Bannayan-Riley-Ruvalcaba Syndrome

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Bannayan-Riley-Ruvalcaba syndrome (BRRS) is a rare genetic disorder that affects multiple systems in the body. It is characterized by macrocephaly (enlarged head), multiple lipomas (benign fatty tumors), hemangiomas (abnormal blood vessel growth), pigmented macules (dark spots on the skin), developmental delay, intellectual disability, and gastrointestinal polyps. This article aims to provide a comprehensive overview of BRRS, its symptoms, causes, diagnosis, and potential treatment options.

Understanding Bannayan-Riley-Ruvalcaba Syndrome

Bannayan-Riley-Ruvalcaba syndrome is a genetic condition that is inherited in an autosomal dominant manner, meaning that an affected individual has a 50% chance of passing the condition on to each of their children. It is caused by mutations in the PTEN gene, which is responsible for regulating cell growth and division. These mutations lead to the development of various characteristic features and medical problems associated with BRRS.

Symptoms of Bannayan-Riley-Ruvalcaba Syndrome

The symptoms of BRRS can vary widely among affected individuals, even within the same family. However, there are several key features that are commonly observed:

  • Macrocephaly: The most prominent feature of BRRS is an enlarged head size. This is often noticeable at birth or during early childhood.
  • Multiple lipomas: Lipomas are benign tumors composed of fatty tissue. Individuals with BRRS may develop multiple lipomas throughout their body, typically appearing in adolescence or early adulthood.
  • Hemangiomas: Hemangiomas are abnormal growths of blood vessels. They can appear as red or purple birthmarks on the skin and may be present at birth or develop later in childhood.
  • Pigmented macules: Dark spots or patches of pigmentation may be present on the skin, particularly in the genital area.
  • Developmental delay and intellectual disability: Many individuals with BRRS experience delays in reaching developmental milestones, such as walking and talking. Intellectual disability can range from mild to severe.
  • Gastrointestinal polyps: Polyps may develop in the gastrointestinal tract, particularly in the colon. These polyps can cause bleeding and may increase the risk of developing certain types of cancer.

Diagnosis and Genetic Testing

Diagnosing Bannayan-Riley-Ruvalcaba syndrome can be challenging due to the variability in symptoms and the overlap with other conditions. A thorough physical examination, medical history review, and genetic testing are typically performed to confirm the diagnosis.

Genetic testing involves analyzing the PTEN gene for mutations. If a mutation is identified, it can help confirm the diagnosis and guide further management and surveillance for associated health issues.

Treatment and Management

Currently, there is no cure for Bannayan-Riley-Ruvalcaba syndrome. Treatment focuses on managing the symptoms and associated health problems to improve the individual’s quality of life. The following approaches may be utilized:

  • Regular medical monitoring: Individuals with BRRS require regular check-ups to monitor their growth, development, and overall health. This includes monitoring for the development of gastrointestinal polyps and other potential complications.
  • Physical therapy and early intervention: Early intervention programs and physical therapy can help individuals with developmental delays reach their full potential.
  • Surgical removal of lipomas and polyps: Lipomas and gastrointestinal polyps may need to be surgically removed if they cause discomfort or pose a risk to the individual’s health.
  • Genetic counseling: Genetic counseling is recommended for individuals with BRRS and their families to understand the inheritance pattern and the risk of passing the condition on to future generations.


Bannayan-Riley-Ruvalcaba syndrome is a complex genetic disorder that affects multiple systems in the body. It is characterized by macrocephaly, multiple lipomas, hemangiomas, pigmented macules, developmental delay, intellectual disability, and gastrointestinal polyps. While there is no cure for BRRS, early diagnosis, regular medical monitoring, and appropriate interventions can help manage the symptoms and improve the individual’s quality of life. Genetic counseling is essential for affected individuals and their families to understand the condition and make informed decisions about family planning.

Haroon Rashid, MD
Rate author
Urgent Care Center of Arlington, VA
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