Tuberous sclerosis in Infant/Neonate
Alerts and Notices
Important News & Links
Synopsis

Tuberous sclerosis (TS), or tuberous sclerosis complex (TSC), also known as Bourneville disease, is an autosomal dominant, multisystem disorder caused by mutations in the genes for the proteins hamartin and tuberin. It is characterized by tumor-like growths, or hamartomas, in almost every organ. Two-thirds of infants with TS/TSC are born to unaffected parents as a result of a sporadic mutation. During the neonate period and infancy, the most common presenting signs are seizures or cardiac rhabdomyomas, typically found on routine antenatal screening.
A majority of TSC patients will have epilepsy, and more than half will have developmental delays collectively termed TSC-associated neuropsychiatric disorders (TAND). Brain lesions including glioneuronal hamartomas and periventricular giant cell astrocytomas are commonly identified in patients with TAND.
Establishing the diagnosis of TS can be challenging due to the wide variation in severity and age-related penetrance of clinical manifestations. In some cases, diagnosis may be delayed until adolescence or adulthood.
A majority of TSC patients will have epilepsy, and more than half will have developmental delays collectively termed TSC-associated neuropsychiatric disorders (TAND). Brain lesions including glioneuronal hamartomas and periventricular giant cell astrocytomas are commonly identified in patients with TAND.
Establishing the diagnosis of TS can be challenging due to the wide variation in severity and age-related penetrance of clinical manifestations. In some cases, diagnosis may be delayed until adolescence or adulthood.
Codes
ICD10CM:
Q85.1 – Tuberous sclerosis
SNOMEDCT:
7199000 – Tuberous sclerosis
Q85.1 – Tuberous sclerosis
SNOMEDCT:
7199000 – Tuberous sclerosis
Look For
Subscription Required
Diagnostic Pearls
Subscription Required
Differential Diagnosis & Pitfalls
- Hypomelanotic macules must be distinguished from nevus depigmentosus, halo nevi, pigmentary mosaicism (hypomelanosis of Ito), nevus anemicus, piebaldism, and vitiligo.
- Other diagnoses that may be confused with angiofibromas include keratosis pilaris and neonatal or infantile acne.
- Hemangiomas of early infancy may look similar to the forehead plaque or shagreen patch in infants. Rapid growth of the hemangioma over the ensuing days to weeks will distinguish between these lesions. Diverse other lesions may appear very similar to the shagreen patch, including the dermal nodules of Hunter syndrome, smooth muscle hamartomas, leiomyomas, plexiform neurofibromas, and lipomas. A biopsy may be necessary to distinguish between these entities when the rest of the clinical picture is uncertain.
- Multiple endocrine neoplasia type 1 (MEN1) shares many cutaneous lesions with TSC (angiofibromas, collagenomas, confetti-like hypopigmented macules, and gingival papules). Close follow-up and strict adherence to the established diagnostic criteria for TSC should allow one to distinguish between these entities.
Best Tests
Subscription Required
Management Pearls
Subscription Required
Therapy
Subscription Required
References
Subscription Required
Last Reviewed:11/07/2018
Last Updated:01/25/2022
Last Updated:01/25/2022