. PATIENTS, DESIGN, AND SETTING Fifty-four males with MAS participated in this prospective cohort study at a clinical research center. INTERVENTION Evaluation included testicular exam, pubertal staging, testicular ultrasound, measurement of LH, FSH, and testosterone. Orchiectomies were performed when considered clinically indicated. MAIN OUTCOME MEASURE Prevalence and characterization of ultrasound lesions with correlation to histology were evaluated. RESULTS Of 54 males, 44 (81%) presented with ultrasound abnormalities including hyperechoic lesions (49%), hypoechoic lesions (30%), microlithiasis (30%), heterogeneity (47%), and focal calcifications (11%). Eight subjects underwent orchiectomy revealing large foci of Leydig cell hyperplasia, which could not be definitively distinguished from Leydig cell tumor. After no subjects developed clinical malignancy, a conservative approach was instituted, and subsequent subjects were followed with serial imaging. Testosterone and gonadotropins were normal in subjects without precocious puberty or pituitary disease. Eleven (21%) presented with precocious puberty, and a combination of aromatase inhibitors, androgen receptor blockers, and leuprolide resulted in improved predicted adult height. In addition, the first cases of testicular adrenal rest and bilateral germ cell tumors in association with MAS are presented. CONCLUSIONS Contrary to prevailing thinking, the incidence of gonadal pathology in MAS is equal in males and females. The predominant histopathological finding was Leydig cell hyperplasia, which carries a low risk of malignant transformation and can be managed conservatively.
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Affiliation(s)
- Alison M Boyce
- Skeletal Clinical Studies Unit, Craniofacial and Skeletal Diseases Branch, National Institute of Dental and Craniofacial Research, National Institutes of Health, Bethesda, Maryland 20892, USA.
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Artini PG, Ruggiero M, Papini F, Valentino V, Uccelli A, Cela V, Genazzani AR. Chromosomal abnormalities in women with premature ovarian failure. Gynecol Endocrinol 2010; 26:717-24. [PMID: 20653407 DOI: 10.3109/09513590.2010.500427] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Premature ovarian failure is a complex disorder that results in the early loss of ovarian function; however this disease must be separated from early menopause because these patients can sporadically ovulate and in literature are described pregnancies. The aetiology and the patho-physiology of premature ovarian failure are still matter of debate, but is commonly accepted that genetic factors play an important role. This review is aimed to present an overview of known inherited factor implied in the pathogenesis of this disorder to help physician in the counselling of affected pregnant women.
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Affiliation(s)
- Paolo Giovanni Artini
- Division of Obstetrics and Gynecology, Department of Reproductive Medicine and Child Development, University of Pisa, Via Roma 56, 56126 Pisa, Italy.
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