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MacFarlane J, Korbonits M. Growth hormone receptor antagonist pegvisomant and its role in the medical therapy of growth hormone excess. Best Pract Res Clin Endocrinol Metab 2024; 38:101910. [PMID: 38981769 DOI: 10.1016/j.beem.2024.101910] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 07/11/2024]
Abstract
Pegvisomant is a growth-hormone (GH) receptor antagonist that prevents the formation of the active heterotrimer of the dimerised GH receptor and the GH molecule necessary for downstream signal transduction. Over the past 20 years, it has become a key therapeutic option for physicians treating syndromes of GH/IGF-1 excess. Sufficient longitudinal follow-up data suggest that it can be deemed both safe and effective. It is the drug with the greatest potential for achieving an amelioration of the biochemical effects of GH excess with a corresponding normalisation of IGF-1 levels; however, insufficient dose titration has lessened real-world therapeutic outcomes. Theoretical concerns about stimulating tumour growth have been resolved as this has not been observed, while derangement of liver enzymes and local skin-related adverse reactions may occur in a minority of the patients. It may be a particularly impactful medication for the treatment of children, young people, and those with inherited disorders of GH excess, where other treatment modalities often fail. Combination therapy of pegvisomant with first- and second-generation somatostatin receptor ligands or with dopamine agonists remains an ongoing area of interest and research. High cost remains a barrier to the use of pegvisomant in many settings.
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Affiliation(s)
- James MacFarlane
- Cambridge Endocrine Molecular Imaging Group, Metabolic Research Laboratories, Institute of Metabolic Science, University of Cambridge, Addenbrooke's Hospital, Cambridge Biomedical Campus, Cambridge, UK.
| | - Márta Korbonits
- Centre for Endocrinology, Barts and The London School of Medicine, Queen Mary University of London, Charterhouse Square, London EC1M 6BQ, UK.
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Korbonits M, Blair JC, Boguslawska A, Ayuk J, Davies JH, Druce MR, Evanson J, Flanagan D, Glynn N, Higham CE, Jacques TS, Sinha S, Simmons I, Thorp N, Swords FM, Storr HL, Spoudeas HA. Consensus guideline for the diagnosis and management of pituitary adenomas in childhood and adolescence: Part 2, specific diseases. Nat Rev Endocrinol 2024; 20:290-309. [PMID: 38336898 DOI: 10.1038/s41574-023-00949-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 12/19/2023] [Indexed: 02/12/2024]
Abstract
Pituitary adenomas are rare in children and young people under the age of 19 (hereafter referred to as CYP) but they pose some different diagnostic and management challenges in this age group than in adults. These rare neoplasms can disrupt maturational, visual, intellectual and developmental processes and, in CYP, they tend to have more occult presentation, aggressive behaviour and are more likely to have a genetic basis than in adults. Through standardized AGREE II methodology, literature review and Delphi consensus, a multidisciplinary expert group developed 74 pragmatic management recommendations aimed at optimizing care for CYP in the first-ever comprehensive consensus guideline to cover the care of CYP with pituitary adenoma. Part 2 of this consensus guideline details 57 recommendations for paediatric patients with prolactinomas, Cushing disease, growth hormone excess causing gigantism and acromegaly, clinically non-functioning adenomas, and the rare TSHomas. Compared with adult patients with pituitary adenomas, we highlight that, in the CYP group, there is a greater proportion of functioning tumours, including macroprolactinomas, greater likelihood of underlying genetic disease, more corticotrophinomas in boys aged under 10 years than in girls and difficulty of peri-pubertal diagnosis of growth hormone excess. Collaboration with pituitary specialists caring for adult patients, as part of commissioned and centralized multidisciplinary teams, is key for optimizing management, transition and lifelong care and facilitates the collection of health-related quality of survival outcomes of novel medical, surgical and radiotherapeutic treatments, which are currently largely missing.
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Affiliation(s)
- Márta Korbonits
- Centre for Endocrinology, William Harvey Research Institute, Barts and the London School of Medicine and Dentistry, Queen Mary University of London, London, UK.
| | | | - Anna Boguslawska
- Department of Endocrinology, Jagiellonian University Medical College, Krakow, Poland
| | - John Ayuk
- University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
| | - Justin H Davies
- University Hospital Southampton NHS Foundation Trust, Southampton, UK
| | - Maralyn R Druce
- Centre for Endocrinology, William Harvey Research Institute, Barts and the London School of Medicine and Dentistry, Queen Mary University of London, London, UK
| | - Jane Evanson
- Neuroradiology, Barts Health NHS Trust, London, UK
| | | | - Nigel Glynn
- Centre for Endocrinology, William Harvey Research Institute, Barts and the London School of Medicine and Dentistry, Queen Mary University of London, London, UK
| | | | - Thomas S Jacques
- Great Ormond Street Institute of Child Health, University College London, London, UK
- Great Ormond Street Hospital for Children NHS Foundation Trust, London, UK
| | - Saurabh Sinha
- Sheffield Children's and Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, UK
| | - Ian Simmons
- The Leeds Teaching Hospitals NHS Trust, Leeds, UK
| | - Nicky Thorp
- The Christie NHS Foundation Trust, Manchester, UK
| | | | - Helen L Storr
- Centre for Endocrinology, William Harvey Research Institute, Barts and the London School of Medicine and Dentistry, Queen Mary University of London, London, UK
| | - Helen A Spoudeas
- Great Ormond Street Hospital for Children NHS Foundation Trust, London, UK
- University College London Hospitals NHS Foundation Trust, London, UK
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Ramírez-Rentería C, Hernández-Ramírez LC. Genetic diagnosis in acromegaly and gigantism: From research to clinical practice. Best Pract Res Clin Endocrinol Metab 2024; 38:101892. [PMID: 38521632 DOI: 10.1016/j.beem.2024.101892] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/25/2024]
Abstract
It is usually considered that only 5% of all pituitary neuroendocrine tumours are due to inheritable causes. Since this estimate was reported, however, multiple genetic defects driving syndromic and nonsyndromic somatotrophinomas have been unveiled. This heterogeneous genetic background results in overlapping phenotypes of GH excess. Genetic tests should be part of the approach to patients with acromegaly and gigantism because they can refine the clinical diagnoses, opening the possibility to tailor the clinical conduct to each patient. Even more, genetic testing and clinical screening of at-risk individuals have a positive impact on disease outcomes, by allowing for the timely detection and treatment of somatotrophinomas at early stages. Future research should focus on determining the actual frequency of novel genetic drivers of somatotrophinomas in the general population, developing up-to-date disease-specific multi-gene panels for clinical use, and finding strategies to improve access to modern genetic testing worldwide.
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Affiliation(s)
- Claudia Ramírez-Rentería
- Unidad de Investigación Médica en Enfermedades Endocrinas, Hospital de Especialidades, Centro Médico Nacional Siglo XXI, Instituto Mexicano del Seguro Social, Mexico City, Mexico
| | - Laura C Hernández-Ramírez
- Red de Apoyo a la Investigación, Universidad Nacional Autónoma de México, e Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City, Mexico.
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Stratakis CA. An update on, and genetics of refractory adenomas of childhood. Pituitary 2023:10.1007/s11102-023-01327-2. [PMID: 37318708 DOI: 10.1007/s11102-023-01327-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 05/16/2023] [Indexed: 06/16/2023]
Abstract
Pituitary adenomas in childhood tend to be more frequently due to germline genetic changes and are often diagnosed at late stages due to delayed recognition by pediatricians and other caretakers who are not familiar with this rare disease in childhood. As a result, often, pediatric pituitary adenomas are aggressive or remain refractory to treatment. In this review, we discuss germline genetic defects that account for the most common pediatric pituitary adenomas that are refractory to treatment. We also discuss some somatic genetic events, such as chromosomal copy number changes that characterize some of the most aggressive pituitary adenomas in childhood that end up being refractory to treatment.
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Affiliation(s)
- Constantine A Stratakis
- Eunice Kennedy Shriver National Institute of Child Health and Human Development (NICHD), National Institutes of Health, 20892, Bethesda, MD, USA.
- Human Genetics & Precision Medicine, IMMB, FORTH, Heraklion, Greece.
- ELPEN Research Institute, Athens, Greece.
- Medical Genetics, H. Dunant Hospital, Athens, Greece.
- Faculty of Medicine, European University of Cyprus, Nicosia, Cyprus.
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Melmed S, Kaiser UB, Lopes MB, Bertherat J, Syro LV, Raverot G, Reincke M, Johannsson G, Beckers A, Fleseriu M, Giustina A, Wass JAH, Ho KKY. Clinical Biology of the Pituitary Adenoma. Endocr Rev 2022; 43:1003-1037. [PMID: 35395078 PMCID: PMC9695123 DOI: 10.1210/endrev/bnac010] [Citation(s) in RCA: 80] [Impact Index Per Article: 40.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/17/2021] [Indexed: 02/06/2023]
Abstract
All endocrine glands are susceptible to neoplastic growth, yet the health consequences of these neoplasms differ between endocrine tissues. Pituitary neoplasms are highly prevalent and overwhelmingly benign, exhibiting a spectrum of diverse behaviors and impact on health. To understand the clinical biology of these common yet often innocuous neoplasms, we review pituitary physiology and adenoma epidemiology, pathophysiology, behavior, and clinical consequences. The anterior pituitary develops in response to a range of complex brain signals integrating with intrinsic ectodermal cell transcriptional events that together determine gland growth, cell type differentiation, and hormonal production, in turn maintaining optimal endocrine health. Pituitary adenomas occur in 10% of the population; however, the overwhelming majority remain harmless during life. Triggered by somatic or germline mutations, disease-causing adenomas manifest pathogenic mechanisms that disrupt intrapituitary signaling to promote benign cell proliferation associated with chromosomal instability. Cellular senescence acts as a mechanistic buffer protecting against malignant transformation, an extremely rare event. It is estimated that fewer than one-thousandth of all pituitary adenomas cause clinically significant disease. Adenomas variably and adversely affect morbidity and mortality depending on cell type, hormone secretory activity, and growth behavior. For most clinically apparent adenomas, multimodal therapy controlling hormone secretion and adenoma growth lead to improved quality of life and normalized mortality. The clinical biology of pituitary adenomas, and particularly their benign nature, stands in marked contrast to other tumors of the endocrine system, such as thyroid and neuroendocrine tumors.
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Affiliation(s)
| | - Ursula B Kaiser
- Brigham & Women's Hospital and Harvard Medical School, Boston, MA, USA
| | - M Beatriz Lopes
- University of Virginia School of Medicine, Charlottesville, VA, USA
| | - Jerome Bertherat
- Université de Paris, Assistance Publique-Hôpitaux de Paris, Paris, France
| | - Luis V Syro
- Hospital Pablo Tobon Uribe and Clinica Medellin - Grupo Quirónsalud, Medellin, Colombia
| | - Gerald Raverot
- Hospices Civils de Lyon and Lyon 1 University, Lyon, France
| | - Martin Reincke
- University Hospital of LMU, Ludwig-Maximilians-Universität, Munich, Germany
| | - Gudmundur Johannsson
- Sahlgrenska University Hospital & Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | | | | | - Andrea Giustina
- San Raffaele Vita-Salute University and IRCCS Hospital, Milan, Italy
| | | | - Ken K Y Ho
- The Garvan Institute of Medical Research and St. Vincents Hospital, Sydney, Australia
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Yamamoto M, Takahashi Y. Genetic and Epigenetic Pathogenesis of Acromegaly. Cancers (Basel) 2022; 14:cancers14163861. [PMID: 36010855 PMCID: PMC9405703 DOI: 10.3390/cancers14163861] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2022] [Revised: 08/03/2022] [Accepted: 08/06/2022] [Indexed: 11/25/2022] Open
Abstract
Simple Summary Various genetic and epigenetic factors are involved in the pathogenesis of somatotroph tumors. Although GNAS mutations are the most prevalent cause of somatotroph tumors, the cause of half of all pathogenesis occurrences remains unclarified. However, recent findings including the pangenomic analysis, such as genome, transcriptome, and methylome approaches, and histological characteristics of pituitary tumors, the involvement of AIP and GPR101, the mechanisms of genomic instability, and possible involvement of miRNAs have gradually unveiled the whole landscape of underlying mechanisms of somatotroph tumors. In this review, we will focus on the recent advances in the pathogenesis of somatotroph tumors. Abstract Acromegaly is caused by excessive secretion of GH and IGF-I mostly from somatotroph tumors. Various genetic and epigenetic factors are involved in the pathogenesis of somatotroph tumors. While somatic mutations of GNAS are the most prevalent cause of somatotroph tumors, germline mutations in various genes (AIP, PRKAR1A, GPR101, GNAS, MEN1, CDKN1B, SDHx, MAX) are also known as the cause of somatotroph tumors. Moreover, recent findings based on multiple perspectives of the pangenomic approach including genome, transcriptome, and methylome analyses, histological characterization, genomic instability, and possible involvement of miRNAs have gradually unveiled the whole landscape of the underlying mechanisms of somatotroph tumors. In this review, we will focus on the recent advances in genetic and epigenetic pathogenesis of somatotroph tumors.
