What are the systemic findings characteristic of tuberous sclerosis complex (TSC)?

Updated: Aug 21, 2018
  • Author: David Neal Franz, MD; Chief Editor: Amy Kao, MD  more...
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Hamartomas and polyposis of stomach, intestine, and colon may occur. These almost never cause significant symptoms, although gastrointestinal hamartomas occasionally may bleed, leading to positive tests for fecal occult blood. Blood loss is almost always minimal, and rarely if ever results in anemia or clinical symptoms.

Hepatic cysts and AMLs (hepatic, not renal), typically asymptomatic and nonprogressive, have been reported in as many as 24% of patients with TSC, with a marked female predominance (female-to-male ratio 5:1).

Sclerotic and hypertrophic lesions of bone may be found incidentally on radiography performed for other indications. Occasionally they may be palpable, or associated with nonspecific, vague, aching pains. Osseous lesions rarely if ever produce serious difficulty, and they require only symptomatic treatment, if any at all. Some patients develop neurogenic scoliosis resulting from asymmetric weakness or intractable partial seizure activity. In these cases, typically a "dominant" tuber is present contralateral to the scoliosis or the supratentorial tuber burden is asymmetrical. These individuals may require standard orthopedic management if the curvature is severe.

A small number of patients with TSC may develop arterial aneurysms. Aneurysms have been reported intracranially [13] , as well as in the aorta and axillary arteries (see following image).

Basilar artery aneurysm in a 2-year-old girl with Basilar artery aneurysm in a 2-year-old girl with tuberous sclerosis. The arrow shows the anterior aspect of the aneurysm where it abuts the clivus. The lesion was not present on MRI performed 11 months earlier.

Like lung disease, gastrointestinal and osseous abnormalities are seen primarily in adults, in whom they may be the presenting manifestations of TSC. Recognition of the true nature of these lesions is important, as adult-oriented practitioners are generally unaware of the broad spectrum of TSC. Pulmonary, renal, gastrointestinal, and bone findings may be mistaken for emphysema, neoplasia, or other disorders, and inappropriate measures undertaken.

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