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Berthon A, Settas N, Delaney A, Giannakou A, Demidowich A, Faucz FR, Seminara SB, Chen ME, Stratakis CA. Kisspeptin deficiency leads to abnormal adrenal glands and excess steroid hormone secretion. Hum Mol Genet 2021; 29:3443-3450. [PMID: 33089319 DOI: 10.1093/hmg/ddaa215] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2020] [Revised: 09/02/2020] [Accepted: 09/07/2020] [Indexed: 01/14/2023] Open
Abstract
Knockout mice for the kisspeptin receptor, Kiss1r (Kiss1r-/-) and its ligand kisspeptin, Kiss1 (Kiss1-/-) replicate the phenotype of isolated hypogonadotropic hypogonadism (IHH) associated with variants of these genes in humans. A recent report suggests that kisspeptin may be involved in human fetal adrenocortical development and function. Herein, we characterized the adrenal function and morphology in Kiss1-/- mice that do not go through normal puberty. Two fetal markers were expressed in eosinophilic cells potentially derived from the X-zone that should disappear at puberty in male mice and during the first pregnancy in female animals. Although the hypercorticosteronism observed in Kiss1-/- females corrected overtime, hyperaldosteronism persisted at 14 months and correlated with the overexpression of Star. To determine if KISS1 and KISS1R genes are involved in the development of primary aldosteronism (PA) and hypercortisolism [Cushing's syndrome (CS)] in humans, we sequenced these 2 genes in 65 patients with PA and/or CS. Interestingly, a patient with CS presented with a germline KISS1 variant (p.H90D, rs201073751). We also found three rare variants in the KISS1R gene in three patients with PA: p.C95W (rs141767649), p.A189T (rs73507527) and p.R229R (rs115335009). The two missense variants have been previously associated with IHH. Our findings suggest that KISS1 may play a role in adrenal function in mice and possibly adrenocortical steroid hormone secretion in humans, beyond its recently described role in human fetal adrenocortical development.
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Affiliation(s)
- Annabel Berthon
- Section on Endocrinology and Genetics (SEGEN), Eunice Kennedy Shriver National Institute of Child Health & Human Development (NICHD), Bethesda, MD 20892, USA.,Institut Cochin, Centre National de la Recherche Scientifique (CNRS), INSERM, Université Paris Descartes, 75014 Paris, France
| | - Nikolaos Settas
- Section on Endocrinology and Genetics (SEGEN), Eunice Kennedy Shriver National Institute of Child Health & Human Development (NICHD), Bethesda, MD 20892, USA
| | - Angela Delaney
- Section on Endocrinology and Genetics (SEGEN), Eunice Kennedy Shriver National Institute of Child Health & Human Development (NICHD), Bethesda, MD 20892, USA.,Endocrinology Inter-Institute Training Programs, Eunice Kennedy Shriver National Institute of Child Health and Human Development (NICHD), National Institutes of Health (NIH), Bethesda, MD 20892, USA
| | - Andreas Giannakou
- Section on Endocrinology and Genetics (SEGEN), Eunice Kennedy Shriver National Institute of Child Health & Human Development (NICHD), Bethesda, MD 20892, USA
| | - Andrew Demidowich
- Section on Endocrinology and Genetics (SEGEN), Eunice Kennedy Shriver National Institute of Child Health & Human Development (NICHD), Bethesda, MD 20892, USA
| | - Fabio R Faucz
- Section on Endocrinology and Genetics (SEGEN), Eunice Kennedy Shriver National Institute of Child Health & Human Development (NICHD), Bethesda, MD 20892, USA
| | - Stephanie B Seminara
- Harvard Reproductive Sciences Center and Reproductive Endocrine Unit, Department of Medicine, Massachusetts General Hospital, Boston, MA02114, USA
| | - Margaret E Chen
- Harvard Reproductive Sciences Center and Reproductive Endocrine Unit, Department of Medicine, Massachusetts General Hospital, Boston, MA02114, USA
| | - Constantine A Stratakis
- Section on Endocrinology and Genetics (SEGEN), Eunice Kennedy Shriver National Institute of Child Health & Human Development (NICHD), Bethesda, MD 20892, USA.,Endocrinology Inter-Institute Training Programs, Eunice Kennedy Shriver National Institute of Child Health and Human Development (NICHD), National Institutes of Health (NIH), Bethesda, MD 20892, USA
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2
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Wurth R, Tirosh A, Kamilaris CDC, Camacho J, Faucz FR, Maria AG, Berthon A, Papadakis GZ, Nilubol N, Hamimi A, Gharib AM, Demidowich A, Zilbermint M, Eisenhofer G, Braun L, Reincke M, Stratakis CA, Hannah-Shmouni F. Volumetric Modeling of Adrenal Gland Size in Primary Bilateral Macronodular Adrenocortical Hyperplasia. J Endocr Soc 2021; 5:bvaa162. [PMID: 33305158 PMCID: PMC7716656 DOI: 10.1210/jendso/bvaa162] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/31/2020] [Indexed: 11/19/2022] Open
Abstract
CONTEXT Radiological characterization of adrenal size in primary bilateral macronodular adrenocortical hyperplasia (PBMAH) has not been previously investigated. OBJECTIVE We hypothesized that volumetric modeling of adrenal gland size may correlate with biochemical disease severity in patients with PBMAH. Secondary analysis of patients with concurrent primary aldosteronism (PA) was performed. DESIGN A retrospective cross-sectional analysis of 44 patients with PBMAH was conducted from 2000 to 2019. SETTING Tertiary care clinical research center. PATIENTS Patients were diagnosed with PBMAH based upon clinical, genetic, radiographic and biochemical characteristics. INTERVENTION Clinical, biochemical, and genetic data were obtained. Computed tomography scans were used to create volumetric models by manually contouring both adrenal glands in each slice using Vitrea Core Fx v6.3 software (Vital Images, Minnetonka, Minnesota). MAIN OUTCOME AND MEASURES 17-hydroxycorticosteroids (17-OHS), ARMC5 genetics, and aldosterone-to-renin ratio (ARR) were retrospectively obtained. Pearson test was used for correlation analysis of biochemical data with adrenal volume. RESULTS A cohort of 44 patients with PBMAH was evaluated, with a mean age (±SD) of 53 ± 11.53. Eight patients met the diagnostic criteria for PA, of whom 6 (75%) were Black. In the Black cohort, total adrenal volumes positively correlated with midnight cortisol (R = 0.76, P = 0.028), urinary free cortisol (R = 0.70, P = 0.035), and 17-OHS (R = 0.87, P = 0.0045), with a more pronounced correlation with left adrenal volume alone. 17-OHS concentration positively correlated with total, left, and right adrenal volume in patients harboring pathogenic variants in ARMC5 (R = 0.72, P = 0.018; R = 0.65, P = 0.042; and R = 0.73, P = 0.016, respectively). CONCLUSIONS Volumetric modeling of adrenal gland size may associate with biochemical severity in patients with PBMAH, with particular utility in Black patients.
