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Gastrointestinal polyps in McCune Albright syndrome
  1. Margaret Zacharin1,2,
  2. Anurag Bajpai3,
  3. Chung Wo Chow4,
  4. Anthony Catto-Smith5,
  5. Constantine Stratakis6,
  6. Michelle W Wong7,
  7. Rodney Scott7
  1. 1Department of Endocrinology and Diabetes, Royal Children's Hospital, Melbourne, Australia
  2. 2Department of Paediatrics, Murdoch Children's Research Institute, Royal Children's Hospital, Melbourne, Australia
  3. 3Kanpur hospital, Regency Hospital Limited, A2 Sarvodaya Nagar, Kanpur, India
  4. 4Department of Anatomical Pathology, Royal Children's Hospital, Melbourne, Australia
  5. 5Department of Gastroenterology and Clinical Nutrition, Royal Children's Hospital, Melbourne, Australia
  6. 6Section on Endocrinology and Genetics, Eunice Kennedy Shriver National Institute of Child Health & Human Development, National Institutes of Health, Maryland, USA
  7. 7Department of Genetics, School of Biomedical Sciences, University of Newcastle, Australia
  1. Correspondence to A/Professor Margaret Zacharin, Department of Endocrinology and Diabetes, Royal Children's Hospital, Flemington Road, Parkville, Melbourne, Victoria 3052, Australia; margaret.zacharin{at}rch.org.au

Abstract

Background McCune Albright syndrome (MAS), a disorder caused by somatic activating mutations in the GNAS gene, usually presents with cutaneous, skeletal, and endocrine manifestations. While focal lesions involving multiple tissues have been identified in MAS, almost nothing is known about gastrointestinal lesions in this disease.

Methods Two MAS patients with perioral freckling, resembling Peutz–Jeghers syndrome (PJS), and two MAS patients without similar pigmentation underwent gastrointestinal endoscopy to establish if they had coexisting hamartomatous polyposis. Three of 4 subjects had documented GNAS mutations in peripheral blood. Genetic testing for STK11 and PRKAR1A genes was performed to exclude presence of coexistent PJS and Carney complex. Genetic testing of biopsy material was also performed.

Results Hamartomatous gastrointestinal polyps with histological features similar to those in PJS were observed in all 4 subjects, only in the stomach and/or upper duodenum. Activating GNAS mutations were found in the polyps or adjacent mucosa in 3 of 4 subjects. One patient each had mutation only in the blood or tissue, while 2 patients had both. No subject harboured any detectable PRKARIA or STK11 mutation as determined by direct DNA sequencing and copy number variation analysis.

Conclusions These findings confirm that gastrointestinal polyps are a common manifestation of MAS, indicate an overlap between MAS and PJS, and point towards a putative interaction between the GNAS and STK11 genes in the pathogenesis of these two disorders. The findings suggest a need for routine gastrointestinal endoscopy in patients with MAS, to establish the true incidence of polyps in these patients.

  • GNAS gene
  • gastrointestinal polyp
  • McCune Albright syndrome
  • STK11 gene
  • Peutz-Jegher Syndrome
  • endocrinology
  • gastroenterology
  • stomach and duodenum
  • genetics, screening

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Footnotes

  • Competing interests None.

  • Patient consent All patients and parents where the boys were under 18, gave written informed consent for the study, for genetic testing and for publication of findings.

  • Ethics approval Ethics committee approval was not required as this was not a specific study but a report of clinical investigations undertaken for 4 patients, as part of their standard clinical care.

  • Provenance and peer review Not commissioned; externally peer reviewed.

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