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Affiliation(s)
- Masaaki Yamamoto
- Division of Diabetes and Endocrinology, Kobe University Graduate School of Medicine, Kobe 650-0017, Japan
- Correspondence: ; Tel.: +81-78-382-5861
| | - Yutaka Takahashi
- Division of Diabetes and Endocrinology, Kobe University Graduate School of Medicine, Kobe 650-0017, Japan
- Department of Diabetes and Endocrinology, Nara Medical University, Kashihara 634-8521, Japan
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Genetics of Acromegaly and Gigantism. J Clin Med 2021; 10:jcm10071377. [PMID: 33805450 PMCID: PMC8036715 DOI: 10.3390/jcm10071377] [Citation(s) in RCA: 23] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2021] [Revised: 03/18/2021] [Accepted: 03/19/2021] [Indexed: 12/11/2022] Open
Abstract
Growth hormone (GH)-secreting pituitary tumours represent the most genetically determined pituitary tumour type. This is true both for germline and somatic mutations. Germline mutations occur in several known genes (AIP, PRKAR1A, GPR101, GNAS, MEN1, CDKN1B, SDHx, MAX) as well as familial cases with currently unknown genes, while somatic mutations in GNAS are present in up to 40% of tumours. If the disease starts before the fusion of the epiphysis, then accelerated growth and increased final height, or gigantism, can develop, where a genetic background can be identified in half of the cases. Hereditary GH-secreting pituitary adenoma (PA) can manifest as isolated tumours, familial isolated pituitary adenoma (FIPA) including cases with AIP mutations or GPR101 duplications (X-linked acrogigantism, XLAG) or can be a part of systemic diseases like multiple endocrine neoplasia type 1 or type 4, McCune-Albright syndrome, Carney complex or phaeochromocytoma/paraganglioma-pituitary adenoma association. Family history and a search for associated syndromic manifestations can help to draw attention to genetic causes; many of these are now tested as part of gene panels. Identifying genetic mutations allows appropriate screening of associated comorbidities as well as finding affected family members before the clinical manifestation of the disease. This review focuses on germline and somatic mutations predisposing to acromegaly and gigantism.
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Liang H, Gong F, Liu Z, Yang Y, Yao Y, Wang R, Wang L, Chen M, Pan H, Zhu H. A Chinese Case of X-Linked Acrogigantism and Systematic Review. Neuroendocrinology 2021; 111:1164-1175. [PMID: 33049741 DOI: 10.1159/000512240] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/10/2020] [Accepted: 10/12/2020] [Indexed: 11/19/2022]
Abstract
INTRODUCTION This study described a Chinese case of X-linked acrogigantism (X-LAG) and summarized the characteristics and treatment of all reported cases. METHODS Clinical materials and biological samples from a 5-year and 2-month-old female due to "growth acceleration for 4 years" were collected. Array comparative genomic hybrid (aCGH) and further verification were performed. All X-LAG cases from the PubMed and Web of Science databases were collected and summarized with available data. RESULTS The patient presented accelerating growth since 1 year, and her height reached 134.6 cm (+5.24 standard deviation score [SDS]) when she was 5-year and 2-month old. She also had coarsening facial features, snoring, and acral enlargement. Growth hormone (GH) was not suppressed by the glucose-GH inhibition test, and insulin-like growth factor 1 (IGF-1) and prolactin (PRL) levels were elevated. Pituitary MRI revealed a pituitary enlargement with a maximum diameter of 22.3 mm. Octreotide imaging indicated the presence of a pituitary adenoma. The tumor shrank slightly after 3 courses of somatostatin analog but without clinical or biochemical remissions, of which the GH nadir value was 9.4 ng/mL, and IGF-1 was elevated to 749 ng/mL. Therefore, she underwent transsphenoidal surgery. Immunohistochemistry showed GH-positive and PRL-positive cells in the pituitary adenoma. Xq26.3 microduplication of the patient's germline DNA was identified by aCGH. Of all 35 reported cases, females accounted for 71.43%. There were 93.10% and 53.83% patients with hyperprolactinemia and hyperinsulinemia, respectively. Pathology showed that 75.00% of cases were adenomas. Ninety percent of cases had germline variants. The clinical and biochemical remission rates were 78.26% and 82.61%, respectively. However, the rate of complication occurrence during therapy reached 80%. CONCLUSION It is important to recognize the possibility of X-LAG when a child under 2-year old presents overgrowth. Early diagnosis and treatment are of great importance for better treatment efficacy and clinical outcome.
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Affiliation(s)
- Hanting Liang
- Key Laboratory of Endocrinology of National Health Commission, Department of Endocrinology, Peking Union Medical College Hospital, Chinese Academy of Medical Science and Peking Union Medical College, Beijing, China
| | - Fengying Gong
- Key Laboratory of Endocrinology of National Health Commission, Department of Endocrinology, Peking Union Medical College Hospital, Chinese Academy of Medical Science and Peking Union Medical College, Beijing, China
| | - Zhihui Liu
- Department of Endocrinology and Metabolism, The First Hospital of Shijiazhuang City, Shijiazhuang, China
| | - Yingying Yang
- Key Laboratory of Endocrinology of National Health Commission, Department of Endocrinology, Peking Union Medical College Hospital, Chinese Academy of Medical Science and Peking Union Medical College, Beijing, China
| | - Yong Yao
- Department of Neurosurgery, Peking Union Medical College Hospital, Chinese Academy of Medical Science and Peking Union Medical College, Beijing, China
| | - Renzhi Wang
- Department of Neurosurgery, Peking Union Medical College Hospital, Chinese Academy of Medical Science and Peking Union Medical College, Beijing, China
| | - Linjie Wang
- Key Laboratory of Endocrinology of National Health Commission, Department of Endocrinology, Peking Union Medical College Hospital, Chinese Academy of Medical Science and Peking Union Medical College, Beijing, China
| | - Meiping Chen
- Key Laboratory of Endocrinology of National Health Commission, Department of Endocrinology, Peking Union Medical College Hospital, Chinese Academy of Medical Science and Peking Union Medical College, Beijing, China
| | - Hui Pan
- Key Laboratory of Endocrinology of National Health Commission, Department of Endocrinology, Peking Union Medical College Hospital, Chinese Academy of Medical Science and Peking Union Medical College, Beijing, China
| | - Huijuan Zhu
- Key Laboratory of Endocrinology of National Health Commission, Department of Endocrinology, Peking Union Medical College Hospital, Chinese Academy of Medical Science and Peking Union Medical College, Beijing, China,
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Srirangam Nadhamuni V, Korbonits M. Novel Insights into Pituitary Tumorigenesis: Genetic and Epigenetic Mechanisms. Endocr Rev 2020; 41:bnaa006. [PMID: 32201880 PMCID: PMC7441741 DOI: 10.1210/endrev/bnaa006] [Citation(s) in RCA: 54] [Impact Index Per Article: 13.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/20/2019] [Accepted: 03/19/2020] [Indexed: 02/08/2023]
Abstract
Substantial advances have been made recently in the pathobiology of pituitary tumors. Similar to many other endocrine tumors, over the last few years we have recognized the role of germline and somatic mutations in a number of syndromic or nonsyndromic conditions with pituitary tumor predisposition. These include the identification of novel germline variants in patients with familial or simplex pituitary tumors and establishment of novel somatic variants identified through next generation sequencing. Advanced techniques have allowed the exploration of epigenetic mechanisms mediated through DNA methylation, histone modifications and noncoding RNAs, such as microRNA, long noncoding RNAs and circular RNAs. These mechanisms can influence tumor formation, growth, and invasion. While genetic and epigenetic mechanisms often disrupt similar pathways, such as cell cycle regulation, in pituitary tumors there is little overlap between genes altered by germline, somatic, and epigenetic mechanisms. The interplay between these complex mechanisms driving tumorigenesis are best studied in the emerging multiomics studies. Here, we summarize insights from the recent developments in the regulation of pituitary tumorigenesis.
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Affiliation(s)
- Vinaya Srirangam Nadhamuni
- Centre for Endocrinology, William Harvey Research Institute, Barts and the London School of Medicine and Dentistry, Queen Mary University of London, UK
| | - Márta Korbonits
- Centre for Endocrinology, William Harvey Research Institute, Barts and the London School of Medicine and Dentistry, Queen Mary University of London, UK
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Vea IM, Shingleton AW. Network-regulated organ allometry: The developmental regulation of morphological scaling. WILEY INTERDISCIPLINARY REVIEWS-DEVELOPMENTAL BIOLOGY 2020; 10:e391. [PMID: 32567243 DOI: 10.1002/wdev.391] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/31/2019] [Revised: 04/30/2020] [Accepted: 05/23/2020] [Indexed: 12/11/2022]
Abstract
Morphological scaling relationships, or allometries, describe how traits grow coordinately and covary among individuals in a population. The developmental regulation of scaling is essential to generate correctly proportioned adults across a range of body sizes, while the mis-regulation of scaling may result in congenital birth defects. Research over several decades has identified the developmental mechanisms that regulate the size of individual traits. Nevertheless, we still have poor understanding of how these mechanisms work together to generate correlated size variation among traits in response to environmental and genetic variation. Conceptually, morphological scaling can be generated by size-regulatory factors that act directly on multiple growing traits (trait-autonomous scaling), or indirectly via hormones produced by central endocrine organs (systemically regulated scaling), and there are a number of well-established examples of such mechanisms. There is much less evidence, however, that genetic and environmental variation actually acts on these mechanisms to generate morphological scaling in natural populations. More recent studies indicate that growing organs can themselves regulate the growth of other organs in the body. This suggests that covariation in trait size can be generated by network-regulated scaling mechanisms that respond to changes in the growth of individual traits. Testing this hypothesis, and one of the main challenges of understanding morphological scaling, requires connecting mechanisms elucidated in the laboratory with patterns of scaling observed in the natural world. This article is categorized under: Establishment of Spatial and Temporal Patterns > Regulation of Size, Proportion, and Timing Comparative Development and Evolution > Organ System Comparisons Between Species.
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Affiliation(s)
- Isabelle M Vea
- Department of Biological Sciences, University of Illinois at Chicago, Chicago, Illinois, USA
| | - Alexander W Shingleton
- Department of Biological Sciences, University of Illinois at Chicago, Chicago, Illinois, USA
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Abstract
Aggressive pituitary tumors (APTs) represent rare pituitary adenomas (PAs) with local invasion of surrounding tissues, increased risk for multiple recurrence, rapid tumor growth, or resistance to standard therapies. The most common APTs in children and adolescents are giant prolactinomas and somatotropinomas. Few cases of Crooke's cell adenomas, silent corticotroph adenomas and pituitary carcinomas have also been reported in the literature. Pediatric patients with APTs have higher risk of harboring germline genetic defects, most commonly in the MEN1 and AIP genes. Since certain genetic defects confer a more aggressive behavior to PAs, genetic testing should be considered in tumors with young onset and positive family history. The management of pediatric APTs involves usually a combination of standard therapies (surgical, medical, radiation). Newer agents, such as temozolomide, have been used in few cases of pediatric pituitary tumors with promising results. In the elderly, PAs are more commonly non-functioning. Their management often poses dilemmas given the coexistence of age-related comorbidities. However, standard surgical treatment and temozolomide seem to be safe and well tolerated in elderly patients.
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Affiliation(s)
- Christina Tatsi
- Section on Genetics and Endocrinology, Eunice Kennedy Shriver National Institute of Child Health and Human Development (NICHD), National Institutes of Health, 10 Center Drive, Building 10, NIH-Clinical Research Center, Room 1-3330, MSC1103, Bethesda, MD, 20892, USA
| | - Constantine A Stratakis
- Section on Genetics and Endocrinology, Eunice Kennedy Shriver National Institute of Child Health and Human Development (NICHD), National Institutes of Health, 10 Center Drive, Building 10, NIH-Clinical Research Center, Room 1-3330, MSC1103, Bethesda, MD, 20892, USA.
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12
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Boguszewski CL, Boguszewski MCDS, de Herder WW. From dwarves to giants: South American's contribution to the history of growth hormone and related disorders. Growth Horm IGF Res 2020; 50:48-56. [PMID: 31864177 DOI: 10.1016/j.ghir.2019.11.004] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/22/2019] [Revised: 11/07/2019] [Accepted: 11/30/2019] [Indexed: 11/30/2022]
Abstract
The aim of this article is to present a historical review on giants and dwarves living in South America and the contribution of South America's researchers to scientific advances on growth hormone (GH) and human disorders related to GH excess and GH deficiency (GHD). We went back in time to investigate facts and myths stemming from countless reports of giants who lived in the Patagonia region, focusing on what is currently known about gigantism in South America. Additionally, we have reviewed the exceptional work carried out in two of the world's largest cohorts of dwarfism related to GH-IGF axis: one living in Itabaianinha, Brazil, suffering from severe GHD due to a mutation in the GHRH receptor (GHRHR) gene, and the other living in El Oro and Loja provinces of Ecuador, who are carriers of GH receptor gene mutation that causes total GH insensitivity (Laron syndrome). Importantly, we present an overview of the outstanding medical contribution of Jose Dantas de Souza Leite, a Brazilian physician that described the first cases of acromegaly, and Bernardo Alberto Houssay, an Argentine researcher graced with the Nobel Prize, who was one the first scientists to establish a link between GH and glucose metabolism.
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Affiliation(s)
- Cesar Luiz Boguszewski
- Department of Internal Medicine, Endocrine Division (SEMPR), University Hospital, Federal University of Parana, 80030-110 Curitiba, Brazil.
| | | | - Wouter W de Herder
- Department of Internal Medicine, Sector of Endocrinology, Erasmus Medical Center, Rotterdam, the Netherlands.
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13
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The Genetics of Pituitary Adenomas. J Clin Med 2019; 9:jcm9010030. [PMID: 31877737 PMCID: PMC7019860 DOI: 10.3390/jcm9010030] [Citation(s) in RCA: 23] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2019] [Revised: 12/12/2019] [Accepted: 12/15/2019] [Indexed: 12/16/2022] Open
Abstract
The genetic landscape of pituitary adenomas (PAs) is diverse and many of the identified cases remain of unclear pathogenetic mechanism. Germline genetic defects account for a small percentage of all patients and may present in the context of relevant family history. Defects in AIP (mutated in Familial Isolated Pituitary Adenoma syndrome or FIPA), MEN1 (coding for menin, mutated in Multiple Endocrine Neoplasia type 1 or MEN 1), PRKAR1A (mutated in Carney complex), GPR101 (involved in X-Linked Acrogigantism or X-LAG), and SDHx (mutated in the so called "3 P association" of PAs with pheochromocytomas and paragangliomas or 3PAs) account for the most common familial syndromes associated with PAs. Tumor genetic defects in USP8, GNAS, USP48 and BRAF are some of the commonly encountered tissue-specific changes and may explain a larger percentage of the developed tumors. Somatic (at the tumor level) genomic changes, copy number variations (CNVs), epigenetic modifications, and differential expression of miRNAs, add to the variable genetic background of PAs.