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Affiliation(s)
- Rachel Wurth
- Section on Endocrinology & Genetics (SEGEN), Eunice Kennedy Shriver National Institute of Child Health and Human Development (NICHD), National Institutes of Health (NIH), Bethesda, MD, USA
| | - Amit Tirosh
- Neuroendocrine Tumors Service, Division of Endocrinology, Diabetes and Metabolism, The Chaim Sheba Medical Center and Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Crystal D C Kamilaris
- Section on Endocrinology & Genetics (SEGEN), Eunice Kennedy Shriver National Institute of Child Health and Human Development (NICHD), National Institutes of Health (NIH), Bethesda, MD, USA
| | - Jancarlos Camacho
- Section on Endocrinology & Genetics (SEGEN), Eunice Kennedy Shriver National Institute of Child Health and Human Development (NICHD), National Institutes of Health (NIH), Bethesda, MD, USA
| | - Fabio R Faucz
- Section on Endocrinology & Genetics (SEGEN), Eunice Kennedy Shriver National Institute of Child Health and Human Development (NICHD), National Institutes of Health (NIH), Bethesda, MD, USA
| | - Andrea Gutierrez Maria
- Section on Endocrinology & Genetics (SEGEN), Eunice Kennedy Shriver National Institute of Child Health and Human Development (NICHD), National Institutes of Health (NIH), Bethesda, MD, USA
| | - Annabel Berthon
- Section on Endocrinology & Genetics (SEGEN), Eunice Kennedy Shriver National Institute of Child Health and Human Development (NICHD), National Institutes of Health (NIH), Bethesda, MD, USA
| | - Georgios Z Papadakis
- Foundation for Research and Technology (FORTH), Institute of Computer Science (ICS), Computational Biomedicine Laboratory, Heraklion, Greece
- Department of Radiology, Medical School, University of Crete, Heraklion, Greece
| | - Naris Nilubol
- Surgical Oncology Program, National Cancer Institute (NCI), National Institutes of Health (NIH), Bethesda, MD, USA
| | - Ahmed Hamimi
- Biomedical and Metabolic Imaging Branch, National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK), National Institutes of Health (NIH), Bethesda, MD, USA
| | - Ahmed M Gharib
- Biomedical and Metabolic Imaging Branch, National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK), National Institutes of Health (NIH), Bethesda, MD, USA
| | - Andrew Demidowich
- Section on Endocrinology & Genetics (SEGEN), Eunice Kennedy Shriver National Institute of Child Health and Human Development (NICHD), National Institutes of Health (NIH), Bethesda, MD, USA
| | - Mihail Zilbermint
- Section on Endocrinology & Genetics (SEGEN), Eunice Kennedy Shriver National Institute of Child Health and Human Development (NICHD), National Institutes of Health (NIH), Bethesda, MD, USA
- Johns Hopkins University School of Medicine, Division of Endocrinology, Diabetes, and Metabolism, Baltimore, MD, USA
- Johns Hopkins Community Physicians at Suburban Hospital, Bethesda, MD, USA
| | - Graeme Eisenhofer
- Institute of Clinical Chemistry and Laboratory Medicine, and Department of Medicine III, University Hospital Carl Gustav Carus, Technische Universität, Dresden, Germany
| | - Leah Braun
- Medizinische Klinik und Poliklinik IV, Division of Endocrinology, Klinikum der Universität, Ludwig-Maximilians-Universität München, Munich, Germany
| | - Martin Reincke
- Medizinische Klinik und Poliklinik IV, Division of Endocrinology, Klinikum der Universität, Ludwig-Maximilians-Universität München, Munich, Germany
| | - Constantine A Stratakis
- Section on Endocrinology & Genetics (SEGEN), Eunice Kennedy Shriver National Institute of Child Health and Human Development (NICHD), National Institutes of Health (NIH), Bethesda, MD, USA
| | - Fady Hannah-Shmouni
- Section on Endocrinology & Genetics (SEGEN), Eunice Kennedy Shriver National Institute of Child Health and Human Development (NICHD), National Institutes of Health (NIH), Bethesda, MD, USA
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Hannah-Shmouni F, Berthon A, Faucz FR, Briceno JM, Maria AG, Demidowich A, Peitzsch M, Masjkur J, Bonnet-Serrano F, Vaczlavik A, Bertherat J, Reincke M, Eisenhofer G, Stratakis CA. Mass spectrometry-based steroid profiling in primary bilateral macronodular adrenocortical hyperplasia. Endocr Relat Cancer 2020; 27:403-413. [PMID: 32348959 PMCID: PMC7354003 DOI: 10.1530/erc-20-0102] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/22/2020] [Accepted: 04/29/2020] [Indexed: 01/19/2023]
Abstract
Biochemical characterization of primary bilateral macronodular adrenocortical hyperplasia (PBMAH) by distinct plasma steroid profiles and its putative correlation to disease has not been previously studied. LC-MS/MS-based steroid profiling of 16 plasma steroids was applied to 36 subjects (22 females, 14 males) with PBMAH, 19 subjects (16 females, 3 males) with other forms of adrenal Cushing's syndrome (ACS), and an age and sex-matched control group. Germline ARMC5 sequencing was performed in all PBMAH cases. Compared to controls, PBMAH showed increased plasma 11-deoxycortisol, corticosterone, 11-deoxycorticosterone, 18-hydroxycortisol, and aldosterone, but lower progesterone, DHEA, and DHEA-S with distinct differences in subjects with and without pathogenic variants in ARMC5. Steroids that showed isolated differences included cortisol and 18-oxocortisol with higher (P < 0.05) concentrations in ACS than in controls and aldosterone with higher concentrations in PBMAH when compared to controls. Larger differences in PBMAH than with ACS were most clear for corticosterone, but there were also trends in this direction for 18-hydroxycortisol and aldosterone. Logistic regression analysis indicated four steroids - DHEA, 11-deoxycortisol, 18-oxocortisol, and corticosterone - with the most power for distinguishing the groups. Discriminant analyses with step-wise variable selection indicated correct classification of 95.2% of all subjects of the four groups using a panel of nine steroids; correct classification of subjects with and without germline variants in ARMC5 was achieved in 91.7% of subjects with PBMAH. Subjects with PBMAH show distinctive plasma steroid profiles that may offer a supplementary single-test alternative for screening purposes.
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Affiliation(s)
- Fady Hannah-Shmouni
- Section on Endocrinology and Genetics, The Eunice Kennedy Shriver Institute of Child Health and Human Development, National Institutes of Health, Bethesda, Maryland, USA
| | - Annabel Berthon
- Section on Endocrinology and Genetics, The Eunice Kennedy Shriver Institute of Child Health and Human Development, National Institutes of Health, Bethesda, Maryland, USA
| | - Fabio R. Faucz
- Section on Endocrinology and Genetics, The Eunice Kennedy Shriver Institute of Child Health and Human Development, National Institutes of Health, Bethesda, Maryland, USA
| | - Juan Medina Briceno
- Section on Endocrinology and Genetics, The Eunice Kennedy Shriver Institute of Child Health and Human Development, National Institutes of Health, Bethesda, Maryland, USA
| | - Andrea Gutierrez Maria
- Section on Endocrinology and Genetics, The Eunice Kennedy Shriver Institute of Child Health and Human Development, National Institutes of Health, Bethesda, Maryland, USA
| | - Andrew Demidowich
- Section on Endocrinology and Genetics, The Eunice Kennedy Shriver Institute of Child Health and Human Development, National Institutes of Health, Bethesda, Maryland, USA
| | - Mirko Peitzsch
- Institute of Clinical Chemistry and Laboratory Medicine & University Hospital Carl Gustav Carus, TechnischeUniversität Dresden, Germany
| | - Jimmy Masjkur
- Department of Medicine III, University Hospital Carl Gustav Carus, TechnischeUniversität Dresden, Germany
| | - Fidéline Bonnet-Serrano
- Department of Endocrinology & Hormonal Biology, Cochin Hospital, INSERM U1506, CNRS 8104, Institut Cochin, Paris Descartes University, Paris, France
| | - Anna Vaczlavik
- Department of Endocrinology & Hormonal Biology, Cochin Hospital, INSERM U1506, CNRS 8104, Institut Cochin, Paris Descartes University, Paris, France
| | - Jérôme Bertherat
- Department of Endocrinology & Hormonal Biology, Cochin Hospital, INSERM U1506, CNRS 8104, Institut Cochin, Paris Descartes University, Paris, France
| | - Martin Reincke
- Medizinische Klinik und Poliklinik IV, Klinikum der Ludwig-Maximilians-Universität München, Munich, Germany
| | - Graeme Eisenhofer
- Institute of Clinical Chemistry and Laboratory Medicine & University Hospital Carl Gustav Carus, TechnischeUniversität Dresden, Germany
- Department of Medicine III, University Hospital Carl Gustav Carus, TechnischeUniversität Dresden, Germany
| | - Constantine A. Stratakis
- Section on Endocrinology and Genetics, The Eunice Kennedy Shriver Institute of Child Health and Human Development, National Institutes of Health, Bethesda, Maryland, USA
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4
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Maria AG, Suzuki M, Berthon A, Kamilaris C, Demidowich A, Lack J, Zilbermint M, Hannah-Shmouni F, Faucz FR, Stratakis CA. Mosaicism for KCNJ5 Causing Early-Onset Primary Aldosteronism due to Bilateral Adrenocortical Hyperplasia. Am J Hypertens 2020; 33:124-130. [PMID: 31637427 DOI: 10.1093/ajh/hpz172] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2019] [Revised: 09/19/2019] [Accepted: 10/18/2019] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Somatic variants in KCNJ5 are the most common cause of primary aldosteronism (PA). There are few patients with PA in whom the disease is caused by germline variants in the KCNJ5 potassium channel gene (familial hyperaldosteronism type III-FH-III). METHODS A 5-year-old patient who developed hypertension due to bilateral adrenocortical hyperplasia (BAH) causing PA had negative peripheral DNA testing for any known genetic causes of PA. He was treated medically with adequate control of his PA but by the third decade of his life, due to worsening renal function, he underwent bilateral adrenalectomy. RESULTS Focused exome sequencing in multiple nodules of his BAH uncovered a "hot-spot" pathogenic KCNJ5 variant, while repeated Sanger sequencing showed no detectable DNA defects in peripheral blood and other tissues. However, whole exome, "deep" sequencing revealed that 0.23% of copies of germline DNA did in fact carry the same KCNJ5 variant that was present in the adrenocortical nodules, suggesting low level germline mosaicism for this PA-causing KCNJ5 defect. CONCLUSIONS Thus, this patient represents a unique case of BAH due to a mosaic KCNJ5 defect. Undoubtedly, his milder PA compared with other known cases of FH-III, was due to his mosaicism. This case has a number of implications for the prognosis, treatment, and counseling of the many patients with PA due to BAH that are seen in hypertension clinics.
