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Dejkhamron P, Ittiwut C, TangNgam H, Sunkonkit K, Natesirinilkul R, Suphapeetiporn K, Shotelersuk V. A Novel GNAS Mutation Causing Isolated Infantile Cushing's Syndrome. Horm Res Paediatr 2020; 92:196-202. [PMID: 31362300 DOI: 10.1159/000501169] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/25/2018] [Accepted: 05/26/2019] [Indexed: 01/30/2023] Open
Abstract
Infantile Cushing's syndrome is potentially found as part of McCune-Albright syndrome (MAS) which is caused by postzygotic somatic mutations of the GNAS gene. MAS is typically characterized by a triad of polyostotic fibrous dysplasia, café-au-lait skin pigmentation, and precocious puberty or other endocrine hyperfunction. Here, we describe a 2-month-old female infant with features of Cushing's syndrome without café au lait spots, polyostotic fibrous dysplasia, and clinical evidence of other endocrine hyperfunction. Investigations demonstrated adrenocorticotropic hormone-independent Cushing's syndrome with bilateral adrenal gland enlargement. Whole-exome sequencing of leukocytes identified a de novo heterozygous novel missense mutation (c.521G>A, p.Cys174Tyr) in the GNAS gene. The patient experienced clinical improvement of Cushing's syndrome during ketoconazole treatment. Her clinical course was complicated by Pneumocystis jiroveci pneumonia. She also had shortened activated partial thromboplastin time indicating a hypercoagulable state and resulting in pulmonary embolism. She eventually manifested gonadotropin-independent precocious puberty at the age of 13 months after ketoco-nazole was discontinued. This patient demonstrated that Cushing syndrome can be the presenting sign of MAS in infancy. A high index of suspicion followed by genetic analysis is essential in order to establish a diagnosis.
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Affiliation(s)
- Prapai Dejkhamron
- Department of Pediatrics, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand
| | - Chupong Ittiwut
- Center of Excellence for Medical Genomics, Department of Pediatrics, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand.,Excellence Center for Medical Genetics, King Chulalongkorn Memorial Hospital, the Thai Red Cross Society, Bangkok, Thailand
| | | | - Kanokkarn Sunkonkit
- Department of Pediatrics, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand
| | | | - Kanya Suphapeetiporn
- Center of Excellence for Medical Genomics, Department of Pediatrics, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand, .,Excellence Center for Medical Genetics, King Chulalongkorn Memorial Hospital, the Thai Red Cross Society, Bangkok, Thailand,
| | - Vorasuk Shotelersuk
- Center of Excellence for Medical Genomics, Department of Pediatrics, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand.,Excellence Center for Medical Genetics, King Chulalongkorn Memorial Hospital, the Thai Red Cross Society, Bangkok, Thailand
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Pierce M, Scottoline B. Neonatal McCune-Albright syndrome with survival beyond two years. Am J Med Genet A 2016; 170:3008-3012. [PMID: 27411099 DOI: 10.1002/ajmg.a.37841] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2016] [Accepted: 06/16/2016] [Indexed: 01/26/2023]
Abstract
McCune-Albright syndrome (MAS) is a rare disease resulting from a somatic, mosaic mutation of GNAS1 encoding the Gs α subunit of the G-protein coupled membrane receptor responsible for multiple hormonal signaling cascades. We present a patient with neonatal MAS who initially presented with neonatal diabetes and concern for congenital cardiac disease, and subsequently was found to have significant ACTH-independent neonatal Cushing syndrome. Her course included multi-system organ involvement, although she initially did not have obvious findings consistent with the MAS classic triad of café-au-lait macules, fibrous dysplasia, or peripheral precocious puberty. After medical and surgical treatment, she remains the only reported survivor of neonatal MAS. This clinical report alerts clinicians to the possibility of this disease in neonates with non-classical endocrine and non-endocrine manifestations of MAS, and demonstrates that this very early presentation is potentially survivable. © 2016 Wiley Periodicals, Inc.
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Affiliation(s)
- Melinda Pierce
- Division of Endocrinology, Department of Pediatrics, Oregon Health and Science University, Portland, Oregon.
| | - Brian Scottoline
- Division of Neonatal-Perinatal Medicine, Department of Pediatrics, Oregon Health and Science University, Portland, Oregon
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Halioui-Louhaichi S, Dridi Y, Azzabi O, Selmi I, Fetni I, Siala N, Maherzi A. [Recovery of Cushing syndrome revealing McCune-Albright syndrome]. Arch Pediatr 2015; 23:61-5. [PMID: 26552628 DOI: 10.1016/j.arcped.2015.09.018] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2015] [Revised: 05/21/2015] [Accepted: 09/17/2015] [Indexed: 11/16/2022]
Abstract
Cushing syndrome (CS) is a rare feature of McCune-Albright syndrome. Treatments consist of bilateral adrenalectomy followed by lifelong glucocorticoid and mineralocorticoid treatment. However, cases of spontaneous remission of CS have been reported in the literature. We report a case of McCune-Albright syndrome with CS treated with metyrapone for 30 months with prolonged remission after a 12-year follow-up. Adrenalectomy may be avoided in some cases of CS caused by McCune-Albright syndrome. Metyrapone could be a good alternative to surgical treatment.
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Affiliation(s)
- S Halioui-Louhaichi
- Service de pédiatrie, hôpital Mongi Slim La Marsa, faculté de médecine de Tunis, université de Tunis El Manar, La Marsa, Tunisie.
| | - Y Dridi
- Service de pédiatrie, hôpital Mongi Slim La Marsa, faculté de médecine de Tunis, université de Tunis El Manar, La Marsa, Tunisie
| | - O Azzabi
- Service de pédiatrie, hôpital Mongi Slim La Marsa, faculté de médecine de Tunis, université de Tunis El Manar, La Marsa, Tunisie
| | - I Selmi
- Service de pédiatrie, hôpital Mongi Slim La Marsa, faculté de médecine de Tunis, université de Tunis El Manar, La Marsa, Tunisie
| | - I Fetni
- Service de pédiatrie, hôpital Mongi Slim La Marsa, faculté de médecine de Tunis, université de Tunis El Manar, La Marsa, Tunisie
| | - N Siala
- Service de pédiatrie, hôpital Mongi Slim La Marsa, faculté de médecine de Tunis, université de Tunis El Manar, La Marsa, Tunisie
| | - A Maherzi
- Service de pédiatrie, hôpital Mongi Slim La Marsa, faculté de médecine de Tunis, université de Tunis El Manar, La Marsa, Tunisie
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