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Franceschi R, Rivieri F, Novelli A, Ferretti D, Anesi A, Soffiati M, Porretti G, Maines E, Mucciolo M, Radetti G. Mosaicism of a novel variant in the ANKRD11 gene in a child with a mild KBG phenotype: A case report. World J Med Genet 2023; 11:21-27. [DOI: 10.5496/wjmg.v11.i2.21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/06/2023] [Revised: 05/03/2023] [Accepted: 05/19/2023] [Indexed: 06/02/2023] Open
Abstract
BACKGROUND KBG syndrome is likely underdiagnosed because of mild and non-specific features in some affected patients especially before the upper permanent central incisors eruption at about the age of 7-8 years. Somatic mosaicisms are usually recognized in the parents only after a typically affected son is diagnosed with KBG syndrome. We describe for the first time the mosaicism of a novel variant in a child with a mild KBG phenotype.
CASE SUMMARY Our patient presented at 24 mo of age with short stature, hand abnormalities, facial dysmorphism and mild developmental delay. Pituitary hypoplasia and central hypothyroidism were also detected. By next generation sequencing (NGS) analysis we found a novel deletion in the ANKRD11 gene (c.4880_4893del.), that can be classified as likely pathogenic for the syndrome, with the percentage of mutated allele of 36%. We considered this finding as causative of the mild and non-specific phenotype for KBG syndrome in our patient, as previously reported in adults. A heterozygous variant in HESX1 gene, classified as variant of uncertain significance, but suspected of causing pituitary hypoplasia and hormonal deficiency, was also found. The patient started levothyroxine and growth hormone treatment.
CONCLUSION The increased use of NGS analysis may expand the phenotypic spectrum of KBG syndrome because it allows genetic diagnosis of somatic mosaicisms also in children.
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Affiliation(s)
- Roberto Franceschi
- Department of Pediatrics, S. Chiara Hospital of Trento, APSS, Trento 38122, Italy
| | - Francesca Rivieri
- Genetic Unit, Laboratory of Clinical Pathology, Department of Laboratories, APSS, Trento 38122, Italy
| | - Antonio Novelli
- Laboratory of Medical Genetics, Ospedale Pediatrico Bambino Gesù, Rome 00165, Italy
| | - Daniele Ferretti
- Human Genetics Laboratory, Ospedale Pediatrico Bambino Gesù, Rome 00165, Italy
| | - Adriano Anesi
- Genetic Unit, Laboratory of Clinical Pathology, Department of Laboratories, APSS, Trento 38122, Italy
| | - Massimo Soffiati
- Department of Pediatrics, S. Chiara General Hospital, APSS, Trento 38122, Italy
| | - Giulia Porretti
- Department of Radiology, S. Chiara General Hospital, APSS, Trento 38122, Italy
| | - Evelina Maines
- Department of Pediatrics, S. Chiara General Hospital, APSS, Trento 38122, Italy
| | - Mafalda Mucciolo
- Human Genetics Laboratory, Ospedale Pediatrico Bambino Gesù, Rome 00165, Italy
| | - Giorgio Radetti
- Department of Pediatrics, General Hospital Bolzano, Marienklinik, Bolzano 39100, Italy
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Szeliga A, Kunicki M, Maciejewska-Jeske M, Rzewuska N, Kostrzak A, Meczekalski B, Bala G, Smolarczyk R, Adashi EY. The Genetic Backdrop of Hypogonadotropic Hypogonadism. Int J Mol Sci 2021; 22:ijms222413241. [PMID: 34948037 PMCID: PMC8708611 DOI: 10.3390/ijms222413241] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2021] [Revised: 11/24/2021] [Accepted: 12/05/2021] [Indexed: 11/30/2022] Open
Abstract
The pituitary is an organ of dual provenance: the anterior lobe is epithelial in origin, whereas the posterior lobe derives from the neural ectoderm. The pituitary gland is a pivotal element of the axis regulating reproductive function in mammals. It collects signals from the hypothalamus, and by secreting gonadotropins (FSH and LH) it stimulates the ovary into cyclic activity resulting in a menstrual cycle and in ovulation. Pituitary organogenesis is comprised of three main stages controlled by different signaling molecules: first, the initiation of pituitary organogenesis and subsequent formation of Rathke’s pouch; second, the migration of Rathke’s pouch cells and their proliferation; and third, lineage determination and cellular differentiation. Any disruption of this sequence, e.g., gene mutation, can lead to numerous developmental disorders. Gene mutations contributing to disordered pituitary development can themselves be classified: mutations affecting transcriptional determinants of pituitary development, mutations related to gonadotropin deficiency, mutations concerning the beta subunit of FSH and LH, and mutations in the DAX-1 gene as a cause of adrenal hypoplasia and disturbed responsiveness of the pituitary to GnRH. All these mutations lead to disruption in the hypothalamic–pituitary–ovarian axis and contribute to the development of primary amenorrhea.