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Affiliation(s)
- Andrea G Maria
- Section on Genetics & Endocrinology, The Eunice Kennedy Shriver National Institute of Child Health and Human Development, Bethesda, Maryland, USA
| | - Mari Suzuki
- Section on Genetics & Endocrinology, The Eunice Kennedy Shriver National Institute of Child Health and Human Development, Bethesda, Maryland, USA
- National Institute of Diabetes and Digestive and Kidney Disorders, Bethesda, Maryland, USA
| | - Annabel Berthon
- Section on Genetics & Endocrinology, The Eunice Kennedy Shriver National Institute of Child Health and Human Development, Bethesda, Maryland, USA
| | - Crystal Kamilaris
- Section on Genetics & Endocrinology, The Eunice Kennedy Shriver National Institute of Child Health and Human Development, Bethesda, Maryland, USA
| | - Andrew Demidowich
- Section on Genetics & Endocrinology, The Eunice Kennedy Shriver National Institute of Child Health and Human Development, Bethesda, Maryland, USA
| | - Justin Lack
- NIAID Collaborative Bioinformatics Resource (NCBR), National Institute of Allergy and Infectious Disease, Frederick, Maryland, USA
- Advanced Biomedical Computational Science, Frederick National Laboratory for Cancer Research, Frederick, Maryland, USA
| | - Mihail Zilbermint
- Section on Genetics & Endocrinology, The Eunice Kennedy Shriver National Institute of Child Health and Human Development, Bethesda, Maryland, USA
- Division of Endocrinology, Diabetes, and Metabolism, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
- Johns Hopkins Community Physicians at Suburban Hospital, Bethesda, Maryland, USA
| | - Fady Hannah-Shmouni
- Section on Genetics & Endocrinology, The Eunice Kennedy Shriver National Institute of Child Health and Human Development, Bethesda, Maryland, USA
| | - Fabio R Faucz
- Section on Genetics & Endocrinology, The Eunice Kennedy Shriver National Institute of Child Health and Human Development, Bethesda, Maryland, USA
| | - Constantine A Stratakis
- Section on Genetics & Endocrinology, The Eunice Kennedy Shriver National Institute of Child Health and Human Development, Bethesda, Maryland, USA
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Levine J, Han JM, Demidowich A, Brady S, Broadney M, Periwal V, Yanovski J. MON-161 Lipolytic Rate in Relation to Skeletal Muscle and Hepatic Insulin Resistance. J Endocr Soc 2019. [PMCID: PMC6550685 DOI: 10.1210/js.2019-mon-161] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
Introduction: Increased circulating free fatty acid (FFA) due to impaired control of adipocyte triglyceride lipolysis contributes to the development of obesity-related insulin resistance (IR). However, it is less clear whether there are differences in the relationship between lipolysis and skeletal muscle vs hepatic IR, or how these relationships are influenced by age, race, sex, body composition, or inflammation. We investigated the associations of lipolytic rate (LR) with skeletal muscle insulin sensitivity, as evidenced by insulin sensitivity index (SI), and hepatic IR, as measured by HOMA-IR. Methods: 46 healthy, non-diabetic adults with obesity (BMI 39.8±6.9 kg/m2) and 11 lean (BMI 25.6±2.1 kg/m2) adults (40% NHB, 20% HISP, 37% NHW, 3% Asian; 65% female; age 45.8±12.6y) underwent fasting blood draws and an insulin-modified frequently sampled intravenous glucose tolerance test (FSIVGTT). LR was calculated by a mathematical minimal model that estimated basal lipolysis and insulin-mediated lipolysis stimulated by insulin modulation of FFA during the FSIVGTT; SI was derived from Bergman’s minimal model. Body composition was determined by DXA. Using ANCOVA, we examined how LR was related to SI and HOMA-IR, controlling for age, race, and sex. Secondary analyses examined if the differences seen could be accounted for by differences in total fat mass or hsCRP. Results: As expected, LR was significantly elevated in adults with obesity (Mean±SD: 0.069±0.047 vs. 0.0052±0.00084 mEq/L*min, p<.001) and was positively correlated with total fat mass (r= +.64, p<.001). LR was also correlated with fasting insulin (r=.+56, p<.001), HOMA-IR (r= +.57, p<.001), SI (r= -.39, p<.01), and hsCRP (r= +.70, p<.001). Controlling for age, race, and sex (all ps>.05), LR remained correlated with SI (B= -.24, p<.01) and with HOMA-IR (B= +.33, p<.001). However, for SI, after including total fat mass and hsCRP in the model, the effect of LR on SI was no longer observed (p>.05). By contrast, for HOMA-IR, even after including total fat mass and hsCRP in the model, the effect of LR was still observed (B= +.30, p<.05). Conclusions: Previous studies have shown that excessive lipolysis plays a significant role in the pathogenesis of IR. By minimal model analysis of an insulin-modified FSIVGTT, we confirmed the well-described association of increased LR with skeletal muscle and hepatic IR. We found that differences in total fat mass fully explained the LR effect in skeletal muscle IR. However, even after controlling for total fat mass and hsCRP, our model revealed a significant association of LR with HOMA-IR. Our data suggest that LR is likely a strong predictor of hepatic IR across age, race, and sex in human obesity. Further studies are warranted to investigate how adiposity and inflammation mediate this relationship between lipolysis and IR.
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Affiliation(s)
| | | | | | | | | | | | - Jack Yanovski
- Pediatric Endocrinology, Metabolism, and Genetics, NIH, Bethesda, MD, United States
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Gubbi S, Araque K, Abdul Sater Z, Tella SH, Demidowich A, Cochran C, Patel S, Xi L, Filie A, Raffeld M, Kebebew E, Klubo-Gwiezdzinska J. SUN-553 Atypical Spindle Cells on a Thyroid Aspirate: A Rare Case of a Thyroid Schwannoma Presenting as a Progressively Expanding Thyroid Nodule. J Endocr Soc 2019. [PMCID: PMC6552818 DOI: 10.1210/js.2019-sun-553] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
Background: Mesenchymal tumors represent around 1% of all thyroid neoplasms. Schwannoma is one such tumor that arises from the peripheral nerve sheath within the thyroid gland. Case: A 40-year-old lady was referred to our center for evaluation of a thyroid mass that was initially noticed 2 years prior and had been rapidly enlarging over the past several months. The patient experienced occasional dysphagia, but no shortness of breath nor change in voice. There was no family history of thyroid cancer or exposure to head and neck radiation. On physical exam, a firm, non-tender, 3 cm nodule was palpated in the right thyroid lobe. There was no cervical lymphadenopathy. Pemberton sign was negative. There was no evidence of café-au-lait spots or cutaneous neurofibromas on skin exam. The thyroid function tests were normal (NL), with serum TSH of 2.06 µIU/mL (NL: 0.27 - 4.2) and free thyroxine of 1.2 ng/dL (NL: 0.9 - 1.7), anti-TPO antibody was elevated (483 IU/mL; NL: 0 - 34.9), serum calcitonin was undetectable (<5 pg/ml, NL <= 7.6 pg/ml), and serum PTH was NL (29.8 pg/ml; NL: 15 - 65). Thyroid ultrasound (US) revealed a solid, heterogeneous, hypoechoic, vascularized nodule, with regular borders and no microcalcifications, measuring 3.2cm x 1.7cm x 3.9cm - consistent with intermediate suspicion for malignancy per the American Thyroid Association risk stratification. There was no cervical lymphadenopathy. A CT scan of the neck revealed the mass causing mild tracheal deviation. A fine needle aspiration biopsy of the nodule revealed atypical spindle cells with hyperchromatic elongated nuclei and rare colloid, representing a spindle cell neoplasm. The patient underwent total thyroidectomy, right central neck lymph node dissection and a right cervical thymectomy. Histopathology was consistent with thyroid schwannoma characterized by a low Ki67 proliferation index, along with background Hashimoto’s thyroiditis. Immunohistochemical staining showed that the tumor cells were focally positive for TTF-1, negative for thyroglobulin and calcitonin and diffusely positive for S-100 and vimentin, further supporting the diagnosis of a schwannoma. Next generation sequencing of the DNA and RNA derived from tumor tissue using Oncomine Comprehensive Assay v3 detected NF2 p.Leu505fs frameshift mutation. The post-operative course was uneventful, and the patient was discharged on replacement levothyroxine. Upon 8 months follow-up, the patient continued to do well without any symptoms. Conclusion: Thyroid schwanommas are exceptionally rare, with around 20 cases reported to this day. Schwannomas may progressively enlarge causing compressive symptoms and mimicking more aggressive spindle cell tumors such as spindle cell papillary, medullary or anaplastic thyroid cancer and thyroid sarcomas. Prompt imaging and cytologic evaluation with appropriate ancillary studies is crucial in the management of these tumors.