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Abstract
Acromegaly is a rare disease caused due to hyper secretion of growth hormone. Most of the cases of acromegaly are caused by pituitary adenoma which can be microadenoma or macroadenomas. This condition has a tendency toward overgrowth of the mandible, maxillary widening, tooth separation and skeletal malocclusion which compromises the aesthetics of an individual. Hence dentists have a role in diagnosing this disorder. The aim of this paper is to present a case report of acromegaly.
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Affiliation(s)
- Akram Belmehdi
- Oral Surgeon, Dental Center of Treatment and Diagnosis, Ibn Sina Hospital, Rabat, Morocco
| | - Saliha Chbicheb
- Oral surgery department, Faculty of Dentistry of Rabat, Mohammed V University, Morocco
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15
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Genetics of Pituitary Tumours. EXPERIENTIA. SUPPLEMENTUM 2019. [PMID: 31588533 DOI: 10.1007/978-3-030-25905-1_10] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/27/2023]
Abstract
Pituitary tumours are relatively common in the general population. Most often they occur sporadically, with somatic mutations accounting for a significant minority of somatotroph and corticotroph adenomas. Pituitary tumours can also develop secondary to germline mutations as part of a complex syndrome or as familial isolated pituitary adenomas. Tumours occurring in a familial setting may present at a younger age and can behave more aggressively with resistance to treatment. This chapter will focus on the genetics and molecular pathogenesis of pituitary tumours.
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Wise-Oringer BK, Zanazzi GJ, Gordon RJ, Wardlaw SL, William C, Anyane-Yeboa K, Chung WK, Kohn B, Wisoff JH, David R, Oberfield SE. Familial X-Linked Acrogigantism: Postnatal Outcomes and Tumor Pathology in a Prenatally Diagnosed Infant and His Mother. J Clin Endocrinol Metab 2019; 104:4667-4675. [PMID: 31166600 PMCID: PMC6736216 DOI: 10.1210/jc.2019-00817] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/05/2019] [Accepted: 05/30/2019] [Indexed: 02/08/2023]
Abstract
CONTEXT X-linked acrogigantism (X-LAG), a condition of infant-onset acrogigantism marked by elevated GH, IGF-1, and prolactin (PRL), is extremely rare. Thirty-three cases, including three kindreds, have been reported. These patients have pituitary adenomas that are thought to be mixed lactotrophs and somatotrophs. CASE DESCRIPTION The patient's mother, diagnosed with acrogigantism at 21 months, underwent pituitary tumor excision at 24 months. For more than 30 years, stable PRL, GH, and IGF-1 concentrations and serial imaging studies indicated no tumor recurrence. During preconception planning, X-LAG was diagnosed: single-nucleotide polymorphism microarray showed chromosome Xq26.3 microduplication. After conception, single-nucleotide polymorphism microarray on a chorionic villus sample showed the same microduplication in the fetus, confirming familial X-LAG. The infant grew rapidly with rising PRL, GH, and IGF-1 concentrations and an enlarging suprasellar pituitary mass, despite treatment with bromocriptine. At 15 months, he underwent tumor resection. The pituitary adenoma resembled the mother's pituitary adenoma, with tumor cells arranged in trabeculae and glandular structures. In both cases, many tumor cells expressed PRL, GH, and pituitary-specific transcription factor-1. Furthermore, the tumor expressed other lineage-specific transcription factors, as well as SOX2 and octamer-binding transcription factor 4, demonstrating the multipotentiality of X-LAG tumors. Both showed an elevated Ki-67 proliferation index, 5.6% in the mother and 8.5% in the infant, the highest reported in X-LAG. CONCLUSIONS This is a prenatally diagnosed case of X-LAG. Clinical follow-up and biochemical evaluation have provided insight into the natural history of this disease. Expression of stem cell markers and several cell lineage-specific transcription factors suggests that these tumors are multipotential.
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Affiliation(s)
- Brittany K Wise-Oringer
- Division of Pediatric Endocrinology, Diabetes and Metabolism, Columbia University Irving Medical Center, New York, New York
| | - George J Zanazzi
- Department of Pathology, Columbia University Irving Medical Center, New York, New York
| | - Rebecca J Gordon
- Division of Endocrinology and Diabetes, Children’s Hospital of Philadelphia, Philadelphia, Pennsylvania
| | - Sharon L Wardlaw
- Division of Endocrinology, Columbia University Irving Medical Center, New York, New York
| | - Christopher William
- Department of Pathology, New York University School of Medicine, New York, New York
| | - Kwame Anyane-Yeboa
- Department of Pediatrics, Columbia University Irving Medical Center, New York, New York
| | - Wendy K Chung
- Departments of Pediatrics and Medicine, Columbia University Irving Medicine Center, New York, New York
| | - Brenda Kohn
- Division of Pediatric Endocrinology, Hassenfeld Children’s Hospital at NYU Langone Health, New York, New York
| | - Jeffrey H Wisoff
- Division of Pediatric Neurosurgery, Hassenfeld Children’s Hospital at NYU Langone Health, New York, New York
| | - Raphael David
- Division of Pediatric Endocrinology, Hassenfeld Children’s Hospital at NYU Langone Health, New York, New York
| | - Sharon E Oberfield
- Division of Pediatric Endocrinology, Diabetes and Metabolism, Columbia University Irving Medical Center, New York, New York
- Correspondence and Reprint Requests: Sharon E. Oberfield, MD, Division of Pediatric Endocrinology, Diabetes and Metabolism, Columbia University Irving Medical Center, 622 West 168 Street, PH 17W – 307, New York, New York 10032. E-mail:
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Abstract
In the general population, height is determined by a complex interplay between genetic and environmental factors. Pituitary gigantism is a rare but very important subgroup of patients with excessive height, as it has an identifiable and clinically treatable cause. The disease is caused by chronic growth hormone and insulin-like growth factor 1 secretion from a pituitary somatotrope adenoma that forms before the closure of the epiphyses. If not controlled effectively, this hormonal hypersecretion could lead to extremely elevated final adult height. The past 10 years have seen marked advances in the understanding of pituitary gigantism, including the identification of genetic causes in ~50% of cases, such as mutations in the AIP gene or chromosome Xq26.3 duplications in X-linked acrogigantism syndrome. Pituitary gigantism has a male preponderance, and patients usually have large pituitary adenomas. The large tumour size, together with the young age of patients and frequent resistance to medical therapy, makes the management of pituitary gigantism complex. Early diagnosis and rapid referral for effective therapy appear to improve outcomes in patients with pituitary gigantism; therefore, a high level of clinical suspicion and efficient use of diagnostic resources is key to controlling overgrowth and preventing patients from reaching very elevated final adult heights.
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Affiliation(s)
- Albert Beckers
- Department of Endocrinology, Centre Hospitalier Universitaire de Liège, Liège Université, Liège, Belgium.
| | - Patrick Petrossians
- Department of Endocrinology, Centre Hospitalier Universitaire de Liège, Liège Université, Liège, Belgium
| | - Julien Hanson
- Laboratory of Molecular Pharmacology, GIGA-Molecular Biology of Diseases and Laboratory of Medicinal Chemistry, Center for Interdisciplinary Research on Medicines, Liège Université, Liège, Belgium
| | - Adrian F Daly
- Department of Endocrinology, Centre Hospitalier Universitaire de Liège, Liège Université, Liège, Belgium
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Trivellin G, Hernández-Ramírez LC, Swan J, Stratakis CA. An orphan G-protein-coupled receptor causes human gigantism and/or acromegaly: Molecular biology and clinical correlations. Best Pract Res Clin Endocrinol Metab 2018; 32:125-140. [PMID: 29678281 DOI: 10.1016/j.beem.2018.02.004] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
X-linked acrogigantism (X-LAG) is a recently described form of familial or sporadic pituitary gigantism characterized by very early onset GH and IGF-1 excess, accelerated growth velocity, gigantism and/or acromegaloid features. Germline or somatic microduplications of the Xq26.3 chromosomal region, invariably involving the GPR101 gene, constitute the genetic defect leading to X-LAG. GPR101 encodes a class A G protein-coupled receptor that activates the 3',5'-cyclic adenosine monophosphate signaling pathway. Highly expressed in the central nervous system, the main physiological function and ligand of GPR101 remain unknown, but it seems to play a role in the normal development of the GHRH-GH axis. Early recognition of X-LAG cases is imperative because these patients require clinical management that differs from that of other patients with acromegaly or gigantism. Medical treatment with pegvisomant seems to be the best approach, since X-LAG tumors are resistant to the treatment with somatostatin analogues and dopamine agonists; surgical cure requires near-total hypophysectomy. Currently, the efforts of our research focus on the identification of GPR101 ligands; in addition, the long-term follow-up of X-LAG patients is of extreme interest as this is expected to lead to better understanding of GPR101 effects on human pathophysiology.
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Affiliation(s)
- Giampaolo Trivellin
- Section on Endocrinology and Genetics (SEGEN), Eunice Kennedy Shriver National Institute of Child Health and Human Development (NICHD), National Institutes of Health (NIH), Bethesda, MD, 20892-1862, USA
| | - Laura C Hernández-Ramírez
- Section on Endocrinology and Genetics (SEGEN), Eunice Kennedy Shriver National Institute of Child Health and Human Development (NICHD), National Institutes of Health (NIH), Bethesda, MD, 20892-1862, USA
| | - Jeremy Swan
- Computer Support Services Core, Eunice Kennedy Shriver National Institute of Child Health and Human Development (NICHD), National Institutes of Health (NIH), Bethesda, MD, 20892-1862, USA
| | - Constantine A Stratakis
- Section on Endocrinology and Genetics (SEGEN), Eunice Kennedy Shriver National Institute of Child Health and Human Development (NICHD), National Institutes of Health (NIH), Bethesda, MD, 20892-1862, USA.
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Abstract
Although most of pituitary adenomas are benign, they may cause significant burden to patients. Sporadic adenomas represent the vast majority of the cases, where recognized somatic mutations (eg, GNAS or USP8), as well as altered gene-expression profile often affecting cell cycle proteins have been identified. More rarely, germline mutations predisposing to pituitary adenomas -as part of a syndrome (eg, MEN1 or Carney complex), or isolated to the pituitary (AIP or GPR101) can be identified. These alterations influence the biological behavior, clinical presentations and therapeutic responses, and their full understanding helps to provide appropriate care for these patients.
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Affiliation(s)
- Pedro Marques
- Centre for Endocrinology, William Harvey Research Institute, Barts and the London School of Medicine and Dentistry, Queen Mary University of London, Charterhouse Square, London EC1M 6BQ, UK
| | - Márta Korbonits
- Centre for Endocrinology, William Harvey Research Institute, Barts and the London School of Medicine and Dentistry, Queen Mary University of London, Charterhouse Square, London EC1M 6BQ, UK.
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20
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Beckers A, Rostomyan L, Potorac I, Beckers P, Daly AF. X-LAG: How did they grow so tall? ANNALES D'ENDOCRINOLOGIE 2017; 78:131-136. [DOI: 10.1016/j.ando.2017.04.013] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
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21
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Iacovazzo D, Hernández-Ramírez LC, Korbonits M. Sporadic pituitary adenomas: the role of germline mutations and recommendations for genetic screening. Expert Rev Endocrinol Metab 2017; 12:143-153. [PMID: 30063429 DOI: 10.1080/17446651.2017.1306439] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
Although most pituitary adenomas occur sporadically, these common tumors can present in a familial setting in approximately 5% of cases. Germline mutations in several genes with autosomal dominant (AIP, MEN1, CDKN1B, PRKAR1A, SDHx) or X-linked dominant (GPR101) inheritance are causative of familial pituitary adenomas. Due to variable disease penetrance and occurrence of de novo mutations, some patients harboring germline mutations have no family history of pituitary adenomas (simplex cases). Areas covered: We summarize the recent findings on the role of germline mutations associated with familial pituitary adenomas in patients with sporadic clinical presentation. Expert commentary: Up to 12% of patients with young onset pituitary adenomas (age at diagnosis/onset ≤30 years) and up to 25% of simplex patients with gigantism carry mutations in the AIP gene, while most cases of X-linked acrogigantism (XLAG) due to GPR101 duplication are simplex female patients with very early disease onset (<5 years). With regard to the syndromes of multiple endocrine neoplasia (MEN), MEN1 mutations can be identified in a significant proportion of patients with childhood onset prolactinomas. Somatotroph and lactotroph adenomas are the most common pituitary adenomas associated with germline predisposing mutations. Genetic screening should be considered in patients with young onset pituitary adenomas.
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Affiliation(s)
- D Iacovazzo
- a Centre for Endocrinology, Barts and The London School of Medicine , Queen Mary University of London , London , UK
| | - L C Hernández-Ramírez
- b Section on Endocrinology and Genetics , Eunice Kennedy Shriver National Institute of Child Health and Human Development (NICHD), NIH , Bethesda , MD , USA
| | - M Korbonits
- a Centre for Endocrinology, Barts and The London School of Medicine , Queen Mary University of London , London , UK
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Abstract
BACKGROUND Acromegaly is a rare and underdiagnosed disorder caused, in more than 95% of cases, by a growth hormone (GH)-secreting pituitary adenoma. The GH hypersecretion leads to overproduction of insulin-like growth factor 1 (IGF-1) which results in a multisystem disease characterized by somatic overgrowth, multiple comorbidities, physical disfigurement, and increased mortality. OBJECTIVE This article aims to review the clinical features of acromegaly at diagnosis. DISCUSSION/CONCLUSION Acromegaly affects both males and females equally and the average age at diagnosis ranges from 40 to 50 years (up to 5% of cases < the age 20). Due to insidious onset and slow progression, acromegaly is often diagnosed five to more than ten years after its onset. The typical coarsening of facial features include furrowing of fronthead, pronounced brow protrusion, enlargement of the nose and the ears, thickening of the lips, skin wrinkles and nasolabial folds, as well as mandibular prognathism that leads to dental malocclusion and increased interdental spacing. Excessive growth of hands and feet (predominantly due to soft tissue swelling) is present in the vast majority of acromegalic patients. Gigantism accounts for up to 5% of cases and occurs when the excess of GH becomes manifest in the young, before the epiphyseal fusion. The disease also has rheumatologic, cardiovascular, respiratory, neoplastic, neurological, and metabolic manifestations which negatively impact its prognosis and patients quality of life. Less than 15% of acromegalic patients actively seek medical attention for change in appearance or enlargement of the extremities. The presentation of acromegaly is more often related to its systemic comorbidities or to local tumor effects.
