Pregnancy Failure and Retained Products of Conception in a Patient with Mccune–Albright Syndrome: A Case Report

Abstract

Introduction: McCune–Albright syndrome (MAS) is a rare mosaic disorder characterized by postzygotic activating mutations in the GNAS gene, leading to constitutive Gsα signalling and autonomous endocrine activity. Gonadotropin-independent precocious puberty due to autonomous ovarian cyst formation is the most frequent endocrine manifestation in affected females. As patients with MAS increasingly reach reproductive age, pregnancy outcomes and gynaecological morbidity have emerged as important clinical considerations, though published data remain limited.
Case Presentation: We report a 19-year-old female with a history of MAS, diagnosed in childhood with precocious puberty, recurrent ovarian cysts, polyostotic fibrous dysplasia and café-au-lait pigmentation. After medical termination of an early pregnancy failure at about six weeks' gestation, she presented with persistent vaginal bleeding and lower abdominal discomfort. Transvaginal ultrasonography revealed a thickened endometrium, 17 mm, heterogeneous echogenic content and internal Doppler vascularity suggestive of retained products of conception (RPOC). She underwent surgical uterine evacuation under anaesthesia with suction curettage. Histopathological examination confirmed products of conception with no evidence of gestational trophoblastic disease. Her post-procedural recovery was uneventful, with resolution of bleeding and no complications.
Discussion: The case highlights where MAS-related ovarian dysfunction and early pregnancy failure overlap with RPOC. This cyst-driven estrogen excess of MAS is likely to create a proliferative and highly vascular endometrial environment that could theoretically predispose to persistent post-termination tissue. As of now, evidence indicates spontaneous conception is possible in MAS, but women with MAS have raised risks of abnormal uterine bleeding, infertility and pregnancy-related complications. Structured reproductive surveillance, early imaging after pregnancy loss, and multidisciplinary endocrine–gynaecological coordination are key to optimising outcomes.
Conclusion: This report highlights the need for heightened clinical awareness of post-pregnancy complications in women with MAS and supports recommendations for protocolised reproductive follow-up in this population.