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Testicular Microlithiasis related to McCune-Albright Syndrome

Case Detail

Anatomy: Genitourinary
Junewick
Joseph Junewick, MD FACR
Diagnostic Category: Developmental or Congenital
Created: over 7 years ago
Updated: over 7 years ago
Tags: PEDS
Modality/Study Types: US CR CT
Activities:
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History

12 year old with McCune-Albright syndrome.


Case Images


Diagnosis

Testicular Microlithiasis related to Mcune-Albright Syndrome

Clinical Notes

Recent partial thyroidectomy for “mass”.

Findings

US – Extensive testicular microlithiasis on conventional and 3D rendered images.

CR – Multifocal osseous lesions involving bilateral ribs, left femur and left sphenoid bone. The medullary cavity is expanded with endosteal scalloping by a mixed sclerotic and lucent lesion in the proximal left femur. The right 5th rib is broadly expanded and the left 5th rib is focally expanded by lesions with a ground glass matrix; likewise the skull base is expanded by a lesion within the sphenoid bone.

CT – Axial images confirm lesion with ground glass matrix in the left sphenoid bone.

Discussion

McCune-Albright syndrome was initially described in females with precocious puberty, cafe-au-lait spots and fibrous dysplasia. This syndrome is linked to a mutation in the GNAS gene which codes for the alpha subunit of the stimulatory G protein which occurs in the post-zygomatic state. As such, this disease has a quite varied phenotypic expression in males and females.

Endocrinopathies are well recognized in McCune-Albright syndrome, including gonadotrophin independent precocious puberty, thyrotoxicosis, acromegaly and Cushing syndrome. Precocious puberty in males usually occurs later and slower than in females. Macro-orchidism in McCune-Albright is more common than true gonadotrophin independent sexual precocity and is likely related to Sertoli cell hyperactivity and elevated anti-mullerian hormone activity. Testicular enlargement and testicular microlithiasis are seen in 62% of males with McCune-Albright syndrome.

Fibrous dysplasia is related to replacement of the normal medullary space of bone with fibro-osseous tissue. Most often lesions are isolated to a single bone but multiple bones can be involvled. Commonly involved bones include the craniofacial bones, ribs and long bones (the epiphysis is usually spared). McCune-Albright syndrome is found in 2-3% of patients with polyostotic fibrous dysplasia.

Reference

Zacharin M. The Spectrum of McCune-Albright Syndrome. Pediatric Endocrinology Reviews 2007; 4(4):412-418.

Wasniewska M, DeLuca F, Bertelloni S, Matarazzo P, et al. Testicular Microlithiasis: An Unreported Feature of McCune-Albright Syndrome in Males. J Pediatr 2004; 145(5):670-672.

Contributor

Linda Woolpert, RRT RDMS



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