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Affiliation(s)
- Lucio Vilar
- Division of Endocrinology, Hospital das Clínicas, Federal University of Pernambuco, Rua Heitor Maia Filho, 100/502, Madalena, Recife, CEP 50.720-525, Brazil.
| | | | - Ruy Lyra
- Division of Endocrinology, Hospital das Clínicas, Federal University of Pernambuco, Rua Heitor Maia Filho, 100/502, Madalena, Recife, CEP 50.720-525, Brazil
| | - Raissa Lyra
- Endocrine Research Center of Pernambuco, Recife, Brazil
| | - Luciana A Naves
- Division of Endocrinology, Brasilia University Hospital, Brasilia, Brazil
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23
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Abstract
Acromegaly is caused by a somatotropinoma in the vast majority of the cases. These are monoclonal tumors that can occur sporadically or rarely in a familial setting. In the last few years, novel familial syndromes have been described and recent studies explored the landscape of somatic mutations in sporadic somatotropinomas. This short review concentrates on the current knowledge of the genetic basis of both familial and sporadic acromegaly.
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Affiliation(s)
- Mônica R Gadelha
- Neuroendocrinology Research Center/Endocrine Section and Medical School - Hospital Universitário Clementino Fraga Filho, Universidade Federal do Rio de Janeiro, Rio de Janeiro, Brazil
- Neuroendocrine Section - Instituto Estadual do Cérebro Paulo Niemeyer, Secretaria Estadual de Saúde do Rio de Janeiro, Rio de Janeiro, Brazil
| | - Leandro Kasuki
- Neuroendocrinology Research Center/Endocrine Section and Medical School - Hospital Universitário Clementino Fraga Filho, Universidade Federal do Rio de Janeiro, Rio de Janeiro, Brazil
- Neuroendocrine Section - Instituto Estadual do Cérebro Paulo Niemeyer, Secretaria Estadual de Saúde do Rio de Janeiro, Rio de Janeiro, Brazil
- Endocrine Unit, Hospital Federal de Bonsucesso, Rio de Janeiro, Brazil
| | - Márta Korbonits
- Centre for Endocrinology, Barts and the London School of Medicine, Queen Mary University of London, Charterhouse Square, London, EC1A 6BQ, UK.
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Gordon RJ, Bell J, Chung WK, David R, Oberfield SE, Wardlaw SL. Childhood acromegaly due to X-linked acrogigantism: long term follow-up. Pituitary 2016; 19:560-564. [PMID: 27631333 PMCID: PMC5244823 DOI: 10.1007/s11102-016-0743-0] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
PURPOSE Acromegaly in infancy is extremely rare. We describe a 32 year old woman who presented at 6 months of age with isolated macrocephaly, followed by accelerated linear growth. At 21 months of age, her head circumference was 55 cm (+5.5 SD), height was 97.6 cm (+4.4 SD) and weight was 20.6 kg (+6.2 SD). She had markedly elevated levels of growth hormone (GH) (135 ng/ml), IGF-1 (1540 ng/ml) and prolactin (370 ng/ml). A pituitary macroadenoma was surgically resected. Immunohistochemical staining was positive for GH. Post-operatively, she developed ACTH and TSH deficiency and diabetes insipidus. METHODS Long term clinical follow-up and genetic testing with chromosomal microarray analysis. RESULTS Despite GH deficiency, she grew well until 7 ½ years old, with subsequent decline in growth velocity, and received GH therapy for 5 years. Puberty was initiated with estrogen therapy. As an adult, she has no stigmata of acromegaly, with a height of 164.5 cm and non-acromegalic features. IGF-1 has remained in the low normal range. Prolactin has been mildly elevated. Serial MRIs have shown no evidence of tumor recurrence. She receives replacement therapy with hydrocortisone, levothyroxine and DDAVP. Chromosomal microarray analysis revealed that she has X-linked acrogigantism (X-LAG) due to a de novo duplication of Xq26.3 (516 kb). She recently became pregnant following ovarian stimulation and chorionic villus sampling revealed that she is carrying a male with the same duplication. CONCLUSION This report provides detailed long term clinical follow-up of a patient with X-LAG syndrome.
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Affiliation(s)
- Rebecca J Gordon
- Department of Pediatrics, Columbia University College of Physicians and Surgeons, New York, NY, USA
| | - Jennifer Bell
- Department of Pediatrics, Columbia University College of Physicians and Surgeons, New York, NY, USA
| | - Wendy K Chung
- Department of Pediatrics, Columbia University College of Physicians and Surgeons, New York, NY, USA
| | - Raphael David
- Department of Pediatrics, New York University School of Medicine, New York, NY, USA
| | - Sharon E Oberfield
- Department of Pediatrics, Columbia University College of Physicians and Surgeons, New York, NY, USA
| | - Sharon L Wardlaw
- Department of Medicine, Columbia University College of Physicians and Surgeons, 630 West 168th Street, New York, NY, 10032, USA.
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Jedidi H, Rostomyan L, Potorac L, Depierreux-Lahaye F, Petrossians P, Beckers A. Advances in diagnosis and management of familial pituitary adenomas. INTERNATIONAL JOURNAL OF ENDOCRINE ONCOLOGY 2016. [DOI: 10.2217/ije-2016-0009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
Familial pituitary adenomas account for approximately 5–8% of all pituitary adenomas. Besides the adenomas occurring as part of syndromic entities that group several endocrine or nonendocrine disorders (multiple endocrine neoplasia type 1 or 4, Carney complex and McCune–Albright syndrome), 2–3% of familial pituitary adenomas fit into the familial isolated pituitary adenomas (FIPA) syndrome, an autosomal dominant condition with incomplete penetrance. About 20% of FIPA cases are due to mutations in the AIP gene and have distinct clinical characteristics. Recent findings have isolated a new non-AIP FIPA syndrome called X-linked acrogigantism, resulting from a microduplication that always includes the GPR101 gene. These new advances in the field of pituitary disease are opening up a new challenging domain to both clinicians and researchers. This review will focus on these recent findings and their contribution to the diagnosis and the management of familial pituitary adenomas.
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Affiliation(s)
- Haroun Jedidi
- Neurology Department, CHU of Liège, 1 Avenue de l'hopital, 4000 Liège, Belgium
| | - Liliya Rostomyan
- Endocrinology Department, CHU of Liège, 1 Avenue de l'hopital, 4000 Liège, Belgium
| | - lulia Potorac
- Endocrinology Department, CHU of Liège, 1 Avenue de l'hopital, 4000 Liège, Belgium
| | | | - Patrick Petrossians
- Endocrinology Department, CHU of Liège, 1 Avenue de l'hopital, 4000 Liège, Belgium
| | - Albert Beckers
- Endocrinology Department, CHU of Liège, 1 Avenue de l'hopital, 4000 Liège, Belgium
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Caimari F, Korbonits M. Novel Genetic Causes of Pituitary Adenomas. Clin Cancer Res 2016; 22:5030-5042. [DOI: 10.1158/1078-0432.ccr-16-0452] [Citation(s) in RCA: 81] [Impact Index Per Article: 10.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2016] [Accepted: 08/24/2016] [Indexed: 11/16/2022]
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Mangupli R, Rostomyan L, Castermans E, Caberg JH, Camperos P, Krivoy J, Cuauro E, Bours V, Daly AF, Beckers A. Combined treatment with octreotide LAR and pegvisomant in patients with pituitary gigantism: clinical evaluation and genetic screening. Pituitary 2016; 19:507-14. [PMID: 27287035 DOI: 10.1007/s11102-016-0732-3] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
INTRODUCTION Pituitary gigantism is a rare condition caused by growth hormone secreting hypersecretion, usually by a pituitary tumor. Acromegaly and gigantism cases that have a genetic cause are challenging to treat, due to large tumor size and poor responses to some medical therapies (e.g. AIP mutation affected cases and those with X-linked acrogigantism syndrome). MATERIALS AND METHODS We performed a retrospective study to identify gigantism cases among 160 somatotropinoma patients treated between 1985 and 2015 at the University Hospital of Caracas, Venezuela. We studied clinical details at diagnosis, hormonal responses to therapy and undertook targeted genetic testing. Among the 160 cases, eight patients (six males; 75 %) were diagnosed with pituitary gigantism and underwent genetic analysis that included array comparative genome hybridization for Xq26.3 duplications. RESULTS All patients had GH secreting pituitary macroadenomas that were difficult to control with conventional treatment options, such as surgery or primary somatostatin receptor ligand (SRL) therapy. Combined therapy (long-acting SRL and pegvisomant) as primary treatment or after pituitary surgery and radiotherapy permitted the normalization of IGF-1 levels and clinical improvement. Novel AIP mutations were the found in three patients. None of the patients had Xq26.3 microduplications. CONCLUSIONS Treatment of pituitary gigantism is frequently challenging; delayed control increases the harmful effects of GH excess, such as, excessive stature and symptom burden, so early diagnosis and effective treatment are particularly important in these cases.
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Affiliation(s)
- Ruth Mangupli
- Section of Neuroendocrinology, Department of Neurosurgery, Hospital Universitario de Caracas, Caracas, Venezuela.
| | - Liliya Rostomyan
- Department of Endocrinology, Centre Hospitalier Universitaire de Liège, University of Liège, Domaine Universitaire du Sart-Tilman, 4000, Liège, Belgium
| | - Emilie Castermans
- Department of Human Genetics, Centre Hospitalier Universitaire de Liège, University of Liège, Domaine Universitaire du Sart-Tilman, 4000, Liège, Belgium
| | - Jean-Hubert Caberg
- Department of Human Genetics, Centre Hospitalier Universitaire de Liège, University of Liège, Domaine Universitaire du Sart-Tilman, 4000, Liège, Belgium
| | - Paul Camperos
- Section of Neuroendocrinology, Department of Neurosurgery, Hospital Universitario de Caracas, Caracas, Venezuela
| | - Jaime Krivoy
- Section of Neuroendocrinology, Department of Neurosurgery, Hospital Universitario de Caracas, Caracas, Venezuela
| | - Elvia Cuauro
- Section of Neuroendocrinology, Department of Neurosurgery, Hospital Universitario de Caracas, Caracas, Venezuela
| | - Vincent Bours
- Department of Human Genetics, Centre Hospitalier Universitaire de Liège, University of Liège, Domaine Universitaire du Sart-Tilman, 4000, Liège, Belgium
| | - Adrian F Daly
- Department of Endocrinology, Centre Hospitalier Universitaire de Liège, University of Liège, Domaine Universitaire du Sart-Tilman, 4000, Liège, Belgium
| | - Albert Beckers
- Department of Endocrinology, Centre Hospitalier Universitaire de Liège, University of Liège, Domaine Universitaire du Sart-Tilman, 4000, Liège, Belgium.
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Iacovazzo D, Korbonits M. Gigantism: X-linked acrogigantism and GPR101 mutations. Growth Horm IGF Res 2016; 30-31:64-69. [PMID: 27743704 DOI: 10.1016/j.ghir.2016.09.007] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/28/2016] [Revised: 09/24/2016] [Accepted: 09/28/2016] [Indexed: 12/30/2022]
Abstract
X-linked acrogigantism (XLAG) is a recently identified condition of early-onset GH excess resulting from the germline or somatic duplication of the GPR101 gene on chromosome Xq26.3. Thirty patients have been formally reported so far. The disease affects mostly females, occurs usually sporadically, and is characterised by early onset and marked overgrowth. Most patients present with concomitant hyperprolactinaemia. Histopathology shows pituitary hyperplasia or pituitary adenoma with or without associated hyperplasia. XLAG-related pituitary adenomas present peculiar histopathological features that should contribute to raise the suspicion of this rare condition. Treatment is frequently challenging and multi-modal. While females present with germline mutations, the sporadic male patients reported so far were somatic mosaics with variable levels of mosaicism, although no differences in the clinical phenotype were observed between patients with germline or somatic duplication. The GPR101 gene encodes an orphan G protein-coupled receptor normally expressed in the central nervous system, and at particularly high levels in the hypothalamus. While the physiological function and the endogenous ligand of GPR101 are unknown, the high expression of GPR101 in the arcuate nucleus and the occurrence of increased circulating GHRH levels in some patients with XLAG, suggest that increased hypothalamic GHRH secretion could play a role in the pathogenesis of this condition. In this review, we summarise the published evidence on XLAG and GPR101 and discuss the results of recent studies that have investigated the potential role of GPR101 variants in the pathogenesis of pituitary adenomas.
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Affiliation(s)
- Donato Iacovazzo
- Centre for Endocrinology, Barts and The London School of Medicine, Queen Mary University of London, London, EC1M 6BQ, UK
| | - Márta Korbonits
- Centre for Endocrinology, Barts and The London School of Medicine, Queen Mary University of London, London, EC1M 6BQ, UK.
