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Hepatic Lesions Associated With McCune Albright Syndrome

Johansen, Lauren*; Haller, Wolfram; Thyagarajan, Manigandan; Kelly, Deirdre*; McKiernan, Patrick§

Journal of Pediatric Gastroenterology and Nutrition: April 2019 - Volume 68 - Issue 4 - p e54–e57
doi: 10.1097/MPG.0000000000002266
Short Communication: Hepatology

ABSTRACT McCune-Albright syndrome (MAS) results from a GNAS gene mutation. It is associated with café au lait macules, fibrous dysplasia, and several endocrinopathies to include gonadotropin-independent precocious puberty, growth hormone excess, Cushing syndrome, thyroid disease, and renal phosphate wasting. It is recognized to be a rare cause of neonatal cholestasis. We describe the hepatic outcome of 3 children with MAS referred to a single national liver unit. All presented with high gamma-glutamyl transpeptidase cholestasis and hepatitis. Cholestasis resolved by 1 year; but hepatic inflammation persisted, and 2 children developed progressive atypical focal nodular hyperplasia and 1 developed hepatoblastoma. This the first reported malignant hepatic lesion associated with MAS. MAS should be considered part of the differential diagnosis of neonatal cholestasis and affected children should be closely monitored for the development of hepatic lesions with regular liver ultrasound and alpha fetoprotein level.

*Liver Unit

Gastroenterology Department

Radiology Department, Birmingham Women's and Children's NHS Foundation Trust, Birmingham, UK

§Division of Gastroenterology, Hepatology and Nutrition, Children's Hospital of Pittsburgh of UPMC, Pittsburgh, PA.

Address correspondence and reprint requests to Lauren Johansen, MBBS (Hons), MRCPCH, Liver Unit, Birmingham Women's and Children's NHS Foundation Trust, Birmingham, B4 6NH, UK (e-mail:

Received 20 October, 2018

Accepted 18 December, 2018

The authors report no conflicts of interest.

© 2019 by European Society for Pediatric Gastroenterology, Hepatology, and Nutrition and North American Society for Pediatric Gastroenterology,