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Affiliation(s)
- Sriram Gubbi
- National Institute of Diabetes and Digestive and Kidney Diseases, National Institutes of Health, Bethesda, MD, United States
| | - Katherine Araque
- National Institute of Diabetes and Digestive and Kidney Diseases, National Institutes of Health, Bethesda, MD, United States
| | - Zahraa Abdul Sater
- NIDDK/DEOB, National Institute of Diabetes and Digestive and Kidney Diseases, National Institutes of Health, Bethesda, MD, United States
| | | | - Andrew Demidowich
- National Institute of Child Health and Human Development, National Institutes of Health, Bethesda, MD, United States
| | - Craig Cochran
- National Institute of Diabetes and Digestive and Kidney Diseases, National Institutes of Health, Bethesda, MD, United States
| | - Snehal Patel
- National Cancer Institute, National Institutes of Health, Bethesda, MD, United States
| | - Liqiang Xi
- National Cancer Institute, National Institutes of Health, Bethesda, MD, United States
| | - Armando Filie
- National Cancer Institute, National Institutes of Health, Bethesda, MD, United States
| | - Mark Raffeld
- National Cancer Institute, National Institutes of Health, Bethesda, MD, United States
| | | | - Joanna Klubo-Gwiezdzinska
- National Institute of Diabetes and Digestive and Kidney Diseases, National Institutes of Health, Bethesda, MD, United States
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7
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Grewal S, Fosam A, Chalk L, Deven A, Suzuki M, Demidowich A, Correa R, Blau J, Stratakis C, Muniyappa R. OR31-6 Insulin Sensitivity and Pancreatic Beta-Cell Function in Patients with Primary Aldosteronism. J Endocr Soc 2019. [PMCID: PMC6554914 DOI: 10.1210/js.2019-or31-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
Insulin sensitivity and pancreatic beta-cell function are primary determinants of glucose tolerance. Primary aldosteronism (PA) is associated with increased risk for glucose intolerance. However, its effects on insulin sensitivity and β-cell function have shown mixed results. In this study, we compared indices of insulin sensitivity and pancreatic β-cell function derived from an oral glucose tolerance test (OGTT) in patients from two cohorts: subjects with PA (n=25) and essential hypertension control (EHC) subjects. The EHC controls (n=25) were similar in age and BMI range, gender composition (female, n=14), and number of subjects with type 2 diabetes (n=3). Group comparisons were performed after adjusting for age, sex, and BMI; data is presented as unadjusted mean ± SD. As expected, the PA group show lower potassium concentrations compared to the EHC group, as well as elevated aldosterone and reduced renin levels. Mean arterial pressure was not significantly different between the groups (PA:100.6 ± 11.7, EHC: 96.7 ± 15.5 mm Hg, p=0.22). The area under the curve (AUC) for insulin during an OGTT, but not glucose, was higher in the PA group (insulin AUC: 14831 ± 9545 vs. 8582 ± 4948, μU/mL∙min, p<0.05). Whole-body and hepatic insulin sensitivity were determined using surrogate indices and oral minimal model (SIMM) analysis. PA individuals were found to be less insulin sensitive compared to EHC subjects (Quantitative insulin sensitivity check index (QUICKI): 0.337 ± 0.035 vs. 0.367 ± 0.062, p<0.001; Matsuda Index: 3.98 ± 2.33 vs. 7.24 ± 6.50, p<0.001; and SIMM: 1.01x10-3 ± 2.01x10-3 vs. 1.87x10-3 ± 2.71x10-3, min-1 per μU/mL, p=0.08). The hepatic insulin resistance index (HIRI) was significantly higher in PA individuals (HIRI: 5.62 ± 4.52 vs. 4.02 ± 2.78, mg/dL∙ μU/mL ∙ 106, p<0.001), suggesting decreased hepatic insulin sensitivity. Insulinogenic index (IGI), a measure of β -cell function is calculated as change in insulin concentrations divided by change in glucose from 0 to 30 min (ΔI0-30/ΔG0-30). IGI was slightly higher in the PA cohort (169 ± 150 vs. 124 ± 122, pmol/mmol, p=0.06). Oral disposition index (DI), a marker of integrated islet β-cell function, is the product of insulin secretion and sensitivity derived from OGTT. DI was similar between the groups (561 ± 434 vs. 605 ± 517, p=0.80). This accounts for the similar glucose tolerance between the groups. In summary, insulin sensitivity is significantly lower in PA and is accompanied by a compensatory increase in β-cell function. These results suggest that excess aldosterone and/or other steroids in the context of PA may negatively affect insulin action without adversely impacting beta-cell function.
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Affiliation(s)
- Shivraj Grewal
- National Institute of Diabetes and Digestive and Kidney Diseases, Bethesda, MD, United States
| | - Andin Fosam
- National Institute of Diabetes and Digestive and Kidney Diseases, Bethesda, MD, United States
| | - Liam Chalk
- National Institute of Diabetes and Digestive and Kidney Diseases, Bethesda, MD, United States
| | - Arjun Deven
- National Institute of Diabetes and Digestive and Kidney Diseases, Bethesda, MD, United States
| | - Mari Suzuki
- National Institute of Diabetes and Digestive and Kidney Diseases, Bethesda, MD, United States
| | - Andrew Demidowich
- National Institute of Child Health and Human Development, Bethesda, MD, United States
| | - Ricardo Correa
- National Institute of Child Health and Human Development, Bethesda, MD, United States
| | - Jenny Blau
- National Institute of Diabetes and Digestive and Kidney Diseases, Bethesda, MD, United States
| | - Constantine Stratakis
- National Institute of Child Health and Human Development, Bethesda, MD, United States
| | - Ranganath Muniyappa
- National Institute of Diabetes and Digestive and Kidney Diseases, Bethesda, MD, United States
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8
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Hannah-Shmouni F, Berthon A, Faucz F, Medina Briceno J, Gutierrez Maria A, Demidowich A, Peitzsch M, Masjkur J, Bonnet-Serrano F, Vaczlavik A, Bertherat J, Reincke M, Eisenhofer G, Stratakis C. OR02-6 Mass Spectrometry-Based Steroid Profiling Inprimary Bilateral Macronodular Adrenocortical Hyperplasia. J Endocr Soc 2019. [PMCID: PMC6554999 DOI: 10.1210/js.2019-or02-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
Background: Biochemical characterization of primary bilateral macronodular adrenocortical hyperplasia (PBMAH) by distinct plasma steroid profiles and its putative correlation to disease has not been previously studied. Methods: LC-MS/MS-based steroid profiling of 16 plasma steroids was applied to 36 subjects (22 females, 14 males) with PBMAH, 19 subjects (16 females, 3 males) with other forms of adrenal CS (ACS), and an age and sex-matched control group. Germline ARMC5 sequencing was performed in all PBMAH cases. Results: The steroids showing the most dramatic differences between subject groups included 11-deoxycortisol, corticosterone, 11-deoxycorticosterone, 18-hydroxycortisol, progesterone and DHEA/DHEA-S. Steroids that showed isolated differences included cortisol and 18-oxocortisol with higher (P<0·05) concentrations in ACS than in controls, and aldosterone with higher concentrations in PBMAH when compared to controls. Larger differences in PBMAH than with ACS were most clear for corticosterone, but there were also trends in this direction for 18-hydroxycortisol and aldosterone. Logistic regression analysis indicated four steroids - DHEA, 11-deoxycortisol, 18-oxocortisol, and corticosterone - with the most power for distinguishing the groups. Discriminant analyses with step-wise variable selection indicated correct classification of 95·2% of all subjects of the four groups using a panel of nine steroids; correct classification of subjects with and without germline variants in ARMC5 was achieved in 91·7% of subjects with PBMAH. Conclusion: Subjects with PBMAH show distinctive plasma steroid profiles that may offer a supplementary single-test alternative for screening purposes.