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Affiliation(s)
- Anna Szeliga
- Department of Gynecological Endocrinology, Poznan University of Medical Sciences, 60-535 Poznan, Poland; (A.S.); (M.M.-J.); (A.K.)
| | - Michal Kunicki
- INVICTA Fertility and Reproductive Center, 00-019 Warsaw, Poland;
- Department of Gynecological Endocrinology, Medical University of Warsaw, 00-315 Warsaw, Poland; (N.R.); (R.S.)
| | - Marzena Maciejewska-Jeske
- Department of Gynecological Endocrinology, Poznan University of Medical Sciences, 60-535 Poznan, Poland; (A.S.); (M.M.-J.); (A.K.)
| | - Natalia Rzewuska
- Department of Gynecological Endocrinology, Medical University of Warsaw, 00-315 Warsaw, Poland; (N.R.); (R.S.)
| | - Anna Kostrzak
- Department of Gynecological Endocrinology, Poznan University of Medical Sciences, 60-535 Poznan, Poland; (A.S.); (M.M.-J.); (A.K.)
| | - Blazej Meczekalski
- Department of Gynecological Endocrinology, Poznan University of Medical Sciences, 60-535 Poznan, Poland; (A.S.); (M.M.-J.); (A.K.)
- Correspondence: ; Tel.: +48-61-65-99-366; Fax: +48-61-65-99-454
| | - Gregory Bala
- Appletree Medical Group, Ottawa, ON K1R 5C1, Canada;
| | - Roman Smolarczyk
- Department of Gynecological Endocrinology, Medical University of Warsaw, 00-315 Warsaw, Poland; (N.R.); (R.S.)
| | - Eli Y. Adashi
- Warren Alpert Medical School, Brown University, 272 George St., Providence, RI 02906, USA;
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Mellone S, Zavattaro M, Vurchio D, Ronzani S, Caputo M, Leone I, Prodam F, Giordano M. A Long Contiguous Stretch of Homozygosity Disclosed a Novel STAG3 Biallelic Pathogenic Variant Causing Primary Ovarian Insufficiency: A Case Report and Review of the Literature. Genes (Basel) 2021; 12:genes12111709. [PMID: 34828315 PMCID: PMC8622734 DOI: 10.3390/genes12111709] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2021] [Revised: 10/20/2021] [Accepted: 10/26/2021] [Indexed: 11/30/2022] Open
Abstract
Primary ovarian insufficiency (POI) refers to an etiologically heterogeneous disorder characterized by hypergonadotropic hypogonadism that represents a major cause of infertility in women under 40 years of age. Most cases are apparently sporadic, but about 10–15% have an affected first-degree relative, indicating a genetic etiology. Pathogenic variations in genes involved in development, meiosis and hormonal signaling have been detected in the hereditary form of the disorder. However, most cases of POI remain unsolved even after exhaustive investigation. A 19-year-old Senegalese female affected by non-syndromic POI presented with primary amenorrhoea and answered well to the hormonal induction of puberty. In order to investigate the presence of a genetic defect, aCGH-SNP analysis was performed. A 13.5 Mb long contiguous stretch of homozygosity (LCSH) was identified on chromosome 7q21.13-q22.1 where the exome sequencing revealed a novel homozygous 4-bp deletion (c.3381_3384delAGAA) in STAG3. Pathogenic variants in this gene, encoding for a meiosis-specific protein, have been previously reported as the cause of POI in only eight families and recently as the cause of infertility in a male. The here-identified mutation leads to the truncation of the last 55 amino acids, confirming the important role in meiosis of the STAG3 C-terminal domain.
