A possible new syndrome with double endocrine tumors in association with an unprecedented type of familial heart-hand syndrome: a case report

Abstract

Introduction: The combination of a pituitary prolactinoma and an aldosterone-producing adrenal adenoma is extremely rare. To the best of our knowledge, double endocrine tumors in association with heart-hand syndrome have not previously been reported.

Case presentation: A 21-year-old Japanese woman presented with galactorrhea and decreased visual acuity. A large pituitary adenoma with an increased level of serum prolactin was apparent by computed tomography. She additionally showed mild hypertension (136/90 mmHg) accompanied by hypokalemia. The plasma aldosterone concentration was increased. Computed tomography showed a mass in the right adrenal gland. No other tumors were found despite extensive imaging studies. Physical and radiographic examinations showed skeletal malformations of the hands and feet, including hypoplasia of the first digit in all four limbs. An atrial septal defect was demonstrated by echocardiography. Similar digital and cardiac abnormalities were detected in our patient's father, and a clinical diagnosis of hereditary heart-hand syndrome was made.

Conclusion: No established heart-hand syndrome was wholly compatible with the family's phenotype. Her father had no obvious endocrine tumors, implying that the parent of transmission determined variable phenotypic expression of the disease: heart-hand syndrome with multiple endocrine tumors from the paternal transmission or no endocrine tumor from the maternal transmission. This suggests that the gene or genes responsible for the disease may be under tissue-specific imprinting control.

Figure 1

Patient's phenotype. (a) Photograph of both hands and feet of our patient. (b) Roentgenogram of the patient's hands and feet. (c) Echocardiogram of the patient (d) Roentgenogram of her father's hands and feet. (e) Echocardiogram of her father. Note symmetric hypoplasia of the first digit in both our patient and her father. Asterisk (*) displays ASD. RA, right atrium. LA, light atrium.

Figure 2

Pedigree of the family. Squares represent males, circles represent females, closed symbols indicate affected status, open symbols indicate unaffected status, an arrowhead indicates the proband.