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Tuberous sclerosis

Tuberous sclerosis

Tuberous sclerosis, angiofibromas  - face
Tuberous sclerosis, angiofibromas - face
Tuberous sclerosis, hypopigmented macule
Tuberous sclerosis, hypopigmented macule

Definition:

Tuberous sclerosis is a group of two genetic disorders characterized by problems with the skin, brain/nervous system, and kidneys. There is also a predisposition to tumors. The diseases are named after a characteristic abnormal growth in the brain, which takes the shape of a tuber or root.

Alternative Names:
Adenoma sebaceum
Causes, incidence, and risk factors:

Tuberous sclerosis is inherited as an autosomal dominant trait (only one parent must pass on the bad gene for the child to get the disease). However, a high percentage of cases are due to new mutations (which occur in the sperm or egg of one of the parents), so there usually is no family history of the disease.

It is one of a group of diseases described as neuro-cutaneous syndromes, because of large involvement of both the skin and the central nervous system (brain and/or spinal cord).

The symptoms of tuberous sclerosis vary considerably: from minimally affected people with normal intelligence and no seizures, to severely affected people with profound retardation and frequent, difficult-to-control seizures or serious tumors. Mutations in two genes, TSC1 and TSC2, are responsible for tuberous sclerosis.

Severely affected people may develop seizures shortly after birth. These are characterized by spasms (hypsarrhythmia). Mental retardation becomes evident as infants begin to miss their normal developmental milestones.

Infants may have heart tumors (rhabdomyoma), which can be detected by ultrasound. These tumors may grow or shrink and usually do not cause problems.

Several different skin lesions are common in tuberous sclerosis.

  • "Ash leaves" are white lesions lacking normal skin color that have the shape or appearance of an ash leaf and may appear anywhere on the body.
  • Shagreen patches: These appear on the lower back as raised patches of skin with an orange-peel texture.
  • Adenoma sebaceum (angiofibroma): These lesions include red, highly vascular (containing many blood vessels) lumps on the face that may resemble irritated acne. These enlarge with age and may run together (become confluent) to form larger patches.

There are no known risk factors other than having a parent with tuberous sclerosis. In that case, each child has a 50% chance of inheriting the disease.

Symptoms:
  • Ash leaf spots on the skin and, less often, cafe-au-lait spots
  • Shagreen spots on the skin -- if present, likely on the back
  • Red, highly vascular lumps on the face (adenoma sebaceum)
  • Mental retardation
  • Seizures
  • Rough growths under or around fingernails and toenails
  • Pitted dental enamel
  • Kidney tumors
Signs and tests:
  • Examination of the eyes may show retinal abnormalities, pale patches, and mulberry, phakoma or astrocytoma tumor.
  • There may be some indications of heart abnormalities, including abnormal heart rhythm (arrhythmia) or a tumor (rhabdomyoma) on ultrasound.
  • An MRI of the head shows tumors or benign "tubers" in the brain.
  • A CAT scan of the head may show calcium deposits in the brain.
  • The mouth may show rubbery growths on the tongue or gingiva.
  • Ultrasound of kidney may show cysts, fatty benign tumors, or serious tumors.
  • Ultraviolet light examination of the skin may show ash leaf spots not visible in ordinary light.
  • There may be a family history of the condition. Genetic testing for either of the two genes that can cause this disease (TSC1 or TSC2) may be available.

Review Date: 8/11/2006
Reviewed By: Brian Kirmse, MD, Mount Sinai School of Medicine, Department of Human Genetics, New York, NY. Review provided by VeriMed Healthcare Network.

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