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Affiliation(s)
- Simona Mellone
- Laboratory of Genetics, SCDU Biochimica Clinica, Ospedale Maggiore della Carità, 28100 Novara, Italy;
| | - Marco Zavattaro
- Endocrinology, Department of Translational Medicine, University of Eastern Piedmont, 13100 Novara, Italy; (M.Z.); (M.C.); (I.L.); (F.P.)
| | - Denise Vurchio
- Laboratory of Genetics, Department of Health Sciences, University of Eastern Piedmont, 13100 Novara, Italy; (D.V.); (S.R.)
| | - Sara Ronzani
- Laboratory of Genetics, Department of Health Sciences, University of Eastern Piedmont, 13100 Novara, Italy; (D.V.); (S.R.)
| | - Marina Caputo
- Endocrinology, Department of Translational Medicine, University of Eastern Piedmont, 13100 Novara, Italy; (M.Z.); (M.C.); (I.L.); (F.P.)
- Laboratory of Genetics, Department of Health Sciences, University of Eastern Piedmont, 13100 Novara, Italy; (D.V.); (S.R.)
| | - Ilaria Leone
- Endocrinology, Department of Translational Medicine, University of Eastern Piedmont, 13100 Novara, Italy; (M.Z.); (M.C.); (I.L.); (F.P.)
| | - Flavia Prodam
- Endocrinology, Department of Translational Medicine, University of Eastern Piedmont, 13100 Novara, Italy; (M.Z.); (M.C.); (I.L.); (F.P.)
- Laboratory of Genetics, Department of Health Sciences, University of Eastern Piedmont, 13100 Novara, Italy; (D.V.); (S.R.)
| | - Mara Giordano
- Laboratory of Genetics, SCDU Biochimica Clinica, Ospedale Maggiore della Carità, 28100 Novara, Italy;
- Laboratory of Genetics, Department of Health Sciences, University of Eastern Piedmont, 13100 Novara, Italy; (D.V.); (S.R.)
- Correspondence:
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Vishnopolska SA, Mercogliano MF, Camilletti MA, Mortensen AH, Braslavsky D, Keselman A, Bergadá I, Olivieri F, Miranda L, Marino R, Ramírez P, Pérez Garrido N, Patiño Mejia H, Ciaccio M, Di Palma MI, Belgorosky A, Martí MA, Kitzman JO, Camper SA, Pérez-Millán MI. Comprehensive Identification of Pathogenic Gene Variants in Patients With Neuroendocrine Disorders. J Clin Endocrinol Metab 2021; 106:1956-1976. [PMID: 33729509 PMCID: PMC8208670 DOI: 10.1210/clinem/dgab177] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/02/2020] [Revised: 02/12/2021] [Indexed: 02/03/2023]
Abstract
PURPOSE Congenital hypopituitarism (CH) can present in isolation or with other birth defects. Mutations in multiple genes can cause CH, and the use of a genetic screening panel could establish the prevalence of mutations in known and candidate genes for this disorder. It could also increase the proportion of patients that receive a genetic diagnosis. METHODS We conducted target panel genetic screening using single-molecule molecular inversion probes sequencing to assess the frequency of mutations in known hypopituitarism genes and new candidates in Argentina. We captured genomic deoxyribonucleic acid from 170 pediatric patients with CH, either alone or with other abnormalities. We performed promoter activation assays to test the functional effects of patient variants in LHX3 and LHX4. RESULTS We found variants classified as pathogenic, likely pathogenic, or with uncertain significance in 15.3% of cases. These variants were identified in known CH causative genes (LHX3, LHX4, GLI2, OTX2, HESX1), in less frequently reported genes (FOXA2, BMP4, FGFR1, PROKR2, PNPLA6) and in new candidate genes (BMP2, HMGA2, HNF1A, NKX2-1). CONCLUSION In this work, we report the prevalence of mutations in known CH genes in Argentina and provide evidence for new candidate genes. We show that CH is a genetically heterogeneous disease with high phenotypic variation and incomplete penetrance, and our results support the need for further gene discovery for CH. Identifying population-specific pathogenic variants will improve the capacity of genetic data to predict eventual clinical outcomes.