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Iacovazzo D, Caswell R, Bunce B, Jose S, Yuan B, Hernández-Ramírez LC, Kapur S, Caimari F, Evanson J, Ferraù F, Dang MN, Gabrovska P, Larkin SJ, Ansorge O, Rodd C, Vance ML, Ramírez-Renteria C, Mercado M, Goldstone AP, Buchfelder M, Burren CP, Gurlek A, Dutta P, Choong CS, Cheetham T, Trivellin G, Stratakis CA, Lopes MB, Grossman AB, Trouillas J, Lupski JR, Ellard S, Sampson JR, Roncaroli F, Korbonits M. Germline or somatic GPR101 duplication leads to X-linked acrogigantism: a clinico-pathological and genetic study. Acta Neuropathol Commun 2016; 4:56. [PMID: 27245663 PMCID: PMC4888203 DOI: 10.1186/s40478-016-0328-1] [Citation(s) in RCA: 68] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2016] [Accepted: 05/19/2016] [Indexed: 11/10/2022] Open
Abstract
Non-syndromic pituitary gigantism can result from AIP mutations or the recently identified Xq26.3 microduplication causing X-linked acrogigantism (XLAG). Within Xq26.3, GPR101 is believed to be the causative gene, and the c.924G > C (p.E308D) variant in this orphan G protein-coupled receptor has been suggested to play a role in the pathogenesis of acromegaly.We studied 153 patients (58 females and 95 males) with pituitary gigantism. AIP mutation-negative cases were screened for GPR101 duplication through copy number variation droplet digital PCR and high-density aCGH. The genetic, clinical and histopathological features of XLAG patients were studied in detail. 395 peripheral blood and 193 pituitary tumor DNA samples from acromegaly patients were tested for GPR101 variants.We identified 12 patients (10 females and 2 males; 7.8 %) with XLAG. In one subject, the duplicated region only contained GPR101, but not the other three genes in found to be duplicated in the previously reported patients, defining a new smallest region of overlap of duplications. While females presented with germline mutations, the two male patients harbored the mutation in a mosaic state. Nine patients had pituitary adenomas, while three had hyperplasia. The comparison of the features of XLAG, AIP-positive and GPR101&AIP-negative patients revealed significant differences in sex distribution, age at onset, height, prolactin co-secretion and histological features. The pathological features of XLAG-related adenomas were remarkably similar. These tumors had a sinusoidal and lobular architecture. Sparsely and densely granulated somatotrophs were admixed with lactotrophs; follicle-like structures and calcifications were commonly observed. Patients with sporadic of familial acromegaly did not have an increased prevalence of the c.924G > C (p.E308D) GPR101 variant compared to public databases.In conclusion, XLAG can result from germline or somatic duplication of GPR101. Duplication of GPR101 alone is sufficient for the development of XLAG, implicating it as the causative gene within the Xq26.3 region. The pathological features of XLAG-associated pituitary adenomas are typical and, together with the clinical phenotype, should prompt genetic testing.
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Rodd C, Millette M, Iacovazzo D, Stiles CE, Barry S, Evanson J, Albrecht S, Caswell R, Bunce B, Jose S, Trouillas J, Roncaroli F, Sampson J, Ellard S, Korbonits M. Somatic GPR101 Duplication Causing X-Linked Acrogigantism (XLAG)-Diagnosis and Management. J Clin Endocrinol Metab 2016; 101:1927-30. [PMID: 26982009 PMCID: PMC4870851 DOI: 10.1210/jc.2015-4366] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
CONTEXT Recent reports have proposed that sporadic or familial germline Xq26.3 microduplications involving the GPR101 gene are associated with early-onset X-linked acrogigantism (XLAG) with a female preponderance. CASE DESCRIPTION A 4-year-old boy presented with rapid growth over the previous 2 years. He complained of sporadic headaches and had coarse facial features. His height Z-score was +4.89, and weight Z-score was +5.57. Laboratory testing revealed elevated serum prolactin (185 μg/L; normal, <18 μg/L), IGF-1 (745 μg/L; normal, 64-369 μg/L), and fasting GH > 35.0 μg/L. Magnetic resonance imaging demonstrated a homogenous bulky pituitary gland (18 × 15 × 13 mm) without obvious adenoma. A pituitary biopsy showed hyperplastic pituitary tissue with enlarged cords of GH and prolactin cells. Germline PRKAR1A, MEN1, AIP, DICER1, CDKN1B, and somatic GNAS mutations were negative. Medical management was challenging until institution of continuous sc infusion of short-acting octreotide combined with sc pegvisomant and oral cabergoline. The patient remains well controlled with minimal side effects 7 years after presentation. His phenotype suggested XLAG, but his peripheral leukocyte-, saliva-, and buccal cell-derived DNA tested negative for microduplication in Xq26.3 or GPR101. However, DNA isolated from the pituitary tissue and forearm skin showed duplicated dosage of GPR101, suggesting that he is mosaic for this genetic abnormality. CONCLUSIONS Our patient is the first to be described with somatic microduplication leading to typical XLAG phenotype. This patient demonstrates that a negative test for Xq26.3 microduplication or GPR101 duplication on peripheral blood DNA does not exclude the diagnosis of XLAG because it can result from a mosaic mutation affecting the pituitary.
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Affiliation(s)
- Celia Rodd
- Pediatrics and Child Health (C.R.), University of Manitoba, Winnipeg MB R3E 0Z2, Canada; Department of Pediatrics (M.M.), Centre mère-enfant Soleil, Centre Hospitalier de l'Université de Quebec, QC G1V 4G2, Canada; Endocrinology (D.I., C.E.S., S.B., J.E., M.K.), Barts and the London School of Medicine, Queen Mary University of London, London EC1M 6BQ, United Kingdom; Department of Pathology (S.A.), McGill University, Montreal QC H4A 2J1, Canada; Molecular Genetics (R.C., B.B., S.E.), University of Exeter, Exeter EX4 4SB, United Kingdom; Institute of Medical Genetics (S.J., J.S.), School of Medicine, Cardiff University, Cardiff CF10 3XQ, United Kingdom; Centre de Pathologie Est (J.T.), Hospices Civils de Lyon, University of Lyon, 69622 Lyon, France; and Neuropathology (F.R.), University of Manchester, Manchester M13 9PL, United Kingdom
| | - Maude Millette
- Pediatrics and Child Health (C.R.), University of Manitoba, Winnipeg MB R3E 0Z2, Canada; Department of Pediatrics (M.M.), Centre mère-enfant Soleil, Centre Hospitalier de l'Université de Quebec, QC G1V 4G2, Canada; Endocrinology (D.I., C.E.S., S.B., J.E., M.K.), Barts and the London School of Medicine, Queen Mary University of London, London EC1M 6BQ, United Kingdom; Department of Pathology (S.A.), McGill University, Montreal QC H4A 2J1, Canada; Molecular Genetics (R.C., B.B., S.E.), University of Exeter, Exeter EX4 4SB, United Kingdom; Institute of Medical Genetics (S.J., J.S.), School of Medicine, Cardiff University, Cardiff CF10 3XQ, United Kingdom; Centre de Pathologie Est (J.T.), Hospices Civils de Lyon, University of Lyon, 69622 Lyon, France; and Neuropathology (F.R.), University of Manchester, Manchester M13 9PL, United Kingdom
| | - Donato Iacovazzo
- Pediatrics and Child Health (C.R.), University of Manitoba, Winnipeg MB R3E 0Z2, Canada; Department of Pediatrics (M.M.), Centre mère-enfant Soleil, Centre Hospitalier de l'Université de Quebec, QC G1V 4G2, Canada; Endocrinology (D.I., C.E.S., S.B., J.E., M.K.), Barts and the London School of Medicine, Queen Mary University of London, London EC1M 6BQ, United Kingdom; Department of Pathology (S.A.), McGill University, Montreal QC H4A 2J1, Canada; Molecular Genetics (R.C., B.B., S.E.), University of Exeter, Exeter EX4 4SB, United Kingdom; Institute of Medical Genetics (S.J., J.S.), School of Medicine, Cardiff University, Cardiff CF10 3XQ, United Kingdom; Centre de Pathologie Est (J.T.), Hospices Civils de Lyon, University of Lyon, 69622 Lyon, France; and Neuropathology (F.R.), University of Manchester, Manchester M13 9PL, United Kingdom
| | - Craig E Stiles
- Pediatrics and Child Health (C.R.), University of Manitoba, Winnipeg MB R3E 0Z2, Canada; Department of Pediatrics (M.M.), Centre mère-enfant Soleil, Centre Hospitalier de l'Université de Quebec, QC G1V 4G2, Canada; Endocrinology (D.I., C.E.S., S.B., J.E., M.K.), Barts and the London School of Medicine, Queen Mary University of London, London EC1M 6BQ, United Kingdom; Department of Pathology (S.A.), McGill University, Montreal QC H4A 2J1, Canada; Molecular Genetics (R.C., B.B., S.E.), University of Exeter, Exeter EX4 4SB, United Kingdom; Institute of Medical Genetics (S.J., J.S.), School of Medicine, Cardiff University, Cardiff CF10 3XQ, United Kingdom; Centre de Pathologie Est (J.T.), Hospices Civils de Lyon, University of Lyon, 69622 Lyon, France; and Neuropathology (F.R.), University of Manchester, Manchester M13 9PL, United Kingdom
| | - Sayka Barry
- Pediatrics and Child Health (C.R.), University of Manitoba, Winnipeg MB R3E 0Z2, Canada; Department of Pediatrics (M.M.), Centre mère-enfant Soleil, Centre Hospitalier de l'Université de Quebec, QC G1V 4G2, Canada; Endocrinology (D.I., C.E.S., S.B., J.E., M.K.), Barts and the London School of Medicine, Queen Mary University of London, London EC1M 6BQ, United Kingdom; Department of Pathology (S.A.), McGill University, Montreal QC H4A 2J1, Canada; Molecular Genetics (R.C., B.B., S.E.), University of Exeter, Exeter EX4 4SB, United Kingdom; Institute of Medical Genetics (S.J., J.S.), School of Medicine, Cardiff University, Cardiff CF10 3XQ, United Kingdom; Centre de Pathologie Est (J.T.), Hospices Civils de Lyon, University of Lyon, 69622 Lyon, France; and Neuropathology (F.R.), University of Manchester, Manchester M13 9PL, United Kingdom
| | - Jane Evanson
- Pediatrics and Child Health (C.R.), University of Manitoba, Winnipeg MB R3E 0Z2, Canada; Department of Pediatrics (M.M.), Centre mère-enfant Soleil, Centre Hospitalier de l'Université de Quebec, QC G1V 4G2, Canada; Endocrinology (D.I., C.E.S., S.B., J.E., M.K.), Barts and the London School of Medicine, Queen Mary University of London, London EC1M 6BQ, United Kingdom; Department of Pathology (S.A.), McGill University, Montreal QC H4A 2J1, Canada; Molecular Genetics (R.C., B.B., S.E.), University of Exeter, Exeter EX4 4SB, United Kingdom; Institute of Medical Genetics (S.J., J.S.), School of Medicine, Cardiff University, Cardiff CF10 3XQ, United Kingdom; Centre de Pathologie Est (J.T.), Hospices Civils de Lyon, University of Lyon, 69622 Lyon, France; and Neuropathology (F.R.), University of Manchester, Manchester M13 9PL, United Kingdom
| | - Steffen Albrecht
- Pediatrics and Child Health (C.R.), University of Manitoba, Winnipeg MB R3E 0Z2, Canada; Department of Pediatrics (M.M.), Centre mère-enfant Soleil, Centre Hospitalier de l'Université de Quebec, QC G1V 4G2, Canada; Endocrinology (D.I., C.E.S., S.B., J.E., M.K.), Barts and the London School of Medicine, Queen Mary University of London, London EC1M 6BQ, United Kingdom; Department of Pathology (S.A.), McGill University, Montreal QC H4A 2J1, Canada; Molecular Genetics (R.C., B.B., S.E.), University of Exeter, Exeter EX4 4SB, United Kingdom; Institute of Medical Genetics (S.J., J.S.), School of Medicine, Cardiff University, Cardiff CF10 3XQ, United Kingdom; Centre de Pathologie Est (J.T.), Hospices Civils de Lyon, University of Lyon, 69622 Lyon, France; and Neuropathology (F.R.), University of Manchester, Manchester M13 9PL, United Kingdom
| | - Richard Caswell
- Pediatrics and Child Health (C.R.), University of Manitoba, Winnipeg MB R3E 0Z2, Canada; Department of Pediatrics (M.M.), Centre mère-enfant Soleil, Centre Hospitalier de l'Université de Quebec, QC G1V 4G2, Canada; Endocrinology (D.I., C.E.S., S.B., J.E., M.K.), Barts and the London School of Medicine, Queen Mary University of London, London EC1M 6BQ, United Kingdom; Department of Pathology (S.A.), McGill University, Montreal QC H4A 2J1, Canada; Molecular Genetics (R.C., B.B., S.E.), University of Exeter, Exeter EX4 4SB, United Kingdom; Institute of Medical Genetics (S.J., J.S.), School of Medicine, Cardiff University, Cardiff CF10 3XQ, United Kingdom; Centre de Pathologie Est (J.T.), Hospices Civils de Lyon, University of Lyon, 69622 Lyon, France; and Neuropathology (F.R.), University of Manchester, Manchester M13 9PL, United Kingdom
| | - Benjamin Bunce
- Pediatrics and Child Health (C.R.), University of Manitoba, Winnipeg MB R3E 0Z2, Canada; Department of Pediatrics (M.M.), Centre mère-enfant Soleil, Centre Hospitalier de l'Université de Quebec, QC G1V 4G2, Canada; Endocrinology (D.I., C.E.S., S.B., J.E., M.K.), Barts and the London School of Medicine, Queen Mary University of London, London EC1M 6BQ, United Kingdom; Department of Pathology (S.A.), McGill University, Montreal QC H4A 2J1, Canada; Molecular Genetics (R.C., B.B., S.E.), University of Exeter, Exeter EX4 4SB, United Kingdom; Institute of Medical Genetics (S.J., J.S.), School of Medicine, Cardiff University, Cardiff CF10 3XQ, United Kingdom; Centre de Pathologie Est (J.T.), Hospices Civils de Lyon, University of Lyon, 69622 Lyon, France; and Neuropathology (F.R.), University of Manchester, Manchester M13 9PL, United Kingdom
| | - Sian Jose
- Pediatrics and Child Health (C.R.), University of Manitoba, Winnipeg MB R3E 0Z2, Canada; Department of Pediatrics (M.M.), Centre mère-enfant Soleil, Centre Hospitalier de l'Université de Quebec, QC G1V 4G2, Canada; Endocrinology (D.I., C.E.S., S.B., J.E., M.K.), Barts and the London School of Medicine, Queen Mary University of London, London EC1M 6BQ, United Kingdom; Department of Pathology (S.A.), McGill University, Montreal QC H4A 2J1, Canada; Molecular Genetics (R.C., B.B., S.E.), University of Exeter, Exeter EX4 4SB, United Kingdom; Institute of Medical Genetics (S.J., J.S.), School of Medicine, Cardiff University, Cardiff CF10 3XQ, United Kingdom; Centre de Pathologie Est (J.T.), Hospices Civils de Lyon, University of Lyon, 69622 Lyon, France; and Neuropathology (F.R.), University of Manchester, Manchester M13 9PL, United Kingdom
