McCune–Albright syndrome

Not to be confused with Albright's hereditary osteodystrophy.

McCune-Albright syndrome
Café-au-lait skin pigmentation. A) A typical lesion on the face, chest, and arm of a 5-year-old girl with McCune-Albright syndrome which demonstrates jagged "coast of Maine" borders, and the tendency for the lesions to both respect the midline and follow the developmental lines of Blaschko. B) Typical lesions that are often found on the nape of the neck and crease of the buttocks are shown (arrows).
Classification and external resources
Specialty
ICD-10	Q78.1
ICD-9-CM	756.54
OMIM	174800
DiseasesDB	7880
MedlinePlus	001217
eMedicine	ped/1386
Patient UK	McCune–Albright syndrome
MeSH	D005359
Orphanet	562

McCune–Albright syndrome, or simply Albright syndrome, described in 1937 by Donovan James McCune and Fuller Albright, is a genetic disorder of bones, skin pigmentation and hormonal problems along with premature puberty.

Signs and symptoms

See also: List of conditions associated with café au lait macules

McCune–Albright syndrome is suspected when two of the three following features are present:

• Autonomous endocrine hormone excess, such as in precocious puberty
• Polyostotic fibrous dysplasia
• Unilateral café au lait spots

Within the syndrome there are bone fractures and deformity of the legs, arms and skull, different pigment patches on the skin, and early puberty with increased rate of growth.

Approximately 20-30% of fibrous dysplasias are polyostotic, which means fibrous dysplasia and sclerotic bone are present in multiple sites; two thirds of patients are polyostotic before the age of ten. The disease frequently involves the skull and facial bones, pelvis, spine and shoulder girdle. The sites of involvement are the femur (91%), tibia (81%), pelvis (78%), ribs, skull and facial bones (50%), upper extremities, lumbar spine, clavicle, and cervical spine, in decreasing order of frequency. The craniofacial pattern of the disease occurs in 50% of patients with the polyostotic form of fibrous dysplasia.

Increased production of hormones by glands regulated by the G protein system is due to a mutation in the gene causing continuous activation of stimulatory G protein. This results in the so-called "autonomous production" of hormones, including thyroid hormone, cortisol, estrogen and growth hormone. Therefore, hyperthyroidism, Cushing syndrome, precocious puberty in women with premature thelarche (breast growth), premature menarche (beginning of menstrual function), increased speed of growth and growth hormone excess can ensue. Increased serum estrogen concentrations correlate with large ovarian cysts. Ovarian cysts appear and disappear with changing estrogen concentrations, causing menstrual bleeding when estrogen decreases.

McCune–Albright syndrome has different levels of severity. For example, one child with McCune–Albright syndrome may be entirely healthy, with no outward evidence of bone or endocrine problems, enter puberty at close to the normal age, and have no unusual skin pigmentation. Diagnosis may be made only after decades. In other cases, children are diagnosed in early infancy, show obvious bone disease, and obvious increased endocrine secretions from several glands.

Genetics

Genetically, there is a postzygotic mutation (spontaneous mutation) of the gene GNAS1, on the long (q) arm of chromosome 20 at position 13.3, which is involved in G-protein signalling. This mutation, often a mosaicism, prevents downregulation of cAMP signalling.

Polyostotic fibrous dysplasia is usually caused by mosaicism for a mutation in a gene called GNAS1 (Guanine Nucleotide binding protein, Alpha Stimulating activity polypeptide 1).

Notable cases

Mauricio Saravia, a Uruguayan artist with the disease

The disease made headlines in December, 2005 when a Haitian teen affected with the disease, Marlie Casseus, underwent a 17-hour emergency surgical procedure to remove a 7 kg (16 pound) tumour-like growth of bone from her face. A series of operations at Holtz Children's Hospital in Miami, Florida restored the child's face to a more normal proportion.

See also

• List of cutaneous conditions
• List of radiographic findings associated with cutaneous conditions

External links

• RockYourPaper
• Medterms.com
• GNAS gene
• NORD
• GFMER
• Fibrous Dysplasia Radiology Image Database