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Affiliation(s)
- Sebastian Alexis Vishnopolska
- Instituto de Biociencias, Biotecnología y Biología Traslacional (IB3), Departamento de Fisiología, Biología Molecular y Celular, Facultad de Ciencias Exactas y Naturales, Universidad de Buenos Aires, Ciudad de Buenos Aires,Argentina
- Instituto de Química Biología en Exactas y Naturales (IQUIBICEN-CONICET), Departamento de Química Biológica, Facultad de Ciencias Exactas y Naturales, Universidad de Buenos Aires, Ciudad de Buenos Aires,Argentina
| | - Maria Florencia Mercogliano
- Instituto de Química Biología en Exactas y Naturales (IQUIBICEN-CONICET), Departamento de Química Biológica, Facultad de Ciencias Exactas y Naturales, Universidad de Buenos Aires, Ciudad de Buenos Aires,Argentina
| | - Maria Andrea Camilletti
- Instituto de Biociencias, Biotecnología y Biología Traslacional (IB3), Departamento de Fisiología, Biología Molecular y Celular, Facultad de Ciencias Exactas y Naturales, Universidad de Buenos Aires, Ciudad de Buenos Aires,Argentina
- Instituto de Química Biología en Exactas y Naturales (IQUIBICEN-CONICET), Departamento de Química Biológica, Facultad de Ciencias Exactas y Naturales, Universidad de Buenos Aires, Ciudad de Buenos Aires,Argentina
| | - Amanda Helen Mortensen
- Deptartment of Human Genetics, University of Michigan Medical School, Ann Arbor, MI 48198-5618, USA
| | - Debora Braslavsky
- Centro de Investigaciones Endocrinológicas “Dr. César Bergadá,” (CEDIE), FEI – CONICET – División de Endocrinología, Hospital de Niños Ricardo Gutiérrez, Ciudad de Buenos Aires, C1425EFD, Argentina
| | - Ana Keselman
- Centro de Investigaciones Endocrinológicas “Dr. César Bergadá,” (CEDIE), FEI – CONICET – División de Endocrinología, Hospital de Niños Ricardo Gutiérrez, Ciudad de Buenos Aires, C1425EFD, Argentina
| | - Ignacio Bergadá
- Centro de Investigaciones Endocrinológicas “Dr. César Bergadá,” (CEDIE), FEI – CONICET – División de Endocrinología, Hospital de Niños Ricardo Gutiérrez, Ciudad de Buenos Aires, C1425EFD, Argentina
| | - Federico Olivieri
- Instituto de Química Biología en Exactas y Naturales (IQUIBICEN-CONICET), Departamento de Química Biológica, Facultad de Ciencias Exactas y Naturales, Universidad de Buenos Aires, Ciudad de Buenos Aires,Argentina
| | - Lucas Miranda
- Instituto de Química Biología en Exactas y Naturales (IQUIBICEN-CONICET), Departamento de Química Biológica, Facultad de Ciencias Exactas y Naturales, Universidad de Buenos Aires, Ciudad de Buenos Aires,Argentina
| | - Roxana Marino
- Servicio de Endocrinología, Hospital Garrahan, Ciudad de Buenos Aires, C1245, Argentina
| | - Pablo Ramírez
- Servicio de Endocrinología, Hospital Garrahan, Ciudad de Buenos Aires, C1245, Argentina
| | - Natalia Pérez Garrido
- Servicio de Endocrinología, Hospital Garrahan, Ciudad de Buenos Aires, C1245, Argentina
| | - Helen Patiño Mejia
- Servicio de Endocrinología, Hospital Garrahan, Ciudad de Buenos Aires, C1245, Argentina
| | - Marta Ciaccio
- Servicio de Endocrinología, Hospital Garrahan, Ciudad de Buenos Aires, C1245, Argentina
| | - Maria Isabel Di Palma
- Servicio de Endocrinología, Hospital Garrahan, Ciudad de Buenos Aires, C1245, Argentina
| | - Alicia Belgorosky
- Hospital de Pediatría Garrahan-CONICET, Ciudad de Buenos Aires, Argentina
| | - Marcelo Adrian Martí
- Instituto de Química Biología en Exactas y Naturales (IQUIBICEN-CONICET), Departamento de Química Biológica, Facultad de Ciencias Exactas y Naturales, Universidad de Buenos Aires, Ciudad de Buenos Aires,Argentina
| | - Jacob Otto Kitzman
