Abstract
We often think of the lentiginoses, phacomatoses and other neurocutaneous syndromes as conditions that affect the skin and also predispose to a variety of tumors. However, we rarely think of Peutz-Jeghers syndrome (PJS), Carney complex (CNC), Cowden disease (CD), neurofibromatosis type-1 (NF-1) or tuberous sclerosis (TSC) as conditions that are multiple endocrine neoplasias (MEN). Indeed, all of these conditions predispose to a variety of endocrine tumors, in addition to many other neoplasms. On the other hand, the classic MENs, type 1 and 2 (MEN-1 and MEN-2, respectively) are almost never thought in terms of their skin manifestations. In this review, we present extensively the MEN-1, MEN-2 and PJS syndromes, and briefly refer to CD, NF-1, and TSC. CNC is discussed in another article in this journal issue.
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References
Chandrasekharappa SC, Guru SC, Manickam P, et al. Positional cloning of the gene for multiple endocrine neoplasia-type 1. Science. 1997;276(5311):404–7.
Marx SJ, Agarwal SK, Kester MB, et al. Multiple endocrine neoplasia type 1: Clinical and genetic features of the hereditary endocrine neoplasias. Recent Prog. Horm. Res. 1999;54:397–438. discussion 438-399.
Vasen HF, Lamers CB, Lips CJ. Screening for the multiple endocrine neoplasia syndrome type I. A study of 11 kindreds in the Netherlands. Arch. Intern. Med. 1989;149(12):2717–22.
Marx S, Spiegel AM, Skarulis MC, Doppman JL, Collins FS, Liotta LA. Multiple endocrine neoplasia type 1: Clinical and genetic topics. Ann. Intern. Med. 1998;129(6):484–94.
Stratakis CA, Schussheim DH, Freedman SM, et al. Pituitary macroadenoma in a 5-year-old: An early expression of multiple endocrine neoplasia type 1. The journal of clinical endocrinology and metabolism. J. Clin. Endocrinol. Metab. 2000;85(12):4776–80.
Vashi N, Hunt R, Fischer M, Meehan S, Pomeranz MK. Angiofibromas in multiple endocrine neoplasia type 1. Dermatol Online J. 2012;18(12):20.
Saggini A, Brandi ML. Skin lesions in hereditary endocrine tumor syndromes. Endocr. Pract. 2011;17(Suppl 3):47–57.
Asgharian B, Turner ML, Gibril F, Entsuah LK, Serrano J, Jensen RT. Cutaneous tumors in patients with multiple endocrine neoplasm type 1 (MEN1) and gastrinomas: Prospective study of frequency and development of criteria with high sensitivity and specificity for MEN1. J. Clin. Endocrinol. Metab. 2004;89(11):5328–36.
Sakurai A, Matsumoto K, Ikeo Y, Nishio SI, Kakizawa T, Arakura F, Ishihara Y, Saida T, Hashizume K. Frequency of facial angiofibromas in Japanese patients with multiple endocrine neoplasia type 1. Endocr. J. 2000;47(5):569–73.
Darling TN, Skarulis MC, Steinberg SM, Marx SJ, Spiegel AM, Turner M. Multiple facial angiofibromas and collagenomas in patients with multiple endocrine neoplasia type 1. Arch. Dermatol. 1997;133(7):853–7.
Pack S, Turner ML, Zhuang Z, Vortmeyer AO, Böni R, Skarulis M, Marx SJ, Darling TN. Cutaneous tumors in patients with multiple endocrine neoplasia type 1 show allelic deletion of the MEN1 gene. J Invest Dermatol. 1998;110(4):438–40.
Baldauf C, Vortmeyer AO, Koch CA, Sticherling M. Combination of multiple skin malignancies with multiple endocrine neoplasia type 1: Coincidental or pathogenetically related? Dermatology. 2009;219(4):365–7.
Thakker RV. Multiple endocrine neoplasia type 1 (MEN1). Best Pract. Res. Clin. Endocrinol. Metab. 2010;24(3):355–70.
Almeida MQ, Stratakis CA. Solid tumors associated with multiple endocrine neoplasias. Cancer Genet. Cytogenet. 2010;203(1):30–6.
Schernthaner-Reiter MH, Trivellin G, Stratakis CA. MEN1, MEN4, and Carney complex: Pathology and molecular genetics. Neuroendocrinology. 2016;103(1):18–31.
Gagel RF. Ret protooncogene mutations and endocrine neoplasia--a story intertwined with neural crest differentiation. Endocrinology. 1996;137(5):1509–11.
Eng C, Clayton D, Schuffenecker I, et al. The relationship between specific RET proto-oncogene mutations and disease phenotype in multiple endocrine neoplasia type 2. International RET mutation consortium analysis. JAMA. 1996;276(19):1575–9.
Edery P, Eng C, Munnich A, Lyonnet S. RET in human development and oncogenesis. BioEssays: News and Reviews in Molecular, Cellular and Developmental Biology. 1997;19(5):389–95.
Gagel RF, Levy ML, Donovan DT, Alford BR, Wheeler T, Tschen JA. Multiple endocrine neoplasia type 2a associated with cutaneous lichen amyloidosis. Ann. Intern. Med. 1989;111(10):802–6.