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Affiliation(s)
- Fady Hannah-Shmouni
- The Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Instit, Bethesda, MD, United States
| | | | - Fabio Faucz
- NICHD-SEGEN, NIH/NICHD, Bethesda, MD, United States
| | - Juan Medina Briceno
- The Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Instit, Bethesda, MD, United States
| | - Andrea Gutierrez Maria
- The Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Instit, Bethesda, MD, United States
| | | | - Mirko Peitzsch
- Institute of Clinical Chemistry and Laboratory Medicine, University Hospital Carl Gustav Carus, Dresden, , Germany
| | - Jimmy Masjkur
- The University Clinic of Heidelberg, Heidelberg, , Germany
| | | | - Anna Vaczlavik
- Department of Endocrinology & Hormonal Biology, Cochin Hospital, Paris, , France
| | | | - Martin Reincke
- Klinikum der Univ Muenchen, Medizinische Klinik und Poliklinik IV, Munich, , Germany
| | - Graeme Eisenhofer
- Div of Neu, Faculty of Medicine, Techniche Universitt Dresden, Dresden, , Germany
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9
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Demidowich A, Levine J, Brady S, Broadney M, Yanovski J. OR31-2 Effects of Colchicine on Insulin Resistance, Pancreatic Beta-Cell Function, and Aspects of the Metabolic Syndrome (MetS) in Adults with Obesity, MetS, and Inflammation: A Pilot Randomized Controlled Trial. J Endocr Soc 2019. [PMCID: PMC6554767 DOI: 10.1210/js.2019-or31-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
Introduction: Low-grade chronic inflammation, due in part to activation of the NLRP3 inflammasome, increases with increasing adiposity and plays a significant role in the development of type 2 diabetes and cardiovascular disease. However, to date, the efficacy of anti-inflammatory medications to improve aspects of the metabolic syndrome (MetS) is not well established. As colchicine has been shown to prevent assembly of the NLRP3 inflammasome and ameliorate other inflammatory conditions, we aimed to evaluate the efficacy and safety of colchicine for improving metabolic and inflammatory outcomes in adults with obesity and MetS. Materials and Methods: We conducted a randomized, double-blind, placebo-controlled pilot trial in which 40 non-diabetic adults with obesity, MetS, and elevated high-sensitivity C-reactive protein (hsCRP≥ 2.0 mg/L) were randomized to colchicine 0.6 mg or placebo twice daily for three months. Fasting labs, insulin-modified frequently sampled intravenous glucose tolerance test (FSIVGTT), and body composition by DXA were performed at baseline and 3-month follow up. The primary outcome was change in FSIVGTT insulin sensitivity (SI) as measured by Bergman’s minimal model. Secondary outcomes included changes in other metabolic parameters and inflammatory markers. ANCOVA was used to examine differences between treatment arms, with age, sex, baseline body fat%, and Δbody fat% as covariates. Data were analyzed according to intention-to-treat and reported as mean±SD. Results: Colchicine significantly reduced inflammatory indices, including hsCRP (-2.8±2.9 vs. 0.4±2.8 mg/L, p=.002), ESR (-5.5±6.4 vs. 0.6±6.3 mm/hr, p=.007), white blood cell count (-1.09±1.23 vs. 0.29±1.16 K/µL, p=.002), and absolute neutrophil count (-1.06±1.05 vs. 0.12±0.93 K/µL, p<.001). However, change in SI was not significantly different between colchicine and placebo arms (2.9x10-6 ± 3.1x10-5 vs 3.4x10-6 ± 2.9x10-5 min-1·mU-1·ml, p=.82). Changes in other metabolic parameters also did not reach significance, although changes in HOMA-IR (p=.097) and glucose effectiveness (SG; p=.067) trended towards improvement in the colchicine group. Adverse events were similar in both groups, and no patients withdrew due to side effects. Post-hoc analyses calculated that a sample size of 166 subjects would be necessary to achieve 80% power to detect a difference in measures of metabolic health (e.g. HOMA-IR, fasting insulin, fasting glucose, SG, and disposition index) between colchicine and placebo groups, for a two-tailed α <0.05. Conclusions: Colchicine significantly improved obesity-associated inflammatory variables and demonstrated a good safety profile among obese non-diabetic adults with MetS. Larger, adequately powered studies are needed to determine whether colchicine has beneficial effects on insulin resistance and other measures of metabolic health in at-risk individuals.
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Affiliation(s)
| | | | | | | | - Jack Yanovski
- Pediatric Endocrinology, Metabolism, and Genetics, NIH, Bethesda, MD, United States
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10
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McCormick CD, Bezrukov L, Waters H, Oneyekaba G, Levine J, Khan S, Blank P, Demidowich A, Yanovski J, Zimmerberg J. Imaging of Human Subcutaneous Adipose Tissue Reveals Insulin Refractive and Responsive Populations. Biophys J 2018. [DOI: 10.1016/j.bpj.2017.11.1947] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022] Open
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11
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Hannah-Shmouni F, Demidowich A, Alves BR, Paluch GD, Margarita D, Lysikatos C, Belyavskaya E, Chang R, Stratakis CA. Management of primary aldosteronism in patients with adrenal hemorrhage following adrenal vein sampling: A brief review with illustrative cases. J Clin Hypertens (Greenwich) 2017; 19:1372-1376. [PMID: 28889455 DOI: 10.1111/jch.13059] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2017] [Revised: 06/01/2017] [Accepted: 05/21/2017] [Indexed: 11/29/2022]
Abstract
The authors describe the clinical investigation of two cases of primary aldosteronism with adrenal hemorrhage (AH) following adrenal vein sampling. A literature review was conducted regarding the medical management of primary aldosteronism in patients with AH following adrenal vein sampling. Guidelines on the management of primary aldosteronism with AH following adrenal vein sampling are lacking. The two patients were followed with serial imaging to document resolution of AH and treated medically with excellent blood pressure response. Resolution of AH was achieved, but a repeat adrenal vein sampling was deferred given the increased morbidity risk associated with a repeat procedure.