- Deptartment of Human Genetics, University of Michigan Medical School, Ann Arbor, MI 48198-5618, USA
| | - Sally Ann Camper
- Deptartment of Human Genetics, University of Michigan Medical School, Ann Arbor, MI 48198-5618, USA
- Correspondence: Sally A. Camper, PhD, University of Michigan Medical School, Ann Arbor, MI 48198-5618, United States. E-mail: ; or Maria Ines Perez-Millan, PhD, University of Buenos Aires, Buenos Aires, C1428EHA, Argentina. E-mail:
| | - Maria Ines Pérez-Millán
- Instituto de Biociencias, Biotecnología y Biología Traslacional (IB3), Departamento de Fisiología, Biología Molecular y Celular, Facultad de Ciencias Exactas y Naturales, Universidad de Buenos Aires, Ciudad de Buenos Aires,Argentina
- Correspondence: Sally A. Camper, PhD, University of Michigan Medical School, Ann Arbor, MI 48198-5618, United States. E-mail: ; or Maria Ines Perez-Millan, PhD, University of Buenos Aires, Buenos Aires, C1428EHA, Argentina. E-mail:
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Bosch I Ara L, Katugampola H, Dattani MT. Congenital Hypopituitarism During the Neonatal Period: Epidemiology, Pathogenesis, Therapeutic Options, and Outcome. Front Pediatr 2020; 8:600962. [PMID: 33634051 PMCID: PMC7902025 DOI: 10.3389/fped.2020.600962] [Citation(s) in RCA: 34] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/31/2020] [Accepted: 12/31/2020] [Indexed: 12/13/2022] Open
Abstract
Introduction: Congenital hypopituitarism (CH) is characterized by a deficiency of one or more pituitary hormones. The pituitary gland is a central regulator of growth, metabolism, and reproduction. The anterior pituitary produces and secretes growth hormone (GH), adrenocorticotropic hormone, thyroid-stimulating hormone, follicle-stimulating hormone, luteinizing hormone, and prolactin. The posterior pituitary hormone secretes antidiuretic hormone and oxytocin. Epidemiology: The incidence is 1 in 4,000-1 in 10,000. The majority of CH cases are sporadic; however, a small number of familial cases have been identified. In the latter, a molecular basis has frequently been identified. Between 80-90% of CH cases remain unsolved in terms of molecular genetics. Pathogenesis: Several transcription factors and signaling molecules are involved in the development of the pituitary gland. Mutations in any of these genes may result in CH including HESX1, PROP1, POU1F1, LHX3, LHX4, SOX2, SOX3, OTX2, PAX6, FGFR1, GLI2, and FGF8. Over the last 5 years, several novel genes have been identified in association with CH, but it is likely that many genes remain to be identified, as the majority of patients with CH do not have an identified mutation. Clinical manifestations: Genotype-phenotype correlations are difficult to establish. There is a high phenotypic variability associated with different genetic mutations. The clinical spectrum includes severe midline developmental disorders, hypopituitarism (in isolation or combined with other congenital abnormalities), and isolated hormone deficiencies. Diagnosis and treatment: Key investigations include MRI and baseline and dynamic pituitary function tests. However, dynamic tests of GH secretion cannot be performed in the neonatal period, and a diagnosis of GH deficiency may be based on auxology, MRI findings, and low growth factor concentrations. Once a hormone deficit is confirmed, hormone replacement should be started. If onset is acute with hypoglycaemia, cortisol deficiency should be excluded, and if identified this should be rapidly treated, as should TSH deficiency. This review aims to give an overview of CH including management of this complex condition.