| | - Jacqueline Trouillas
- Pediatrics and Child Health (C.R.), University of Manitoba, Winnipeg MB R3E 0Z2, Canada; Department of Pediatrics (M.M.), Centre mère-enfant Soleil, Centre Hospitalier de l'Université de Quebec, QC G1V 4G2, Canada; Endocrinology (D.I., C.E.S., S.B., J.E., M.K.), Barts and the London School of Medicine, Queen Mary University of London, London EC1M 6BQ, United Kingdom; Department of Pathology (S.A.), McGill University, Montreal QC H4A 2J1, Canada; Molecular Genetics (R.C., B.B., S.E.), University of Exeter, Exeter EX4 4SB, United Kingdom; Institute of Medical Genetics (S.J., J.S.), School of Medicine, Cardiff University, Cardiff CF10 3XQ, United Kingdom; Centre de Pathologie Est (J.T.), Hospices Civils de Lyon, University of Lyon, 69622 Lyon, France; and Neuropathology (F.R.), University of Manchester, Manchester M13 9PL, United Kingdom
| | - Federico Roncaroli
- Pediatrics and Child Health (C.R.), University of Manitoba, Winnipeg MB R3E 0Z2, Canada; Department of Pediatrics (M.M.), Centre mère-enfant Soleil, Centre Hospitalier de l'Université de Quebec, QC G1V 4G2, Canada; Endocrinology (D.I., C.E.S., S.B., J.E., M.K.), Barts and the London School of Medicine, Queen Mary University of London, London EC1M 6BQ, United Kingdom; Department of Pathology (S.A.), McGill University, Montreal QC H4A 2J1, Canada; Molecular Genetics (R.C., B.B., S.E.), University of Exeter, Exeter EX4 4SB, United Kingdom; Institute of Medical Genetics (S.J., J.S.), School of Medicine, Cardiff University, Cardiff CF10 3XQ, United Kingdom; Centre de Pathologie Est (J.T.), Hospices Civils de Lyon, University of Lyon, 69622 Lyon, France; and Neuropathology (F.R.), University of Manchester, Manchester M13 9PL, United Kingdom
| | - Julian Sampson
- Pediatrics and Child Health (C.R.), University of Manitoba, Winnipeg MB R3E 0Z2, Canada; Department of Pediatrics (M.M.), Centre mère-enfant Soleil, Centre Hospitalier de l'Université de Quebec, QC G1V 4G2, Canada; Endocrinology (D.I., C.E.S., S.B., J.E., M.K.), Barts and the London School of Medicine, Queen Mary University of London, London EC1M 6BQ, United Kingdom; Department of Pathology (S.A.), McGill University, Montreal QC H4A 2J1, Canada; Molecular Genetics (R.C., B.B., S.E.), University of Exeter, Exeter EX4 4SB, United Kingdom; Institute of Medical Genetics (S.J., J.S.), School of Medicine, Cardiff University, Cardiff CF10 3XQ, United Kingdom; Centre de Pathologie Est (J.T.), Hospices Civils de Lyon, University of Lyon, 69622 Lyon, France; and Neuropathology (F.R.), University of Manchester, Manchester M13 9PL, United Kingdom
| | - Sian Ellard
- Pediatrics and Child Health (C.R.), University of Manitoba, Winnipeg MB R3E 0Z2, Canada; Department of Pediatrics (M.M.), Centre mère-enfant Soleil, Centre Hospitalier de l'Université de Quebec, QC G1V 4G2, Canada; Endocrinology (D.I., C.E.S., S.B., J.E., M.K.), Barts and the London School of Medicine, Queen Mary University of London, London EC1M 6BQ, United Kingdom; Department of Pathology (S.A.), McGill University, Montreal QC H4A 2J1, Canada; Molecular Genetics (R.C., B.B., S.E.), University of Exeter, Exeter EX4 4SB, United Kingdom; Institute of Medical Genetics (S.J., J.S.), School of Medicine, Cardiff University, Cardiff CF10 3XQ, United Kingdom; Centre de Pathologie Est (J.T.), Hospices Civils de Lyon, University of Lyon, 69622 Lyon, France; and Neuropathology (F.R.), University of Manchester, Manchester M13 9PL, United Kingdom
| | - Márta Korbonits
- Pediatrics and Child Health (C.R.), University of Manitoba, Winnipeg MB R3E 0Z2, Canada; Department of Pediatrics (M.M.), Centre mère-enfant Soleil, Centre Hospitalier de l'Université de Quebec, QC G1V 4G2, Canada; Endocrinology (D.I., C.E.S., S.B., J.E., M.K.), Barts and the London School of Medicine, Queen Mary University of London, London EC1M 6BQ, United Kingdom; Department of Pathology (S.A.), McGill University, Montreal QC H4A 2J1, Canada; Molecular Genetics (R.C., B.B., S.E.), University of Exeter, Exeter EX4 4SB, United Kingdom; Institute of Medical Genetics (S.J., J.S.), School of Medicine, Cardiff University, Cardiff CF10 3XQ, United Kingdom; Centre de Pathologie Est (J.T.), Hospices Civils de Lyon, University of Lyon, 69622 Lyon, France; and Neuropathology (F.R.), University of Manchester, Manchester M13 9PL, United Kingdom
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Daly AF, Yuan B, Fina F, Caberg JH, Trivellin G, Rostomyan L, de Herder WW, Naves LA, Metzger D, Cuny T, Rabl W, Shah N, Jaffrain-Rea ML, Zatelli MC, Faucz FR, Castermans E, Nanni-Metellus I, Lodish M, Muhammad A, Palmeira L, Potorac I, Mantovani G, Neggers SJ, Klein M, Barlier A, Liu P, Ouafik L, Bours V, Lupski JR, Stratakis CA, Beckers A. Somatic mosaicism underlies X-linked acrogigantism syndrome in sporadic male subjects. Endocr Relat Cancer 2016; 23:221-33. [PMID: 26935837 PMCID: PMC4877443 DOI: 10.1530/erc-16-0082] [Citation(s) in RCA: 52] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/01/2016] [Accepted: 03/01/2016] [Indexed: 12/15/2022]
Abstract
Somatic mosaicism has been implicated as a causative mechanism in a number of genetic and genomic disorders. X-linked acrogigantism (XLAG) syndrome is a recently characterized genomic form of pediatric gigantism due to aggressive pituitary tumors that is caused by submicroscopic chromosome Xq26.3 duplications that include GPR101 We studied XLAG syndrome patients (n= 18) to determine if somatic mosaicism contributed to the genomic pathophysiology. Eighteen subjects with XLAG syndrome caused by Xq26.3 duplications were identified using high-definition array comparative genomic hybridization (HD-aCGH). We noted that males with XLAG had a decreased log2ratio (LR) compared with expected values, suggesting potential mosaicism, whereas females showed no such decrease. Compared with familial male XLAG cases, sporadic males had more marked evidence for mosaicism, with levels of Xq26.3 duplication between 16.1 and 53.8%. These characteristics were replicated using a novel, personalized breakpoint junction-specific quantification droplet digital polymerase chain reaction (ddPCR) technique. Using a separate ddPCR technique, we studied the feasibility of identifying XLAG syndrome cases in a distinct patient population of 64 unrelated subjects with acromegaly/gigantism, and identified one female gigantism patient who had had increased copy number variation (CNV) threshold for GPR101 that was subsequently diagnosed as having XLAG syndrome on HD-aCGH. Employing a combination of HD-aCGH and novel ddPCR approaches, we have demonstrated, for the first time, that XLAG syndrome can be caused by variable degrees of somatic mosaicism for duplications at chromosome Xq26.3. Somatic mosaicism was shown to occur in sporadic males but not in females with XLAG syndrome, although the clinical characteristics of the disease were similarly severe in both sexes.
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Affiliation(s)
- Adrian F Daly
- Department of Endocrinology, Centre Hospitalier Universitaire de Liege, University of Liege, Liege, Belgium
| | - Bo Yuan
- Department of Molecular and Human Genetics, Baylor College of Medicine, Houston, TexasUSA
| | - Frederic Fina
- Assistance Publique Hôpitaux de Marseille (AP-HM), Hôpital Nord, Service de Transfert d'Oncologie Biologique, Marseille, France Laboratoire de Biologie Médicale, and Aix-Marseille UniversitéInserm, CRO2 UMR_S 911, Marseille, France
| | - Jean-Hubert Caberg
- Department of Human Genetics, Centre Hospitalier Universitaire de Liege, University of Liege, Liege, Belgium
| | - Giampaolo Trivellin
- Section on Endocrinology and Genetics, Eunice Kennedy Shriver National Institute of Child Health and Human Development (NICHD), National Institutes of Health (NIH), Bethesda, Maryland, USA
| | - Liliya Rostomyan
- Department of Endocrinology, Centre Hospitalier Universitaire de Liege, University of Liege, Liege, Belgium
| | - Wouter W de Herder
- Section of Endocrinology, Department of Medicine, Erasmus University Medical Center Rotterdam and Pituitary Center Rotterdam, Rotterdam, The Netherlands
| | - Luciana A Naves
- Department of Endocrinology, University of Brasilia, Brasilia, Brazil
| | - Daniel Metzger
- Endocrinology and Diabetes Unit, BC Children's Hospital, Vancouver, British Columbia, Canada
| | - Thomas Cuny
- Department of Endocrinology, University Hospital, Nancy, France
| | - Wolfgang Rabl
- Kinderklinik, Technische Universität München, Munich, Germany
| | - Nalini Shah
- Department of Endocrinology, KEM Hospital, Mumbai, India
| | - Marie-Lise Jaffrain-Rea
- Department of Biotechnological and Applied Clinical Sciences, University of L'Aquila, L'Aquila and Neuromed Institute, IRCCS, Pozzilli, Italy
| | - Maria Chiara Zatelli
- Section of Endocrinology, Department of Medical Sciences, University of Ferrara, Ferrara, Italy
| | - Fabio R Faucz
- Section on Endocrinology and Genetics, Eunice Kennedy Shriver National Institute of Child Health and Human Development (NICHD), National Institutes of Health (NIH), Bethesda, Maryland, USA
| | - Emilie Castermans
- Department of Human Genetics, Centre Hospitalier Universitaire de Liege, University of Liege, Liege, Belgium
| | - Isabelle Nanni-Metellus
- Assistance Publique Hôpitaux de Marseille (AP-HM), Hôpital Nord, Service de Transfert d'Oncologie Biologique, Marseille, France
| | - Maya Lodish
- Section on Endocrinology and Genetics, Eunice Kennedy Shriver National Institute of Child Health and Human Development (NICHD), National Institutes of Health (NIH), Bethesda, Maryland, USA
| | - Ammar Muhammad
- Section of Endocrinology, Department of Medicine, Erasmus University Medical Center Rotterdam and Pituitary Center Rotterdam, Rotterdam, The Netherlands
| | - Leonor Palmeira
- Department of Endocrinology, Centre Hospitalier Universitaire de Liege, University of Liege, Liege, Belgium
| | - Iulia Potorac
- Department of Endocrinology, Centre Hospitalier Universitaire de Liege, University of Liege, Liege, Belgium Department of Human GeneticsCentre Hospitalier Universitaire de Liege, University of Liege, Liege, Belgium
| | - Giovanna Mantovani
- Endocrinology and Diabetology Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Department of Clinical Sciences and Community Health, University of Milan, Milan, Italy
| | - Sebastian J Neggers
- Section of Endocrinology, Department of Medicine, Erasmus University Medical Center Rotterdam and Pituitary Center Rotterdam, Rotterdam, The Netherlands
| | - Marc Klein
- Department of Endocrinology, University Hospital, Nancy, France
| | - Anne Barlier
- Laboratory of Molecular Biology, APHM, Hopital la Conception, Aix Marseille Universite, Marseilles, France CRNSCRN2M-UMR 7286, Marseille, France
| | - Pengfei Liu
- Assistance Publique Hôpitaux de Marseille (AP-HM), Hôpital Nord, Service de Transfert d'Oncologie Biologique, Marseille, France
| | - L'Houcine Ouafik
- Laboratoire de Biologie Médicale, and Aix-Marseille Université, Inserm, CRO2 UMR_S 911, Marseille, France
| | - Vincent Bours
- Department of Human Genetics, Centre Hospitalier Universitaire de Liege, University of Liege, Liege, Belgium
| | - James R Lupski
- Human Genome Sequencing Center, Baylor College of Medicine, Houston, Texas, USA
| | - Constantine A Stratakis
- Section on Endocrinology and Genetics, Eunice Kennedy Shriver National Institute of Child Health and Human Development (NICHD), National Institutes of Health (NIH), Bethesda, Maryland, USA
| | - Albert Beckers
- Department of Endocrinology, Centre Hospitalier Universitaire de Liege, University of Liege, Liege, Belgium
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32
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Daly AF, Lysy PA, Desfilles C, Rostomyan L, Mohamed A, Caberg JH, Raverot V, Castermans E, Marbaix E, Maiter D, Brunelle C, Trivellin G, Stratakis CA, Bours V, Raftopoulos C, Beauloye V, Barlier A, Beckers A. GHRH excess and blockade in X-LAG syndrome. Endocr Relat Cancer 2016; 23:161-70. [PMID: 26671997 PMCID: PMC6300999 DOI: 10.1530/erc-15-0478] [Citation(s) in RCA: 37] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/04/2015] [Accepted: 12/15/2015] [Indexed: 01/20/2023]
Abstract
X-linked acrogigantism (X-LAG) syndrome is a newly described form of inheritable pituitary gigantism that begins in early childhood and is usually associated with markedly elevated GH and prolactin secretion by mixed pituitary adenomas/hyperplasia. Microduplications on chromosome Xq26.3 including the GPR101 gene cause X-LAG syndrome. In individual cases random GHRH levels have been elevated. We performed a series of hormonal profiles in a young female sporadic X-LAG syndrome patient and subsequently undertook in vitro studies of primary pituitary tumor culture following neurosurgical resection. The patient demonstrated consistently elevated circulating GHRH levels throughout preoperative testing, which was accompanied by marked GH and prolactin hypersecretion; GH demonstrated a paradoxical increase following TRH administration. In vitro, the pituitary cells showed baseline GH and prolactin release that was further stimulated by GHRH administration. Co-incubation with GHRH and the GHRH receptor antagonist, acetyl-(d-Arg(2))-GHRH (1-29) amide, blocked the GHRH-induced GH stimulation; the GHRH receptor antagonist alone significantly reduced GH release. Pasireotide, but not octreotide, inhibited GH secretion. A ghrelin receptor agonist and an inverse agonist led to modest, statistically significant increases and decreases in GH secretion, respectively. GHRH hypersecretion can accompany the pituitary abnormalities seen in X-LAG syndrome. These data suggest that the pathology of X-LAG syndrome may include hypothalamic dysregulation of GHRH secretion, which is in keeping with localization of GPR101 in the hypothalamus. Therapeutic blockade of GHRH secretion could represent a way to target the marked hormonal hypersecretion and overgrowth that characterizes X-LAG syndrome.