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Affiliation(s)
- Fady Hannah-Shmouni
- Section on Endocrinology & Genetics (SEGEN), Eunice Kennedy Shriver National Institute of Child Health and Human Development (NICHD), National Institutes of Health (NIH), Bethesda, MD, USA
| | - Andrew Demidowich
- Section on Endocrinology & Genetics (SEGEN), Eunice Kennedy Shriver National Institute of Child Health and Human Development (NICHD), National Institutes of Health (NIH), Bethesda, MD, USA
| | - Beatriz Rizkallah Alves
- Section on Endocrinology & Genetics (SEGEN), Eunice Kennedy Shriver National Institute of Child Health and Human Development (NICHD), National Institutes of Health (NIH), Bethesda, MD, USA
| | - Gabriela Dockhorn Paluch
- Section on Endocrinology & Genetics (SEGEN), Eunice Kennedy Shriver National Institute of Child Health and Human Development (NICHD), National Institutes of Health (NIH), Bethesda, MD, USA
| | - Dionysiou Margarita
- Section on Endocrinology & Genetics (SEGEN), Eunice Kennedy Shriver National Institute of Child Health and Human Development (NICHD), National Institutes of Health (NIH), Bethesda, MD, USA
| | - Charalampos Lysikatos
- Section on Endocrinology & Genetics (SEGEN), Eunice Kennedy Shriver National Institute of Child Health and Human Development (NICHD), National Institutes of Health (NIH), Bethesda, MD, USA
| | - Elena Belyavskaya
- Section on Endocrinology & Genetics (SEGEN), Eunice Kennedy Shriver National Institute of Child Health and Human Development (NICHD), National Institutes of Health (NIH), Bethesda, MD, USA
| | - Richard Chang
- Interventional Radiology Section, Diagnostic Radiology Department, Clinical Center, NIH, Bethesda, MD, USA
| | - Constantine A Stratakis
- Section on Endocrinology & Genetics (SEGEN), Eunice Kennedy Shriver National Institute of Child Health and Human Development (NICHD), National Institutes of Health (NIH), Bethesda, MD, USA
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12
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Hodes A, Lodish MB, Tirosh A, Meyer J, Belyavskaya E, Lyssikatos C, Rosenberg K, Demidowich A, Swan J, Jonas N, Stratakis CA, Zilbermint M. Hair cortisol in the evaluation of Cushing syndrome. Endocrine 2017; 56:164-174. [PMID: 28194652 PMCID: PMC5437744 DOI: 10.1007/s12020-017-1231-7] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/26/2016] [Accepted: 01/06/2017] [Indexed: 01/13/2023]
Abstract
PURPOSE Hair cortisol evaluation has been used to help detect patients with suspected Cushing syndrome. Our goal was to correlate segmental hair cortisol with biochemical testing in patients with Cushing syndrome and controls. This study was a prospective analysis of hair cortisol in confirmed Cushing syndrome cases over 16 months. METHODS Thirty-six subjects (26.5 ± 18.9 years, 75% female, and 75% Caucasian) were analyzed by diurnal serum cortisol, 24 h urinary free cortisol corrected for body surface area (UFC/BSA), and 24 h urinary 17-hydroxysteroids corrected for creatinine (17OHS/Cr). Thirty patients were diagnosed with Cushing syndrome, and six were defined as controls. 3-cm hair samples nearest to the scalp, cut into 1-cm segments (proximal, medial, and distal), were analyzed for cortisol by enzyme immunoassay and measured as pmol cortisol/g dry hair. Hair cortisol levels were compared with laboratory testing done within previous 2 months of the evaluation. RESULTS Proximal hair cortisol was higher in Cushing syndrome patients (266.6 ± 738.4 pmol/g) than control patients (38.9 ± 25.3 pmol/g) (p = 0.003). Proximal hair cortisol was highest of all segments in 25/36 (69%) patients. Among all subjects, proximal hair cortisol was strongly correlated with UFC/BSA (r = 0.5, p = 0.005), midnight serum cortisol (r = 0.4, p = 0.03), and 17OHS/Cr, which trended towards significance (r = 0.3, p = 0.06). CONCLUSIONS Among the three examined hair segments, proximal hair contained the highest cortisol levels and correlated the most with the initial biochemical tests for Cushing syndrome in our study. Further studies are needed to validate proximal hair cortisol in the diagnostic workup for Cushing syndrome.
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Affiliation(s)
- Aaron Hodes
- Section on Endocrinology and Genetics, Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health, Bethesda, MD, 20892, USA
- Albert Einstein College of Medicine, Department of Radiology, Jacobi Medical Center, Bronx, NY, 10461, USA
| | - Maya B Lodish
- Section on Endocrinology and Genetics, Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health, Bethesda, MD, 20892, USA
| | - Amit Tirosh
- Section on Endocrinology and Genetics, Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health, Bethesda, MD, 20892, USA
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, 6997801, Israel
| | - Jerrold Meyer
- Department of Psychological and Brain Sciences, University of Massachusetts, Amherst, MA, 01003, USA
| | - Elena Belyavskaya
- Section on Endocrinology and Genetics, Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health, Bethesda, MD, 20892, USA
| | - Charalampos Lyssikatos
- Section on Endocrinology and Genetics, Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health, Bethesda, MD, 20892, USA
| | - Kendra Rosenberg
- Department of Psychological and Brain Sciences, University of Massachusetts, Amherst, MA, 01003, USA
| | - Andrew Demidowich
- Section on Endocrinology and Genetics, Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health, Bethesda, MD, 20892, USA
| | - Jeremy Swan
- Section on Endocrinology and Genetics, Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health, Bethesda, MD, 20892, USA
| | - Nichole Jonas
- Section on Endocrinology and Genetics, Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health, Bethesda, MD, 20892, USA
| | - Constantine A Stratakis
- Section on Endocrinology and Genetics, Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health, Bethesda, MD, 20892, USA
| | - Mihail Zilbermint
- Section on Endocrinology and Genetics, Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health, Bethesda, MD, 20892, USA.
- Johns Hopkins University School of Medicine, Division of Endocrinology, Diabetes, and Metabolism, Baltimore, MD, 21287, USA.
- Suburban Hospital, Bethesda, MD, 20814, USA.
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13
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McCormick CD, Waters H, Bezrukov L, Busse B, Demidowich A, Blank PS, Yanovski JA, Zimmerberg JJ. Human Subcutaneous Adipose Tissue Adipocytes Demonstrate Two Physiological States: Insulin Responsive or Insulin Refractory. Biophys J 2017. [DOI: 10.1016/j.bpj.2016.11.819] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
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14
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Radin RM, Shomaker LB, Kelly NR, Pickworth CK, Thompson KA, Brady SM, Demidowich A, Galescu O, Altschul AM, Shank LM, Yanovski SZ, Tanofsky-Kraff M, Yanovski JA. Cortisol response to an induction of negative affect among adolescents with and without loss of control eating. Pediatr Obes 2016; 11:513-520. [PMID: 26667312 PMCID: PMC4909600 DOI: 10.1111/ijpo.12095] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/06/2015] [Revised: 11/11/2015] [Accepted: 11/12/2015] [Indexed: 01/08/2023]
Abstract
BACKGROUND Adults with binge eating disorder may have an exaggerated or blunted cortisol response to stress. Yet, limited data exist among youth who report loss of control (LOC) eating, a developmental precursor to binge eating disorder. METHODS We studied cortisol reactivity among 178 healthy adolescents with and without LOC eating. Following a buffet lunch meal adolescents were randomly assigned to watch a neutral or sad film clip. After, they were offered snacks from a multi-item array to assess eating in the absence of hunger. Salivary cortisol was collected at -80, 0, 30 and 50 min relative to film administration, and state mood ratings were reported before and after the film. RESULTS Adolescents with LOC had greater increases in negative affect during the experimental paradigm in both conditions (ps > 0.05). Depressive symptoms, but not LOC, related to a greater cortisol response in the sad film condition (ps > 0.05). Depressive symptoms and state LOC were related to different aspects of eating behaviour, independent of film condition or cortisol response (ps > 0.05). CONCLUSIONS A film clip that induced depressed state affect increased salivary cortisol only in adolescents with more elevated depressive symptoms. Adolescents with and without LOC were differentiated by greater increases in state depressed affect during laboratory test meals but had no difference in cortisol reactivity. Future studies are required to determine if adolescents with LOC manifest alterations in stress reactivity to alternative stress-inducing situations.
