(Category 1) Parents of school-going age should be considered for an individual

education plan (IEP) based on the individual TAND profile. (Category 2A) At the time of diagnosis, abdominal imaging should be obtained regardless of age. As for brain, MRI is the preferred modality for evaluation of angiomyolipomata because many can be fat-poor and hence missed when abdominal CT or US are performed.23 MRI of the abdomen may be combined in the same session as MRI of the brain, thereby limiting the need for multiple sessions of anesthesia selleck inhibitor if anesthesia is needed for successful MRI. MRI of the abdomen may also reveal aortic aneurysms or extrarenal hamartomas of the liver, pancreas, and other abdominal organs that also can occur in individuals with TSC. In addition to imaging, accurate blood pressure assessment is important because of increased risk of secondary hypertension.

To assess renal function at time of diagnosis, blood tests to determine glomerular filtration rate (GFR) using creatinine equations for adults24 and 25 or children.26 Alternatively, measurement of serum cystatin C concentration can be used to evaluate GFR.27 (Category 1) To evaluate for LAM, females 18 years or older should have baseline pulmonary function testing, 6-minute walk test, and high-resolution chest computed tomography (HRCT). When possible, low-radiation protocols should be used. A serum vascular endothelial growth factor type D (VEGF-D) level may be helpful to establish a baseline for future LAM development or progression.28 and 29 MS-275 molecular weight Counseling on smoking risks and estrogen use (such as some oral contraceptive preparations), which can compound the impact of LAM, should also occur in adolescents and adults. (Category 2A) All patients should undergo a detailed clinical dermatologic and dental exam at time of diagnosis to evaluate for facial angiofibromas, Metformin solubility dmso fibrous cephalic plaques, hypomelanotic macules or confetti lesions, ungual fibromas, shagreen patch,

defects in tooth enamel, and intraoral fibroma. (Category 2A) In pediatric patients, especially younger than three years of age, an echocardiogram and electrocardiogram (ECG) should be obtained to evaluate for rhabdomyomas and arrhythmia, respectively. In those individuals with rhabdomyomas identified via prenatal ultrasound, fetal echocardiogram may be useful to detect those individuals with high risk of heart failure after delivery. (Category 1) In the absence of cardiac symptoms or concerning medical history, echocardiogram is not necessary in adults, but as conduction defects may still be present and may influence medication choice and dosing,30 a baseline ECG is still recommended. (Category 2A) A baseline ophthalmologic evaluation, including funduscopic evaluation, is recommended for all individuals diagnosed with TSC to evaluate for hamartomas and hypopigmented lesions of the retina.