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Affiliation(s)
- Adrian F Daly
- Department of EndocrinologyCentre Hospitalier Universitaire de Liège, University of Liège, Domaine Universitaire du Sart-Tilman, 4000 Liège, BelgiumDepartment of Human GeneticsCentre Hospitalier Universitaire de Liège, University of Liège, Domaine Universitaire du Sart-Tilman, 4000 Liège, BelgiumPediatric Endocrinology UnitUniversité Catholique de Louvain, Avenue Hippocrate 10, 1200 Brussels, BelgiumCliniques Universitaires Saint Luc and Department of PathologyUniversité Catholique de Louvain, Avenue Hippocrate 10, 1200 Brussels, BelgiumLaboratory of Molecular BiologyAPHM, Hôpital la Conception, 13385, Marseille, FranceAix Marseille UniversitéCRNS, CRN2M-UMR 7286, 13344, Marseille, FranceSection on Endocrinology and GeneticsProgram on Developmental Endocrinology and Genetics (PDEGEN) and Pediatric Endocrinology Inter-institute Training Program, Eunice Kennedy Shriver National Institute of Child Health and Human Development (NICHD), National Institutes of Health (NIH), Bethesda, Maryland 20892, USALaboratoire d'Hormonologie - CBPEGroupement Hospitalier Est, Hospices Civils de Lyon, 59 bd Pinel - 69677 Bron Cedex, FranceUniversité Catholique de LouvainPole d'endocrinologie, diabete et nutrition (EDIN), Brussels, BelgiumDepartment of NeurosurgeryUniversité Catholique de Louvain, Brussels, Belgium
| | - Philippe A Lysy
- Department of EndocrinologyCentre Hospitalier Universitaire de Liège, University of Liège, Domaine Universitaire du Sart-Tilman, 4000 Liège, BelgiumDepartment of Human GeneticsCentre Hospitalier Universitaire de Liège, University of Liège, Domaine Universitaire du Sart-Tilman, 4000 Liège, BelgiumPediatric Endocrinology UnitUniversité Catholique de Louvain, Avenue Hippocrate 10, 1200 Brussels, BelgiumCliniques Universitaires Saint Luc and Department of PathologyUniversité Catholique de Louvain, Avenue Hippocrate 10, 1200 Brussels, BelgiumLaboratory of Molecular BiologyAPHM, Hôpital la Conception, 13385, Marseille, FranceAix Marseille UniversitéCRNS, CRN2M-UMR 7286, 13344, Marseille, FranceSection on Endocrinology and GeneticsProgram on Developmental Endocrinology and Genetics (PDEGEN) and Pediatric Endocrinology Inter-institute Training Program, Eunice Kennedy Shriver National Institute of Child Health and Human Development (NICHD), National Institutes of Health (NIH), Bethesda, Maryland 20892, USALaboratoire d'Hormonologie - CBPEGroupement Hospitalier Est, Hospices Civils de Lyon, 59 bd Pinel - 69677 Bron Cedex, FranceUniversité Catholique de LouvainPole d'endocrinologie, diabete et nutrition (EDIN), Brussels, BelgiumDepartment of NeurosurgeryUniversité Catholique de Louvain, Brussels, Belgium
| | - Céline Desfilles
- Department of EndocrinologyCentre Hospitalier Universitaire de Liège, University of Liège, Domaine Universitaire du Sart-Tilman, 4000 Liège, BelgiumDepartment of Human GeneticsCentre Hospitalier Universitaire de Liège, University of Liège, Domaine Universitaire du Sart-Tilman, 4000 Liège, BelgiumPediatric Endocrinology UnitUniversité Catholique de Louvain, Avenue Hippocrate 10, 1200 Brussels, BelgiumCliniques Universitaires Saint Luc and Department of PathologyUniversité Catholique de Louvain, Avenue Hippocrate 10, 1200 Brussels, BelgiumLaboratory of Molecular BiologyAPHM, Hôpital la Conception, 13385, Marseille, FranceAix Marseille UniversitéCRNS, CRN2M-UMR 7286, 13344, Marseille, FranceSection on Endocrinology and GeneticsProgram on Developmental Endocrinology and Genetics (PDEGEN) and Pediatric Endocrinology Inter-institute Training Program, Eunice Kennedy Shriver National Institute of Child Health and Human Development (NICHD), National Institutes of Health (NIH), Bethesda, Maryland 20892, USALaboratoire d'Hormonologie - CBPEGroupement Hospitalier Est, Hospices Civils de Lyon, 59 bd Pinel - 69677 Bron Cedex, FranceUniversité Catholique de LouvainPole d'endocrinologie, diabete et nutrition (EDIN), Brussels, BelgiumDepartment of NeurosurgeryUniversité Catholique de Louvain, Brussels, Belgium Department of EndocrinologyCentre Hospitalier Universitaire de Liège, University of Liège, Domaine Universitaire du Sart-Tilman, 4000 Liège, BelgiumDepartment of Human GeneticsCentre Hospitalier Universitaire de Liège, University of Liège, Domaine Universitaire du Sart-Tilman, 4000 Liège, BelgiumPediatric Endocrinology UnitUniversité Catholique de Louvain, Avenue Hippocrate 10, 1200 Brussels, BelgiumCliniques Universitaires Saint Luc and Department of PathologyUniversité Catholique de Louvain, Avenue Hippocrate 10, 1200 Brussels, BelgiumLaboratory of Molecular BiologyAPHM, Hôpital la Conception, 13385, Marseille, FranceAix Marseille UniversitéCRNS, CRN2M-
| | - Liliya Rostomyan
- Department of EndocrinologyCentre Hospitalier Universitaire de Liège, University of Liège, Domaine Universitaire du Sart-Tilman, 4000 Liège, BelgiumDepartment of Human GeneticsCentre Hospitalier Universitaire de Liège, University of Liège, Domaine Universitaire du Sart-Tilman, 4000 Liège, BelgiumPediatric Endocrinology UnitUniversité Catholique de Louvain, Avenue Hippocrate 10, 1200 Brussels, BelgiumCliniques Universitaires Saint Luc and Department of PathologyUniversité Catholique de Louvain, Avenue Hippocrate 10, 1200 Brussels, BelgiumLaboratory of Molecular BiologyAPHM, Hôpital la Conception, 13385, Marseille, FranceAix Marseille UniversitéCRNS, CRN2M-UMR 7286, 13344, Marseille, FranceSection on Endocrinology and GeneticsProgram on Developmental Endocrinology and Genetics (PDEGEN) and Pediatric Endocrinology Inter-institute Training Program, Eunice Kennedy Shriver National Institute of Child Health and Human Development (NICHD), National Institutes of Health (NIH), Bethesda, Maryland 20892, USALaboratoire d'Hormonologie - CBPEGroupement Hospitalier Est, Hospices Civils de Lyon, 59 bd Pinel - 69677 Bron Cedex, FranceUniversité Catholique de LouvainPole d'endocrinologie, diabete et nutrition (EDIN), Brussels, BelgiumDepartment of NeurosurgeryUniversité Catholique de Louvain, Brussels, Belgium
| | - Amira Mohamed
- Department of EndocrinologyCentre Hospitalier Universitaire de Liège, University of Liège, Domaine Universitaire du Sart-Tilman, 4000 Liège, BelgiumDepartment of Human GeneticsCentre Hospitalier Universitaire de Liège, University of Liège, Domaine Universitaire du Sart-Tilman, 4000 Liège, BelgiumPediatric Endocrinology UnitUniversité Catholique de Louvain, Avenue Hippocrate 10, 1200 Brussels, BelgiumCliniques Universitaires Saint Luc and Department of PathologyUniversité Catholique de Louvain, Avenue Hippocrate 10, 1200 Brussels, BelgiumLaboratory of Molecular BiologyAPHM, Hôpital la Conception, 13385, Marseille, FranceAix Marseille UniversitéCRNS, CRN2M-UMR 7286, 13344, Marseille, FranceSection on Endocrinology and GeneticsProgram on Developmental Endocrinology and Genetics (PDEGEN) and Pediatric Endocrinology Inter-institute Training Program, Eunice Kennedy Shriver National Institute of Child Health and Human Development (NICHD), National Institutes of Health (NIH), Bethesda, Maryland 20892, USALaboratoire d'Hormonologie - CBPEGroupement Hospitalier Est, Hospices Civils de Lyon, 59 bd Pinel - 69677 Bron Cedex, FranceUniversité Catholique de LouvainPole d'endocrinologie, diabete et nutrition (EDIN), Brussels, BelgiumDepartment of NeurosurgeryUniversité Catholique de Louvain, Brussels, Belgium Department of EndocrinologyCentre Hospitalier Universitaire de Liège, University of Liège, Domaine Universitaire du Sart-Tilman, 4000 Liège, BelgiumDepartment of Human GeneticsCentre Hospitalier Universitaire de Liège, University of Liège, Domaine Universitaire du Sart-Tilman, 4000 Liège, BelgiumPediatric Endocrinology UnitUniversité Catholique de Louvain, Avenue Hippocrate 10, 1200 Brussels, BelgiumCliniques Universitaires Saint Luc and Department of PathologyUniversité Catholique de Louvain, Avenue Hippocrate 10, 1200 Brussels, BelgiumLaboratory of Molecular BiologyAPHM, Hôpital la Conception, 13385, Marseille, FranceAix Marseille UniversitéCRNS, CRN2M-
| | - Jean-Hubert Caberg
- Department of EndocrinologyCentre Hospitalier Universitaire de Liège, University of Liège, Domaine Universitaire du Sart-Tilman, 4000 Liège, BelgiumDepartment of Human GeneticsCentre Hospitalier Universitaire de Liège, University of Liège, Domaine Universitaire du Sart-Tilman, 4000 Liège, BelgiumPediatric Endocrinology UnitUniversité Catholique de Louvain, Avenue Hippocrate 10, 1200 Brussels, BelgiumCliniques Universitaires Saint Luc and Department of PathologyUniversité Catholique de Louvain, Avenue Hippocrate 10, 1200 Brussels, BelgiumLaboratory of Molecular BiologyAPHM, Hôpital la Conception, 13385, Marseille, FranceAix Marseille UniversitéCRNS, CRN2M-UMR 7286, 13344, Marseille, FranceSection on Endocrinology and GeneticsProgram on Developmental Endocrinology and Genetics (PDEGEN) and Pediatric Endocrinology Inter-institute Training Program, Eunice Kennedy Shriver National Institute of Child Health and Human Development (NICHD), National Institutes of Health (NIH), Bethesda, Maryland 20892, USALaboratoire d'Hormonologie - CBPEGroupement Hospitalier Est, Hospices Civils de Lyon, 59 bd Pinel - 69677 Bron Cedex, FranceUniversité Catholique de LouvainPole d'endocrinologie, diabete et nutrition (EDIN), Brussels, BelgiumDepartment of NeurosurgeryUniversité Catholique de Louvain, Brussels, Belgium
| | - Veronique Raverot
- Department of EndocrinologyCentre Hospitalier Universitaire de Liège, University of Liège, Domaine Universitaire du Sart-Tilman, 4000 Liège, BelgiumDepartment of Human GeneticsCentre Hospitalier Universitaire de Liège, University of Liège, Domaine Universitaire du Sart-Tilman, 4000 Liège, BelgiumPediatric Endocrinology UnitUniversité Catholique de Louvain, Avenue Hippocrate 10, 1200 Brussels, BelgiumCliniques Universitaires Saint Luc and Department of PathologyUniversité Catholique de Louvain, Avenue Hippocrate 10, 1200 Brussels, BelgiumLaboratory of Molecular BiologyAPHM, Hôpital la Conception, 13385, Marseille, FranceAix Marseille UniversitéCRNS, CRN2M-UMR 7286, 13344, Marseille, FranceSection on Endocrinology and GeneticsProgram on Developmental Endocrinology and Genetics (PDEGEN) and Pediatric Endocrinology Inter-institute Training Program, Eunice Kennedy Shriver National Institute of Child Health and Human Development (NICHD), National Institutes of Health (NIH), Bethesda, Maryland 20892, USALaboratoire d'Hormonologie - CBPEGroupement Hospitalier Est, Hospices Civils de Lyon, 59 bd Pinel - 69677 Bron Cedex, FranceUniversité Catholique de LouvainPole d'endocrinologie, diabete et nutrition (EDIN), Brussels, BelgiumDepartment of NeurosurgeryUniversité Catholique de Louvain, Brussels, Belgium
| | - Emilie Castermans
- Department of EndocrinologyCentre Hospitalier Universitaire de Liège, University of Liège, Domaine Universitaire du Sart-Tilman, 4000 Liège, BelgiumDepartment of Human GeneticsCentre Hospitalier Universitaire de Liège, University of Liège, Domaine Universitaire du Sart-Tilman, 4000 Liège, BelgiumPediatric Endocrinology UnitUniversité Catholique de Louvain, Avenue Hippocrate 10, 1200 Brussels, BelgiumCliniques Universitaires Saint Luc and Department of PathologyUniversité Catholique de Louvain, Avenue Hippocrate 10, 1200 Brussels, BelgiumLaboratory of Molecular BiologyAPHM, Hôpital la Conception, 13385, Marseille, FranceAix Marseille UniversitéCRNS, CRN2M-UMR 7286, 13344, Marseille, FranceSection on Endocrinology and GeneticsProgram on Developmental Endocrinology and Genetics (PDEGEN) and Pediatric Endocrinology Inter-institute Training Program, Eunice Kennedy Shriver National Institute of Child Health and Human Development (NICHD), National Institutes of Health (NIH), Bethesda, Maryland 20892, USALaboratoire d'Hormonologie - CBPEGroupement Hospitalier Est, Hospices Civils de Lyon, 59 bd Pinel - 69677 Bron Cedex, FranceUniversité Catholique de LouvainPole d'endocrinologie, diabete et nutrition (EDIN), Brussels, BelgiumDepartment of NeurosurgeryUniversité Catholique de Louvain, Brussels, Belgium