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Affiliation(s)
- Laura Bosch I Ara
- Department of Paediatric Endocrinology, Great Ormond Street Hospital for Children, London, United Kingdom
| | - Harshini Katugampola
- Department of Paediatric Endocrinology, Great Ormond Street Hospital for Children, London, United Kingdom
| | - Mehul T Dattani
- Department of Paediatric Endocrinology, Great Ormond Street Hospital for Children, London, United Kingdom.,Genetics and Genomic Medicine Programme, UCL Great Ormond Street Institute of Child Health, London, United Kingdom
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Gergics P. Pituitary Transcription Factor Mutations Leading to Hypopituitarism. EXPERIENTIA SUPPLEMENTUM (2012) 2019; 111:263-298. [PMID: 31588536 DOI: 10.1007/978-3-030-25905-1_13] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
Congenital pituitary hormone deficiency is a disabling condition. It is part of a spectrum of disorders including craniofacial midline developmental defects ranging from holoprosencephaly through septo-optic dysplasia to combined and isolated pituitary hormone deficiency. The first genes discovered in the human disease were based on mouse models of dwarfism due to mutations in transcription factor genes. High-throughput DNA sequencing technologies enabled clinicians and researchers to find novel genetic causes of hypopituitarism for the more than three quarters of patients without a known genetic diagnosis to date. Transcription factor (TF) genes are at the forefront of the functional analysis of novel variants of unknown significance due to the relative ease in in vitro testing in a research lab. Genetic testing in hypopituitarism is of high importance to the individual and their family to predict phenotype composition, disease progression and to avoid life-threatening complications such as secondary adrenal insufficiency.This chapter aims to highlight our current understanding about (1) the contribution of TF genes to pituitary development (2) the diversity of inheritance and phenotype features in combined and select isolated pituitary hormone deficiency and (3) provide an initial assessment on how to approach variants of unknown significance in human hypopituitarism. Our better understanding on how transcription factor gene variants lead to hypopituitarism is a meaningful step to plan advanced therapies to specific genetic changes in the future.
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Affiliation(s)
- Peter Gergics
- Department of Human Genetics, University of Michigan, Ann Arbor, MI, USA.
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Abstract
Research over the last 20 years has led to the elucidation of the genetic aetiologies of Isolated Growth Hormone Deficiency (IGHD) and Combined Pituitary Hormone Deficiency (CPHD). The pituitary plays a central role in growth regulation, coordinating the multitude of central and peripheral signals to maintain the body's internal balance. Naturally occurring mutation in humans and in mice have demonstrated a role for several factors in the aetiology of IGHD/CPHD. Mutations in the GH1 and GHRHR genes shed light on the phenotype and pathogenesis of IGHD whereas mutations in transcription factors such as HESX1, PROP1, POU1F1, LHX3, LHX4, GLI2 and SOX3 contributed to the understanding of CPHD. Depending upon the expression patterns of these molecules, the phenotype may consist of isolated hypopituitarism, or more complex disorders such as septo-optic dysplasia (SOD) and holoprosencephaly. Although numerous monogenic causes of growth disorders have been identified, most of the patients with IGHD/CPHD remain with an explained aetiology as shown by the relatively low mutation detection rate. The introduction of novel diagnostic approaches is now leading to the disclosure of novel genetic causes in disorders characterized by pituitary hormone defects.
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Affiliation(s)
- Mara Giordano
- Department of Health Sciences, Laboratory of Human Genetics, University of Eastern Piedmont, Novara, Italy.
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Fang Q, Figueredo Benedetti AF, Ma Q, Gregory L, Li JZ, Dattani M, Sadeghi-Nejad A, Arnhold IJ, de Mendonça BB, Camper SA, Carvalho LR. HESX1 mutations in patients with congenital hypopituitarism: variable phenotypes with the same genotype. Clin Endocrinol (Oxf) 2016; 85:408-14. [PMID: 27000987 PMCID: PMC4988903 DOI: 10.1111/cen.13067] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/02/2016] [Revised: 02/22/2016] [Accepted: 03/16/2016] [Indexed: 02/01/2023]
Abstract
INTRODUCTION Mutations in the transcription factor HESX1 can cause isolated growth hormone deficiency (IGHD) or combined pituitary hormone deficiency (CPHD) with or without septo-optic dysplasia (SOD). So far there is no clear genotype-phenotype correlation. PATIENTS AND RESULTS We report four different recessive loss-of-function mutations in three unrelated families with CPHD and no midline defects or SOD. A homozygous p.R160C mutation was found by Sanger sequencing in two siblings from a consanguineous family. These patients presented with ACTH, TSH and GH deficiencies, severe anterior pituitary hypoplasia (APH) or pituitary aplasia (PA) and normal posterior pituitary. The p.R160C mutation was previously reported in a case with SOD, CPHD and ectopic posterior pituitary (EPP). Using exome sequencing, a homozygous p.I26T mutation was found in a Brazilian patient born to consanguineous parents. This patient had evolving CPHD, normal ACTH, APH and normal posterior pituitary (NPP). A previously reported patient homozygous for p.I26T had evolving CPHD and EPP. Finally, we identified compound heterozygous mutations in HESX1, p.[R159W];[R160H], in a patient with PA and CPHD. We showed that both of these mutations abrogate the ability of HESX1 to repress PROP1-mediated transcriptional activation. A patient homozygous for p.R160H was previously reported in a patient with CPHD, EPP, APH. CONCLUSION These three examples demonstrate that HESX1 mutations cause variable clinical features in patients, which suggests an influence of modifier genes or environmental factors on the phenotype.
