The McCune-Albright syndrome is rare disease diagnosed by the clinical triad, fibrous dysplasia, café-au lait skin pigmentations and endocrine hyperfunction. Those patients with bone issues could have various sur...The McCune-Albright syndrome is rare disease diagnosed by the clinical triad, fibrous dysplasia, café-au lait skin pigmentations and endocrine hyperfunction. Those patients with bone issues could have various surgeries under general anesthesia. Airway abnormality and various endocrine abnormalities should be considered during general anesthesia for McCune-Albright syndrome patients. A 15-year-old male with McCune-Albright syndrome was admitted with complaint of right nasal obstruction originated from fibrous dysplasia. Endoscopic resection of nasal cavity lesion was scheduled under navigation system guidance. Difficult airway could be anticipated due to protrusion of maxilla and right nostril. Awake fiberoptic intubation was performed by spray-as-you-go technique. When an anesthesiologist expects to take care of the patient with the McCune-Albright syndrome, the most appropriate anesthetic induction and tracheal intubation technique should be selected, and multiple backup instruments such as supraglottic device, video laryngoscope and fiberoptic bronchoscopy should be prepared.展开更多
McCune Albright syndrome is a rare genetic disorder which is characterized by café au lait skin pigmentation, precocious puberty and polyostotic fibrous dysplasia. Treating recurring pathological fractures due to...McCune Albright syndrome is a rare genetic disorder which is characterized by café au lait skin pigmentation, precocious puberty and polyostotic fibrous dysplasia. Treating recurring pathological fractures due to Albright syndrome is a very challenging endeavor, and more so when it is accompanied by poor bone quality and deformity. We hereby present the case of a 23-year-old male patient who is treated several times for recurrent pathological fractures of the femur at our center. We analyze the difficulties associated with treating a patient with poor bone quality over several years, discuss our treatment options, review the literature for similar cases and look at what we could have done differently. We weigh in on the difficulties in treating a severely deformed shepherd’s crook, the ways of achieving proper internal fixation and the dangers of using plating instead of an IM nail as suggested in the literature. Our main goal in reporting this case is to bring forth the unusual challenges encountered when treating patients with Albright syndrome and discussing the options of the orthopedic surgeons when treating these types of patients.展开更多
BACKGROUND McCune–Albright syndrome(MAS)is caused by postzygotic somatic mutations of the GNAS gene.It is characterized by the clinical triad of fibrous dysplasia,caféau-lait skin spots,and endocrinological dysf...BACKGROUND McCune–Albright syndrome(MAS)is caused by postzygotic somatic mutations of the GNAS gene.It is characterized by the clinical triad of fibrous dysplasia,caféau-lait skin spots,and endocrinological dysfunction.Myriad complications in MAS,including hepatobiliary manifestations,are also reported.CASE SUMMARY This is a case of a 4-year-old boy who presented with MAS with neonatal cholestasis.He was suspected to have Alagille syndrome due to neonatal cholestasis with intrahepatic bile duct paucity in liver biopsy,peripheral pulmonary artery stenosis,and renal tubular dysfunction.By the age of 2 years,his cholestatic liver injury gradually improved,but he had repeated left femoral fractures.He did not exhibit endocrinological abnormality or café-au-lait skin spots.However,MAS was suspected due to fibrous dysplasia at the age of 4 years.No mutation was identified in the GNAS gene in the DNA isolated from the peripheral blood,but an activating point mutation(c.601C>T,p.Arg201Cys)was observed in the DNA extracted from the affected bone tissue and that extracted from the formalin-fixed paraffin-embedded liver tissue,which was obtained at the age of 1 mo.CONCLUSION MAS should be considered as a differential diagnosis for transient cholestasis in infancy.展开更多
Mc Cune-Albright综合征(MAS)是一种临床罕见的疾病,其典型三联征包括多骨性骨纤维异常增殖症、牛奶咖啡色斑及性早熟。本文报告1例伴有甲状腺功能亢进的Mc Cune-Albright综合征患者,并通过相关文献复习,阐述MAS的病因、临床表现、诊断...Mc Cune-Albright综合征(MAS)是一种临床罕见的疾病,其典型三联征包括多骨性骨纤维异常增殖症、牛奶咖啡色斑及性早熟。本文报告1例伴有甲状腺功能亢进的Mc Cune-Albright综合征患者,并通过相关文献复习,阐述MAS的病因、临床表现、诊断及治疗等。展开更多
文摘The McCune-Albright syndrome is rare disease diagnosed by the clinical triad, fibrous dysplasia, café-au lait skin pigmentations and endocrine hyperfunction. Those patients with bone issues could have various surgeries under general anesthesia. Airway abnormality and various endocrine abnormalities should be considered during general anesthesia for McCune-Albright syndrome patients. A 15-year-old male with McCune-Albright syndrome was admitted with complaint of right nasal obstruction originated from fibrous dysplasia. Endoscopic resection of nasal cavity lesion was scheduled under navigation system guidance. Difficult airway could be anticipated due to protrusion of maxilla and right nostril. Awake fiberoptic intubation was performed by spray-as-you-go technique. When an anesthesiologist expects to take care of the patient with the McCune-Albright syndrome, the most appropriate anesthetic induction and tracheal intubation technique should be selected, and multiple backup instruments such as supraglottic device, video laryngoscope and fiberoptic bronchoscopy should be prepared.