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Affiliation(s)
- Rachel M. Radin
- Section on Growth and Obesity, Program in Developmental Endocrinology and Genetics, Eunice Kennedy Shriver National Institute of Child Health and Human Development (NICHD) National Institutes of Health (NIH), DHHS, Bethesda, Maryland, 20892, USA,Department of Medical and Clinical Psychology, Uniformed Services University of the Health Sciences, Bethesda, MD 20814, USA
| | - Lauren B. Shomaker
- Section on Growth and Obesity, Program in Developmental Endocrinology and Genetics, Eunice Kennedy Shriver National Institute of Child Health and Human Development (NICHD) National Institutes of Health (NIH), DHHS, Bethesda, Maryland, 20892, USA,Department of Human Development and Family Studies, Colorado State University, Fort Collins, Colorado, 80523, USA
| | - Nichole R. Kelly
- Section on Growth and Obesity, Program in Developmental Endocrinology and Genetics, Eunice Kennedy Shriver National Institute of Child Health and Human Development (NICHD) National Institutes of Health (NIH), DHHS, Bethesda, Maryland, 20892, USA,Department of Medical and Clinical Psychology, Uniformed Services University of the Health Sciences, Bethesda, MD 20814, USA,Department of Human Development and Family Studies, Colorado State University, Fort Collins, Colorado, 80523, USA
| | - Courtney K. Pickworth
- Section on Growth and Obesity, Program in Developmental Endocrinology and Genetics, Eunice Kennedy Shriver National Institute of Child Health and Human Development (NICHD) National Institutes of Health (NIH), DHHS, Bethesda, Maryland, 20892, USA
| | - Katherine A. Thompson
- Section on Growth and Obesity, Program in Developmental Endocrinology and Genetics, Eunice Kennedy Shriver National Institute of Child Health and Human Development (NICHD) National Institutes of Health (NIH), DHHS, Bethesda, Maryland, 20892, USA
| | - Sheila M. Brady
- Section on Growth and Obesity, Program in Developmental Endocrinology and Genetics, Eunice Kennedy Shriver National Institute of Child Health and Human Development (NICHD) National Institutes of Health (NIH), DHHS, Bethesda, Maryland, 20892, USA
| | - Andrew Demidowich
- Section on Growth and Obesity, Program in Developmental Endocrinology and Genetics, Eunice Kennedy Shriver National Institute of Child Health and Human Development (NICHD) National Institutes of Health (NIH), DHHS, Bethesda, Maryland, 20892, USA
| | - Ovidiu Galescu
- Section on Growth and Obesity, Program in Developmental Endocrinology and Genetics, Eunice Kennedy Shriver National Institute of Child Health and Human Development (NICHD) National Institutes of Health (NIH), DHHS, Bethesda, Maryland, 20892, USA
| | - Anne M. Altschul
- Section on Growth and Obesity, Program in Developmental Endocrinology and Genetics, Eunice Kennedy Shriver National Institute of Child Health and Human Development (NICHD) National Institutes of Health (NIH), DHHS, Bethesda, Maryland, 20892, USA
| | - Lisa M. Shank
- Section on Growth and Obesity, Program in Developmental Endocrinology and Genetics, Eunice Kennedy Shriver National Institute of Child Health and Human Development (NICHD) National Institutes of Health (NIH), DHHS, Bethesda, Maryland, 20892, USA,Department of Medical and Clinical Psychology, Uniformed Services University of the Health Sciences, Bethesda, MD 20814, USA
| | - Susan Z. Yanovski
- Section on Growth and Obesity, Program in Developmental Endocrinology and Genetics, Eunice Kennedy Shriver National Institute of Child Health and Human Development (NICHD) National Institutes of Health (NIH), DHHS, Bethesda, Maryland, 20892, USA,Office of Obesity Research, Division of Digestive Diseases and Nutrition, National Institute of Diabetes, Digestive, and Kidney Disorders, NIH, DHHS, Bethesda, Maryland, 20892, USA
| | - Marian Tanofsky-Kraff
- Section on Growth and Obesity, Program in Developmental Endocrinology and Genetics, Eunice Kennedy Shriver National Institute of Child Health and Human Development (NICHD) National Institutes of Health (NIH), DHHS, Bethesda, Maryland, 20892, USA,Department of Medical and Clinical Psychology, Uniformed Services University of the Health Sciences, Bethesda, MD 20814, USA
| | - Jack A. Yanovski
- Section on Growth and Obesity, Program in Developmental Endocrinology and Genetics, Eunice Kennedy Shriver National Institute of Child Health and Human Development (NICHD) National Institutes of Health (NIH), DHHS, Bethesda, Maryland, 20892, USA
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15
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Tanofsky-Kraff M, Shomaker LB, Wilfley DE, Young JF, Sbrocco T, Stephens M, Brady SM, Galescu O, Demidowich A, Olsen CH, Kozlosky M, Reynolds JC, Yanovski JA. Excess weight gain prevention in adolescents: Three-year outcome following a randomized controlled trial. J Consult Clin Psychol 2016; 85:218-227. [PMID: 27808536 DOI: 10.1037/ccp0000153] [Citation(s) in RCA: 34] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
OBJECTIVE Interpersonal psychotherapy (IPT) prevents weight gain in adults with obesity and binge-eating-disorder, and is especially effective among those with increased psychosocial problems. However, IPT was not superior to health education (HE) to prevent excess weight gain at 1-year follow-up in 113 adolescent girls at high-risk for excess weight gain because of loss-of-control eating and high body mass index (BMI; kg/m2; Tanofsky-Kraff et al., 2014). METHOD Participants from the original trial were recontacted 3 years later for assessment. At baseline, adolescent- and parent-reported social-adjustment problems and trait anxiety were evaluated. At baseline and follow-ups, BMIz and adiposity by dual-energy x-ray absorptiometry were obtained. RESULTS Nearly 60% were reassessed at 3 years, with no group differences in participation (ps ≥ .70). Consistent with 1 year, there was no main effect of group on change in BMIz/adiposity (ps ≥ .18). In exploratory analyses, baseline social-adjustment problems and trait-anxiety moderated outcome (ps < .01). Among girls with high self-reported baseline social-adjustment problems or anxiety, IPT, compared to HE, was associated with the steepest declines in BMIz (p < .001). For adiposity, girls with high or low anxiety in HE and girls with low anxiety in IPT experienced gains (ps ≤ .03), while girls in IPT with high anxiety stabilized. Parent-reports yielded complementary findings. CONCLUSION In obesity-prone adolescent girls, IPT was not superior to HE in preventing excess weight gain at 3 years. Consistent with theory, exploratory analyses suggested that IPT was associated with improvements in BMIz over 3 years among youth with high social-adjustment problems or trait anxiety. Future studies should test the efficacy of IPT for obesity prevention among at-risk girls with social-adjustment problems and/or anxiety. (PsycINFO Database Record
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Affiliation(s)
| | - Lauren B Shomaker
- Section on Growth and Obesity, Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health
| | - Denise E Wilfley
- Department of Psychiatry, Washington University School of Medicine
| | - Jami F Young
- Department of Applied and Professional Psychology, Rutgers University
| | | | | | - Sheila M Brady
- Section on Growth and Obesity, Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health
| | - Ovidiu Galescu
- Section on Growth and Obesity, Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health
| | - Andrew Demidowich
- Section on Growth and Obesity, Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health
| | - Cara H Olsen
- Department of Preventative Medicine and Biometrics, Uniformed Services University of the Health Sciences
| | - Merel Kozlosky
- Department of Nutrition, Hatfield Clinical Research Center, National Institutes of Health
| | - James C Reynolds
- Department of Nuclear Medicine, Hatfield Clinical Research Center, National Institutes of Health
| | - Jack A Yanovski
- Section on Growth and Obesity, Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health
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16
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Affiliation(s)
- Fady Hannah-Shmouni
- Section on Endocrinology and Genetics, Program on Developmental Endocrinology and Genetics, National Institute of Child Health and Human Development, National Institutes of Health, Bethesda, Maryland
| | - Andrew Demidowich
- Section on Endocrinology and Genetics, Program on Developmental Endocrinology and Genetics, National Institute of Child Health and Human Development, National Institutes of Health, Bethesda, Maryland
| | - Constantine A Stratakis
- Section on Endocrinology and Genetics, Program on Developmental Endocrinology and Genetics, National Institute of Child Health and Human Development, National Institutes of Health, Bethesda, Maryland
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17
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Shank LM, Tanofsky-Kraff M, Nelson EE, Shomaker LB, Ranzenhofer LM, Hannallah LM, Field SE, Vannucci A, Bongiorno DM, Brady SM, Condarco T, Demidowich A, Kelly NR, Cassidy O, Simmons WK, Engel SG, Pine DS, Yanovski JA. Attentional bias to food cues in youth with loss of control eating. Appetite 2015; 87:68-75. [PMID: 25435490 PMCID: PMC4333006 DOI: 10.1016/j.appet.2014.11.027] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2014] [Revised: 11/12/2014] [Accepted: 11/25/2014] [Indexed: 12/14/2022]
Abstract
Emerging data indicate that adults with binge eating may exhibit an attentional bias toward highly palatable foods, which may promote obesogenic eating patterns and excess weight gain. However, it is unknown to what extent youth with loss of control (LOC) eating display a similar bias. We therefore studied 76 youth (14.5 ± 2.3 years; 86.8% female; BMI-z 1.7 ± .73) with (n = 47) and without (n = 29) reported LOC eating. Following a breakfast to reduce hunger, youth participated in a computerized visual probe task of sustained attention that assessed reaction time to pairs of pictures consisting of high palatable foods, low palatable foods, and neutral household objects. Although sustained attentional bias did not differ by LOC eating presence and was unrelated to body weight, a two-way interaction between BMI-z and LOC eating was observed (p = .01), such that only among youth with LOC eating, attentional bias toward high palatable foods versus neutral objects was positively associated with BMI-z. These findings suggest that LOC eating and body weight interact in their association with attentional bias to highly palatable foods cues, and may partially explain the mixed literature linking attentional bias to food cues with excess body weight.