Borrego S, Eng C, Sanchez B, Saez ME, Navarro E, Antinolo G. Molecular analysis of the ret and GDNF genes in a family with multiple endocrine neoplasia type 2A and Hirschsprung disease. J. Clin. Endocrinol. Metab. 1998;83(9):3361–4.
Eng C, Mulligan LM. Mutations of the RET proto-oncogene in the multiple endocrine neoplasia type 2 syndromes, related sporadic tumours, and hirschsprung disease. Hum. Mutat. 1997;9(2):97–109.
Hoff AO, Cote GJ, Gagel RF. Multiple endocrine neoplasias. Annu. Rev. Physiol. 2000;62:377–411.
Angrist M, Bolk S, Halushka M, Lapchak PA, Chakravarti A. Germline mutations in glial cell line-derived neurotrophic factor (GDNF) and RET in a hirschsprung disease patient. Nat. Genet. 1996;14(3):341–4.
Decker RA, Peacock ML, Watson P. Hirschsprung disease in MEN 2A: Increased spectrum of RET exon 10 genotypes and strong genotype-phenotype correlation. Hum. Mol. Genet. 1998;7(1):129–34.
Koch CA. Molecular pathogenesis of MEN2-associated tumors. Familial Cancer. 2005;4(1):3–7.
Brauer VF, Scholz GH, Neumann S, Lohmann T, Paschke R, Koch CA. RET germline mutation in codon 791 in a family representing 3 generations from age 5 to age 70 years: Should thyroidectomy be performed ? Endocr. Pract. 2004;10(1):5–9.
Scapineli JO, Ceolin L, Puñales MK, Dora JM, Maia AL. MEN 2A-related cutaneous lichen amyloidosis: Report of three kindred and systematic literature review of clinical, biochemical and molecular characteristics. Fam cancer. 2016Rodriguez FJ, Stratakis CA, Evans DG. Genetic predisposition to peripheral nerve neoplasia: Diagnostic criteria and pathogenesis of neurofibromatoses, carney complex, and related syndromes. Acta Neuropathol. 2012;123(3):349–67.
Verga U, Fugazzola L, Cambiaghi S, Pritelli C, Alessi E, Cortelazzi D, Gangi E, Beck-Peccoz P. Frequent association between MEN 2A and cutaneous lichen amyloidosis. Clin. Endocrinol. 2003;59(2):156–61.
Lodish MB, Stratakis CA. RET oncogene in MEN2, MEN2B, MTC and other forms of thyroid cancer. Expert. Rev. Anticancer. Ther. 2008;8(4):625–32.
Boikos SA, Stratakis CA. Molecular mechanisms of medullary thyroid carcinoma: Current approaches in diagnosis and treatment. Histol. Histopathol. 2008;23(1):109–16.
Lodish M, Dagalakis U, Chen CC, Sinaii N, Whitcomb P, Aikin A, Dombi E, Marcus L, Widemann B, Fox E, Chuk M, Balis F, Wells Jr S, Stratakis CA. (111)In-octreotide scintigraphy for identification of metastatic medullary thyroid carcinoma in children and adolescents. J. Clin. Endocrinol. Metab. 2012;97(2):E207–12.
Nella AA, Lodish MB, Fox E, Balis FM, Quezado MM, Whitcomb PO, Derdak J, Kebebew E, Widemann BC, Stratakis CA. Vandetanib successfully controls medullary thyroid cancer-related Cushing syndrome in an adolescent patient. J. Clin. Endocrinol. Metab. 2014;99(9):3055–9.
Lodish MB, Stratakis CA. The differential diagnosis of familial lentiginosis syndromes. Familial Cancer. 2011;10(3):481–90.
Sammour T, Hayes IP, Hill AG, Macrae FA, Winter DC. Familial colorectal cancer syndromes: An overview of clinical management. Expert Rev Gastroenterol Hepatol. 2015;9(6):757–64.
Beggs AD, Latchford AR, Vasen HF, Moslein G, Alonso A, Aretz S, Bertario L, Blanco I, Bülow S, Burn J, Capella G, Colas C, Friedl W, Møller P, Hes FJ, Järvinen H, Mecklin JP, Nagengast FM, Parc Y, Phillips RK, Hyer W, Ponz de Leon M, Renkonen-Sinisalo L, Sampson JR, Stormorken A, Tejpar S, Thomas HJ, Wijnen JT, Clark SK, Hodgson SV. Peutz-Jeghers syndrome: A systematic review and recommendations for management. Gut. 2010;59(7):975–86.
van Lier MG, Westerman AM, Wagner A, Looman CW, Wilson JH, de Rooij FW, Lemmens VE, Kuipers EJ, Mathus-Vliegen EM, van Leerdam ME. High cancer risk and increased mortality in patients with Peutz-Jeghers syndrome. Gut. 2011;60(2):141–7.
Gondak RO, da Silva-Jorge R, Jorge J, Lopes MA, Vargas PA. Oral pigmented lesions: Clinicopathologic features and review of the literature. Med. Oral Patol. Oral Cir. Bucal. 2012;17(6):e919–24.