文摘McCune Albright syndrome is a rare genetic disorder which is characterized by café au lait skin pigmentation, precocious puberty and polyostotic fibrous dysplasia. Treating recurring pathological fractures due to Albright syndrome is a very challenging endeavor, and more so when it is accompanied by poor bone quality and deformity. We hereby present the case of a 23-year-old male patient who is treated several times for recurrent pathological fractures of the femur at our center. We analyze the difficulties associated with treating a patient with poor bone quality over several years, discuss our treatment options, review the literature for similar cases and look at what we could have done differently. We weigh in on the difficulties in treating a severely deformed shepherd’s crook, the ways of achieving proper internal fixation and the dangers of using plating instead of an IM nail as suggested in the literature. Our main goal in reporting this case is to bring forth the unusual challenges encountered when treating patients with Albright syndrome and discussing the options of the orthopedic surgeons when treating these types of patients.
基金ORCID number:Yoshinori Satomura,ORCID number:0000-0002-0083-1774Corresponding author:Kazuhiko Bessho,MD,PhD,Associate Professor,Department of Pediatrics,Osaka University Graduate School of Medicine,2-2-D5 Yamada-oka,Suita City,Osaka 565-0871,Japan.bessho@ped.med.osaka-u.ac.jp,ORCID number:0000-0003-1684-2213+4 种基金Taichi Kitaoka,ORCID number:0000-0002-3531-884XShinji Takeyari,ORCID number:0000-0002-3627-1932Yasuhisa Ohata,ORCID number:0000-0001-6084-6620Takuo Kubota,ORCID number:0000-0003-4483-4405Keiichi Ozono,ORCID number:0000-0002-6517-8825.
文摘BACKGROUND McCune–Albright syndrome(MAS)is caused by postzygotic somatic mutations of the GNAS gene.It is characterized by the clinical triad of fibrous dysplasia,caféau-lait skin spots,and endocrinological dysfunction.Myriad complications in MAS,including hepatobiliary manifestations,are also reported.CASE SUMMARY This is a case of a 4-year-old boy who presented with MAS with neonatal cholestasis.He was suspected to have Alagille syndrome due to neonatal cholestasis with intrahepatic bile duct paucity in liver biopsy,peripheral pulmonary artery stenosis,and renal tubular dysfunction.By the age of 2 years,his cholestatic liver injury gradually improved,but he had repeated left femoral fractures.He did not exhibit endocrinological abnormality or café-au-lait skin spots.However,MAS was suspected due to fibrous dysplasia at the age of 4 years.No mutation was identified in the GNAS gene in the DNA isolated from the peripheral blood,but an activating point mutation(c.601C>T,p.Arg201Cys)was observed in the DNA extracted from the affected bone tissue and that extracted from the formalin-fixed paraffin-embedded liver tissue,which was obtained at the age of 1 mo.CONCLUSION MAS should be considered as a differential diagnosis for transient cholestasis in infancy.