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Affiliation(s)
- Qing Fang
- Department of Human Genetics, University of Michigan Medical School, Ann Arbor, MI, USA
| | - Anna Flavia Figueredo Benedetti
- Division of Endocrinology, Unit of Endocrinology and Development, Laboratory of Hormones and Molecular Genetics, Clinical Hospital of the Faculty of Medicine of the University of São Paulo, São Paulo, Brazil
| | - Qianyi Ma
- Department of Human Genetics, University of Michigan Medical School, Ann Arbor, MI, USA
| | - Louise Gregory
- Developmental Endocrinology Research Group, Section of Genetics and Epigenetics in Health and Disease, Genetics and Genomic Medicine Programme, University College London, Institute of Child Health, London, UK
| | - Jun Z. Li
- Department of Human Genetics, University of Michigan Medical School, Ann Arbor, MI, USA
| | - Mehul Dattani
- Developmental Endocrinology Research Group, Section of Genetics and Epigenetics in Health and Disease, Genetics and Genomic Medicine Programme, University College London, Institute of Child Health, London, UK
| | - Abdollah Sadeghi-Nejad
- Division of Pediatric Endocrinology, Floating Hospital for Children at Tufts Medical Center, Tufts University School of Medicine, Boston, MA, USA
| | - Ivo J.P. Arnhold
- Division of Endocrinology, Unit of Endocrinology and Development, Laboratory of Hormones and Molecular Genetics, Clinical Hospital of the Faculty of Medicine of the University of São Paulo, São Paulo, Brazil
| | - Berenice Bilharinho de Mendonça
- Division of Endocrinology, Unit of Endocrinology and Development, Laboratory of Hormones and Molecular Genetics, Clinical Hospital of the Faculty of Medicine of the University of São Paulo, São Paulo, Brazil
| | - Sally A. Camper
- Department of Human Genetics, University of Michigan Medical School, Ann Arbor, MI, USA
- Correspondence should be addressed to: Sally A. Camper, Ph.D., Department of Human Genetics, University of Michigan Medical School, Ann Arbor, MI 48109-5618, USA, Fax: 1-734-763-3784, , Luciani R. Carvalho, M.D., Ph.D., Endocrinology Discipline of Internal Medicine Department, University of Sao Paulo Medical School, Sao Paulo, Brazil, Fax: 55-11-2661-7519,
| | - Luciani R. Carvalho
- Division of Endocrinology, Unit of Endocrinology and Development, Laboratory of Hormones and Molecular Genetics, Clinical Hospital of the Faculty of Medicine of the University of São Paulo, São Paulo, Brazil
- Correspondence should be addressed to: Sally A. Camper, Ph.D., Department of Human Genetics, University of Michigan Medical School, Ann Arbor, MI 48109-5618, USA, Fax: 1-734-763-3784, , Luciani R. Carvalho, M.D., Ph.D., Endocrinology Discipline of Internal Medicine Department, University of Sao Paulo Medical School, Sao Paulo, Brazil, Fax: 55-11-2661-7519,
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Smuel K, Kauli R, Lilos P, Laron Z. Growth, development, puberty and adult height before and during treatment in children with congenital isolated growth hormone deficiency. Growth Horm IGF Res 2015; 25:182-188. [PMID: 26077773 DOI: 10.1016/j.ghir.2015.05.001] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/04/2015] [Revised: 05/03/2015] [Accepted: 05/07/2015] [Indexed: 11/21/2022]
Abstract
OBJECTIVE To describe the growth, development and puberty in children with congenital IGHD before and during hGH treatment. SUBJECTS Patients with cIGHD treated by hGH between the years 1958-1992. SETTING All patients were diagnosed, treated and followed in our clinic. PARTICIPANTS Data were found in 37/41 patients (21 m, 16 f). 