Richey JD, Bradish JR, Lacy SR, Warren S. Carney syndrome in a patient previously considered to have Peutz-Jeghers syndrome. J. Am. Acad. Dermatol. 2014;70(2):e44–6.
Bauer AJ, Stratakis CA. The lentiginoses: Cutaneous markers of systemic disease and a window to new aspects of tumourigenesis. J. Med. Genet. 2005;42(11):801–10.
Hearle N, Schumacher V, Menko FH, Olschwang S, Boardman LA, Gille JJ, et al. Frequency and spectrum of cancers in the Peutz-Jeghers syndrome. Clin. Cancer Res. 2006;12(10):3209–15.
Stratakis CA. Genetics of Carney complex and related familial lentiginoses, and other multiple tumor syndromes. Front. Biosci. 2000;5:D353–66.
Winterfield L, Schultz J, Stratakis CA, Cowen EW. Gynecomastia and mucosal lentigines in an 8-year-old boy. J. Am. Acad. Dermatol. 2005;53(4):660–2.
Gourgari E, Saloustros E, Stratakis CA. Large-cell calcifying sertoli cell tumors of the testes in pediatrics. Curr. Opin. Pediatr. 2012;24(4):518–22.
Crocker MK, Gourgari E, Lodish M, Stratakis CA. Use of aromatase inhibitors in large cell calcifying sertoli cell tumors: Effects on gynecomastia, growth velocity, and bone age. J. Clin. Endocrinol. Metab. 2014;99(12):E2673–80. doi:10.1210/jc.2014-2530.
Mester J, Eng C. Cowden syndrome: Recognizing and managing a not-so-rare hereditary cancer syndrome. J. Surg. Oncol. 2015;111:125–30.
Pilarski R. Cowden syndrome: A critical review of the clinical literature. J. Genet. Couns. 2009;18(1):13–27.
Farooq A, Walker LJ, Bowling J, Audisio RA. Cowden syndrome. Cancer Treat. Rev. 2010;36(8):577–83.
Yin Y, Shen WH. PTEN: A new guardian of the genome. Oncogene. 2008;27(41):5443–53.
Lodish MB, Stratakis CA. Endocrine tumours in neurofibromatosis type 1, tuberous sclerosis and related syndromes. Best Pract. Res. Clin. Endocrinol. Metab. 2010;24(3):439–49.
Rasmussen SA, Friedman JM. NF1 gene and neurofibromatosis 1. Am. J. Epidemiol. 2000;151(1):33–40.
Neurofibromatosis. Conference statement. National Institutes of Health Consensus Development Conference. Arch. Neurol. 1988;45(5):575–8.
Zoller ME, Rembeck B, Oden A, Samuelsson M, Angervall L. Malignant and benign tumors in patients with neurofibromatosis type 1 in a defined Swedish population. Cancer. 1997;79(11):2125–31.
Mao C, Shah A, Hanson DJ, Howard JM. Von Recklinghausen's disease associated with duodenal somatostatinoma: Contrast of duodenal versus pancreatic somatostatinomas. J. Surg. Oncol. 1995;59(1):67–73.
Hersh JH. Health supervision for children with neurofibromatosis. Pediatrics. 2008;121(3):633–42.
Osborne JP, Fryer A, Webb D. Epidemiology of tuberous sclerosis. Ann. N. Y. Acad. Sci. 1991;615:125–7.
Rosser T, Panigrahy A, McClintock W. The diverse clinical manifestations of tuberous sclerosis complex: A review. Semin. Pediatr. Neurol. 2006;13(1):27–36.
Dworakowska D, Grossman AB. Are neuroendocrine tumours a feature of tuberous sclerosis? A systematic review. Endocr Relat Cancer. 2009;16(1):45–58.
Nandagopal R, Vortmeyer A, Oldfield EH, Keil MF, Stratakis CA. Cushing's syndrome due to a pituitary corticotropinoma in a child with tuberous sclerosis: An association or a coincidence? Clin. Endocrinol. 2007;67(4):639–41.
Roach ES, Sparagana SP. Diagnosis of tuberous sclerosis complex. J. Child Neurol. 2004;19(9):643–9.
Bissler JJ, McCormack FX, Young LR, Elwing JM, Chuck G, Leonard JM, et al. Sirolimus for angiomyolipoma in tuberous sclerosis complex or lymphangioleiomyomatosis. N. Engl. J. Med. 2008;358(2):140–51.
Acknowledgements
This review was supported by the research project Z01-HD008920 (Principal Investigator: Dr. Constantine A Stratakis) of the Intramural Research Program of the Eunice Kennedy Shriver National Institute of Child Health & Human Development (NICHD), National Institutes of Health (NIH), Bethesda, MD, USA.
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Stratakis, C.A. Hereditary syndromes predisposing to endocrine tumors and their skin manifestations. Rev Endocr Metab Disord 17, 381–388 (2016). https://doi.org/10.1007/s11154-016-9401-0
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DOI: https://doi.org/10.1007/s11154-016-9401-0