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Affiliation(s)
- Lisa M Shank
- Department of Medical and Clinical Psychology, Uniformed Services University of the Health Sciences (USUHS), DoD, 4301 Jones Bridge Road, Bethesda, MD 20814, USA; Section on Growth and Obesity, Program in Developmental Endocrinology and Genetics, Eunice Kennedy Shriver National Institute of Child Health and Human Development (NICHD), National Institutes of Health (NIH), DHHS, 10 Center Drive, Bethesda, MD 20892, USA
| | - Marian Tanofsky-Kraff
- Department of Medical and Clinical Psychology, Uniformed Services University of the Health Sciences (USUHS), DoD, 4301 Jones Bridge Road, Bethesda, MD 20814, USA; Section on Growth and Obesity, Program in Developmental Endocrinology and Genetics, Eunice Kennedy Shriver National Institute of Child Health and Human Development (NICHD), National Institutes of Health (NIH), DHHS, 10 Center Drive, Bethesda, MD 20892, USA.
| | - Eric E Nelson
- Section on Development and Affective Neuroscience of the National Institute of Mental Health, NIH, DHHS, 15K North Drive, Bethesda, MD 20892, USA
| | - Lauren B Shomaker
- Section on Growth and Obesity, Program in Developmental Endocrinology and Genetics, Eunice Kennedy Shriver National Institute of Child Health and Human Development (NICHD), National Institutes of Health (NIH), DHHS, 10 Center Drive, Bethesda, MD 20892, USA; Colorado State University, 303 Behavioral Sciences Building, Campus Delivery 1570, 410 Pitkin Street, Fort Collins, CO 80523, USA
| | - Lisa M Ranzenhofer
- Department of Medical and Clinical Psychology, Uniformed Services University of the Health Sciences (USUHS), DoD, 4301 Jones Bridge Road, Bethesda, MD 20814, USA; Section on Growth and Obesity, Program in Developmental Endocrinology and Genetics, Eunice Kennedy Shriver National Institute of Child Health and Human Development (NICHD), National Institutes of Health (NIH), DHHS, 10 Center Drive, Bethesda, MD 20892, USA
| | - Louise M Hannallah
- Department of Medical and Clinical Psychology, Uniformed Services University of the Health Sciences (USUHS), DoD, 4301 Jones Bridge Road, Bethesda, MD 20814, USA; Section on Growth and Obesity, Program in Developmental Endocrinology and Genetics, Eunice Kennedy Shriver National Institute of Child Health and Human Development (NICHD), National Institutes of Health (NIH), DHHS, 10 Center Drive, Bethesda, MD 20892, USA
| | - Sara E Field
- Department of Medical and Clinical Psychology, Uniformed Services University of the Health Sciences (USUHS), DoD, 4301 Jones Bridge Road, Bethesda, MD 20814, USA; Section on Growth and Obesity, Program in Developmental Endocrinology and Genetics, Eunice Kennedy Shriver National Institute of Child Health and Human Development (NICHD), National Institutes of Health (NIH), DHHS, 10 Center Drive, Bethesda, MD 20892, USA
| | - Anna Vannucci
- Department of Medical and Clinical Psychology, Uniformed Services University of the Health Sciences (USUHS), DoD, 4301 Jones Bridge Road, Bethesda, MD 20814, USA; Section on Growth and Obesity, Program in Developmental Endocrinology and Genetics, Eunice Kennedy Shriver National Institute of Child Health and Human Development (NICHD), National Institutes of Health (NIH), DHHS, 10 Center Drive, Bethesda, MD 20892, USA
| | - Diana M Bongiorno
- Section on Development and Affective Neuroscience of the National Institute of Mental Health, NIH, DHHS, 15K North Drive, Bethesda, MD 20892, USA
| | - Sheila M Brady
- Section on Growth and Obesity, Program in Developmental Endocrinology and Genetics, Eunice Kennedy Shriver National Institute of Child Health and Human Development (NICHD), National Institutes of Health (NIH), DHHS, 10 Center Drive, Bethesda, MD 20892, USA
| | - Tania Condarco
- Section on Growth and Obesity, Program in Developmental Endocrinology and Genetics, Eunice Kennedy Shriver National Institute of Child Health and Human Development (NICHD), National Institutes of Health (NIH), DHHS, 10 Center Drive, Bethesda, MD 20892, USA
| | - Andrew Demidowich
- Section on Growth and Obesity, Program in Developmental Endocrinology and Genetics, Eunice Kennedy Shriver National Institute of Child Health and Human Development (NICHD), National Institutes of Health (NIH), DHHS, 10 Center Drive, Bethesda, MD 20892, USA
| | - Nichole R Kelly
- Department of Medical and Clinical Psychology, Uniformed Services University of the Health Sciences (USUHS), DoD, 4301 Jones Bridge Road, Bethesda, MD 20814, USA; Section on Growth and Obesity, Program in Developmental Endocrinology and Genetics, Eunice Kennedy Shriver National Institute of Child Health and Human Development (NICHD), National Institutes of Health (NIH), DHHS, 10 Center Drive, Bethesda, MD 20892, USA
| | - Omni Cassidy
- Department of Medical and Clinical Psychology, Uniformed Services University of the Health Sciences (USUHS), DoD, 4301 Jones Bridge Road, Bethesda, MD 20814, USA; Section on Growth and Obesity, Program in Developmental Endocrinology and Genetics, Eunice Kennedy Shriver National Institute of Child Health and Human Development (NICHD), National Institutes of Health (NIH), DHHS, 10 Center Drive, Bethesda, MD 20892, USA
| | - W Kyle Simmons
- Laureate Institute for Brain Research, 6655 S Yale Ave, Tulsa, OK 74136, USA; Faculty of Community Medicine, The University of Tulsa, 4502 E. 41st Street, Tulsa, OK 74135, USA
| | - Scott G Engel
- Neuropsychiatric Research Institute, 700 1st Ave S, Fargo, ND 58103, USA
| | - Daniel S Pine
- Section on Development and Affective Neuroscience of the National Institute of Mental Health, NIH, DHHS, 15K North Drive, Bethesda, MD 20892, USA
| | - Jack A Yanovski
- Section on Growth and Obesity, Program in Developmental Endocrinology and Genetics, Eunice Kennedy Shriver National Institute of Child Health and Human Development (NICHD), National Institutes of Health (NIH), DHHS, 10 Center Drive, Bethesda, MD 20892, USA
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Holland SM, DeLeo FR, Elloumi HZ, Hsu AP, Uzel G, Brodsky N, Freeman AF, Demidowich A, Davis J, Turner ML, Anderson VL, Darnell DN, Welch PA, Kuhns DB, Frucht DM, Malech HL, Gallin JI, Kobayashi SD, Whitney AR, Voyich JM, Musser JM, Woellner C, Schäffer AA, Puck JM, Grimbacher B. STAT3 mutations in the hyper-IgE syndrome. N Engl J Med 2007; 357:1608-19. [PMID: 17881745 DOI: 10.1056/nejmoa073687] [Citation(s) in RCA: 845] [Impact Index Per Article: 49.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
BACKGROUND The hyper-IgE syndrome (or Job's syndrome) is a rare disorder of immunity and connective tissue characterized by dermatitis, boils, cyst-forming pneumonias, elevated serum IgE levels, retained primary dentition, and bone abnormalities. Inheritance is autosomal dominant; sporadic cases are also found. METHODS We collected longitudinal clinical data on patients with the hyper-IgE syndrome and their families and assayed the levels of cytokines secreted by stimulated leukocytes and the gene expression in resting and stimulated cells. These data implicated the signal transducer and activator of transcription 3 gene (STAT3) as a candidate gene, which we then sequenced. RESULTS We found increased levels of proinflammatory gene transcripts in unstimulated peripheral-blood neutrophils and mononuclear cells from patients with the hyper-IgE syndrome, as compared with levels in control cells. In vitro cultures of mononuclear cells from patients that were stimulated with lipopolysaccharide, with or without interferon-gamma, had higher tumor necrosis factor alpha levels than did identically treated cells from unaffected persons (P=0.003). In contrast, the cells from patients with the hyper-IgE syndrome generated lower levels of monocyte chemoattractant protein 1 in response to the presence of interleukin-6 (P=0.03), suggesting a defect in interleukin-6 signaling through its downstream mediators, one of which is STAT3. We identified missense mutations and single-codon in-frame deletions in STAT3 in 50 familial and sporadic cases of the hyper-IgE syndrome. Eighteen discrete mutations, five of which were hot spots, were predicted to directly affect the DNA-binding and SRC homology 2 (SH2) domains. CONCLUSIONS Mutations in STAT3 underlie sporadic and dominant forms of the hyper-IgE syndrome, an immunodeficiency syndrome involving increased innate immune response, recurrent infections, and complex somatic features.
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Affiliation(s)
- Steven M Holland
- National Institute of Allergy and Infectious Diseases, Bethesda, MD 20892, USA.
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