34 had hGH-1A deletions, 7 GHRH-R mutations. Patients, referred after age 25, were excluded. RESULTS The birth length of 10/37 neonates was 48.29±2.26 (44-50) cm. Birth weight of 28/37 neonates was 3380±370 g (m), 3230±409 g (f). Neuromotor milestones were variable. Age at referral was 5.7±4.2 y (m) and 5.6±3.8 y (f). Initiation of hGH treatment (35μg/kg/d) was 7.5±4.8, (0.8-15.08) y (m) and 6.8±4.36 (0.8-16.5) y (f). Height SDS increased from -4.3 to -1.8 (m) and from -4.5 to -2.6 (f). Head circumference increased from -2.6 to -1.3 (m) and from -2.7 to -2.3 (f). BMI increased from 15.8 to 20.6 (m) and from 15.5 to 20.4 (f). There was a negative correlation between age of hGH initiation and change in height SDS (r=-0.66; ρ<0.01), same for bone age (r=-0.69; ρ<0.01). Upper/lower body ratio decreased from 2.5±2.1 (m±SD) to 1.08±0.1 (ρ<0.0005). Puberty was delayed in boys, less so in girls. Mean age of 1st ejaculation (14 m) was 17.6±2.2 y and of menarche (14 f. was 13.7±1.2 y. In both genders there was a positive correlation between age at start of hGH and age at onset of puberty (r=0.57; ρ<0.01). All reached full sexual development but the penile and testicular sizes were below normal. There was a positive correlation between length of hGH treatment and final testicular volume (r=0.597, ρ=0.05) and a negative correlation between the age at initiation of hGH treatment and final testicular volume(r=-0.523, ρ=0.018). All were obese and hGH treatment increased the adiposity progressively (r=0.418, ρ=0.013). CONCLUSION Early diagnosis and treatment of cIGHD enables normal or near normal growth, development and puberty.
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Affiliation(s)
- Keren Smuel
- Endocrinology and Diabetes Research Unit, Schneider Children's Medical Center, Sackler Faculty of Medicine, Tel Aviv University, Israel
| | - Rivka Kauli
- Endocrinology and Diabetes Research Unit, Schneider Children's Medical Center, Sackler Faculty of Medicine, Tel Aviv University, Israel
| | - Pearl Lilos
- Endocrinology and Diabetes Research Unit, Schneider Children's Medical Center, Sackler Faculty of Medicine, Tel Aviv University, Israel
| | - Zvi Laron
- Endocrinology and Diabetes Research Unit, Schneider Children's Medical Center, Sackler Faculty of Medicine, Tel Aviv University, Israel.
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Identification of HESX1 mutations in Kallmann syndrome. Fertil Steril 2013; 99:1831-7. [PMID: 23465708 DOI: 10.1016/j.fertnstert.2013.01.149] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2012] [Revised: 01/28/2013] [Accepted: 01/29/2013] [Indexed: 11/24/2022]
Abstract
OBJECTIVE To determine whether HESX1 mutations are present in patients with idiopathic hypogonadotropic hypogonadism (IHH)/Kallmann syndrome (KS). DESIGN Polymerase chain reaction-based DNA sequencing was performed on 217 well-characterized IHH/KS patients. Putative missense mutations were analyzed by sorting intolerant from tolerant (SIFT) and Clustal Ω. SETTING Academic medical center. PATIENT(S) Two hundred seventeen patients with IHH/KS and 192 controls. INTERVENTION(S) Deoxyribonucleic acid was extracted from patients and controls; genotype/phenotype comparisons were made. MAIN OUTCOME MEASURE(S) Deoxyribonucleic acid sequence of HESX1, SIFT analysis, and ortholog alignment. RESULT(S) Two novel heterozygous missense mutations (p.H42Y and p.V75L) and previously reported heterozygous missense mutation p.Q6H in HESX1 were identified in 3 of 217 patients (1.4%). All were males with KS. Both p.Q6H and p.H42Y were predicted to be deleterious by SIFT, whereas p.V75L was conserved in 8 of 9 species. No other IHH/KS gene mutations were present. CONCLUSION(S) HESX1 mutations may cause KS in addition to more severe phenotypes. Our findings expand the phenotypic spectrum of HESX1 mutations in humans, thereby broadening its role in development.
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Current world literature. Curr Opin Endocrinol Diabetes Obes 2012; 19:328-37. [PMID: 22760515 DOI: 10.1097/med.0b013e3283567080] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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