| | - Etienne Marbaix
- Department of EndocrinologyCentre Hospitalier Universitaire de Liège, University of Liège, Domaine Universitaire du Sart-Tilman, 4000 Liège, BelgiumDepartment of Human GeneticsCentre Hospitalier Universitaire de Liège, University of Liège, Domaine Universitaire du Sart-Tilman, 4000 Liège, BelgiumPediatric Endocrinology UnitUniversité Catholique de Louvain, Avenue Hippocrate 10, 1200 Brussels, BelgiumCliniques Universitaires Saint Luc and Department of PathologyUniversité Catholique de Louvain, Avenue Hippocrate 10, 1200 Brussels, BelgiumLaboratory of Molecular BiologyAPHM, Hôpital la Conception, 13385, Marseille, FranceAix Marseille UniversitéCRNS, CRN2M-UMR 7286, 13344, Marseille, FranceSection on Endocrinology and GeneticsProgram on Developmental Endocrinology and Genetics (PDEGEN) and Pediatric Endocrinology Inter-institute Training Program, Eunice Kennedy Shriver National Institute of Child Health and Human Development (NICHD), National Institutes of Health (NIH), Bethesda, Maryland 20892, USALaboratoire d'Hormonologie - CBPEGroupement Hospitalier Est, Hospices Civils de Lyon, 59 bd Pinel - 69677 Bron Cedex, FranceUniversité Catholique de LouvainPole d'endocrinologie, diabete et nutrition (EDIN), Brussels, BelgiumDepartment of NeurosurgeryUniversité Catholique de Louvain, Brussels, Belgium
| | - Dominique Maiter
- Department of EndocrinologyCentre Hospitalier Universitaire de Liège, University of Liège, Domaine Universitaire du Sart-Tilman, 4000 Liège, BelgiumDepartment of Human GeneticsCentre Hospitalier Universitaire de Liège, University of Liège, Domaine Universitaire du Sart-Tilman, 4000 Liège, BelgiumPediatric Endocrinology UnitUniversité Catholique de Louvain, Avenue Hippocrate 10, 1200 Brussels, BelgiumCliniques Universitaires Saint Luc and Department of PathologyUniversité Catholique de Louvain, Avenue Hippocrate 10, 1200 Brussels, BelgiumLaboratory of Molecular BiologyAPHM, Hôpital la Conception, 13385, Marseille, FranceAix Marseille UniversitéCRNS, CRN2M-UMR 7286, 13344, Marseille, FranceSection on Endocrinology and GeneticsProgram on Developmental Endocrinology and Genetics (PDEGEN) and Pediatric Endocrinology Inter-institute Training Program, Eunice Kennedy Shriver National Institute of Child Health and Human Development (NICHD), National Institutes of Health (NIH), Bethesda, Maryland 20892, USALaboratoire d'Hormonologie - CBPEGroupement Hospitalier Est, Hospices Civils de Lyon, 59 bd Pinel - 69677 Bron Cedex, FranceUniversité Catholique de LouvainPole d'endocrinologie, diabete et nutrition (EDIN), Brussels, BelgiumDepartment of NeurosurgeryUniversité Catholique de Louvain, Brussels, Belgium
| | - Chloe Brunelle
- Department of EndocrinologyCentre Hospitalier Universitaire de Liège, University of Liège, Domaine Universitaire du Sart-Tilman, 4000 Liège, BelgiumDepartment of Human GeneticsCentre Hospitalier Universitaire de Liège, University of Liège, Domaine Universitaire du Sart-Tilman, 4000 Liège, BelgiumPediatric Endocrinology UnitUniversité Catholique de Louvain, Avenue Hippocrate 10, 1200 Brussels, BelgiumCliniques Universitaires Saint Luc and Department of PathologyUniversité Catholique de Louvain, Avenue Hippocrate 10, 1200 Brussels, BelgiumLaboratory of Molecular BiologyAPHM, Hôpital la Conception, 13385, Marseille, FranceAix Marseille UniversitéCRNS, CRN2M-UMR 7286, 13344, Marseille, FranceSection on Endocrinology and GeneticsProgram on Developmental Endocrinology and Genetics (PDEGEN) and Pediatric Endocrinology Inter-institute Training Program, Eunice Kennedy Shriver National Institute of Child Health and Human Development (NICHD), National Institutes of Health (NIH), Bethesda, Maryland 20892, USALaboratoire d'Hormonologie - CBPEGroupement Hospitalier Est, Hospices Civils de Lyon, 59 bd Pinel - 69677 Bron Cedex, FranceUniversité Catholique de LouvainPole d'endocrinologie, diabete et nutrition (EDIN), Brussels, BelgiumDepartment of NeurosurgeryUniversité Catholique de Louvain, Brussels, Belgium
| | - Giampaolo Trivellin
- Department of EndocrinologyCentre Hospitalier Universitaire de Liège, University of Liège, Domaine Universitaire du Sart-Tilman, 4000 Liège, BelgiumDepartment of Human GeneticsCentre Hospitalier Universitaire de Liège, University of Liège, Domaine Universitaire du Sart-Tilman, 4000 Liège, BelgiumPediatric Endocrinology UnitUniversité Catholique de Louvain, Avenue Hippocrate 10, 1200 Brussels, BelgiumCliniques Universitaires Saint Luc and Department of PathologyUniversité Catholique de Louvain, Avenue Hippocrate 10, 1200 Brussels, BelgiumLaboratory of Molecular BiologyAPHM, Hôpital la Conception, 13385, Marseille, FranceAix Marseille UniversitéCRNS, CRN2M-UMR 7286, 13344, Marseille, FranceSection on Endocrinology and GeneticsProgram on Developmental Endocrinology and Genetics (PDEGEN) and Pediatric Endocrinology Inter-institute Training Program, Eunice Kennedy Shriver National Institute of Child Health and Human Development (NICHD), National Institutes of Health (NIH), Bethesda, Maryland 20892, USALaboratoire d'Hormonologie - CBPEGroupement Hospitalier Est, Hospices Civils de Lyon, 59 bd Pinel - 69677 Bron Cedex, FranceUniversité Catholique de LouvainPole d'endocrinologie, diabete et nutrition (EDIN), Brussels, BelgiumDepartment of NeurosurgeryUniversité Catholique de Louvain, Brussels, Belgium
| | - Constantine A Stratakis
- Department of EndocrinologyCentre Hospitalier Universitaire de Liège, University of Liège, Domaine Universitaire du Sart-Tilman, 4000 Liège, BelgiumDepartment of Human GeneticsCentre Hospitalier Universitaire de Liège, University of Liège, Domaine Universitaire du Sart-Tilman, 4000 Liège, BelgiumPediatric Endocrinology UnitUniversité Catholique de Louvain, Avenue Hippocrate 10, 1200 Brussels, BelgiumCliniques Universitaires Saint Luc and Department of PathologyUniversité Catholique de Louvain, Avenue Hippocrate 10, 1200 Brussels, BelgiumLaboratory of Molecular BiologyAPHM, Hôpital la Conception, 13385, Marseille, FranceAix Marseille UniversitéCRNS, CRN2M-UMR 7286, 13344, Marseille, FranceSection on Endocrinology and GeneticsProgram on Developmental Endocrinology and Genetics (PDEGEN) and Pediatric Endocrinology Inter-institute Training Program, Eunice Kennedy Shriver National Institute of Child Health and Human Development (NICHD), National Institutes of Health (NIH), Bethesda, Maryland 20892, USALaboratoire d'Hormonologie - CBPEGroupement Hospitalier Est, Hospices Civils de Lyon, 59 bd Pinel - 69677 Bron Cedex, FranceUniversité Catholique de LouvainPole d'endocrinologie, diabete et nutrition (EDIN), Brussels, BelgiumDepartment of NeurosurgeryUniversité Catholique de Louvain, Brussels, Belgium
| | - Vincent Bours
- Department of EndocrinologyCentre Hospitalier Universitaire de Liège, University of Liège, Domaine Universitaire du Sart-Tilman, 4000 Liège, BelgiumDepartment of Human GeneticsCentre Hospitalier Universitaire de Liège, University of Liège, Domaine Universitaire du Sart-Tilman, 4000 Liège, BelgiumPediatric Endocrinology UnitUniversité Catholique de Louvain, Avenue Hippocrate 10, 1200 Brussels, BelgiumCliniques Universitaires Saint Luc and Department of PathologyUniversité Catholique de Louvain, Avenue Hippocrate 10, 1200 Brussels, BelgiumLaboratory of Molecular BiologyAPHM, Hôpital la Conception, 13385, Marseille, FranceAix Marseille UniversitéCRNS, CRN2M-UMR 7286, 13344, Marseille, FranceSection on Endocrinology and GeneticsProgram on Developmental Endocrinology and Genetics (PDEGEN) and Pediatric Endocrinology Inter-institute Training Program, Eunice Kennedy Shriver National Institute of Child Health and Human Development (NICHD), National Institutes of Health (NIH), Bethesda, Maryland 20892, USALaboratoire d'Hormonologie - CBPEGroupement Hospitalier Est, Hospices Civils de Lyon, 59 bd Pinel - 69677 Bron Cedex, FranceUniversité Catholique de LouvainPole d'endocrinologie, diabete et nutrition (EDIN), Brussels, BelgiumDepartment of NeurosurgeryUniversité Catholique de Louvain, Brussels, Belgium
| | - Christian Raftopoulos
- Department of EndocrinologyCentre Hospitalier Universitaire de Liège, University of Liège, Domaine Universitaire du Sart-Tilman, 4000 Liège, BelgiumDepartment of Human GeneticsCentre Hospitalier Universitaire de Liège, University of Liège, Domaine Universitaire du Sart-Tilman, 4000 Liège, BelgiumPediatric Endocrinology UnitUniversité Catholique de Louvain, Avenue Hippocrate 10, 1200 Brussels, BelgiumCliniques Universitaires Saint Luc and Department of PathologyUniversité Catholique de Louvain, Avenue Hippocrate 10, 1200 Brussels, BelgiumLaboratory of Molecular BiologyAPHM, Hôpital la Conception, 13385, Marseille, FranceAix Marseille UniversitéCRNS, CRN2M-UMR 7286, 13344, Marseille, FranceSection on Endocrinology and GeneticsProgram on Developmental Endocrinology and Genetics (PDEGEN) and Pediatric Endocrinology Inter-institute Training Program, Eunice Kennedy Shriver National Institute of Child Health and Human Development (NICHD), National Institutes of Health (NIH), Bethesda, Maryland 20892, USALaboratoire d'Hormonologie - CBPEGroupement Hospitalier Est, Hospices Civils de Lyon, 59 bd Pinel - 69677 Bron Cedex, FranceUniversité Catholique de LouvainPole d'endocrinologie, diabete et nutrition (EDIN), Brussels, BelgiumDepartment of NeurosurgeryUniversité Catholique de Louvain, Brussels, Belgium
| | - Veronique Beauloye
- Department of EndocrinologyCentre Hospitalier Universitaire de Liège, University of Liège, Domaine Universitaire du Sart-Tilman, 4000 Liège, BelgiumDepartment of Human GeneticsCentre Hospitalier Universitaire de Liège, University of Liège, Domaine Universitaire du Sart-Tilman, 4000 Liège, BelgiumPediatric Endocrinology UnitUniversité Catholique de Louvain, Avenue Hippocrate 10, 1200 Brussels, BelgiumCliniques Universitaires Saint Luc and Department of PathologyUniversité Catholique de Louvain, Avenue Hippocrate 10, 1200 Brussels, BelgiumLaboratory of Molecular BiologyAPHM, Hôpital la Conception, 13385, Marseille, FranceAix Marseille UniversitéCRNS, CRN2M-UMR 7286, 13344, Marseille, FranceSection on Endocrinology and GeneticsProgram on Developmental Endocrinology and Genetics (PDEGEN) and Pediatric Endocrinology Inter-institute Training Program, Eunice Kennedy Shriver National Institute of Child Health and Human Development (NICHD), National Institutes of Health (NIH), Bethesda, Maryland 20892, USALaboratoire d'Hormonologie - CBPEGroupement Hospitalier Est, Hospices Civils de Lyon, 59 bd Pinel - 69677 Bron Cedex, FranceUniversité Catholique de LouvainPole d'endocrinologie, diabete et nutrition (EDIN), Brussels, BelgiumDepartment of NeurosurgeryUniversité Catholique de Louvain, Brussels, Belgium
| | - Anne Barlier
- Department of EndocrinologyCentre Hospitalier Universitaire de Liège, University of Liège, Domaine Universitaire du Sart-Tilman, 4000 Liège, BelgiumDepartment of Human GeneticsCentre Hospitalier Universitaire de Liège, University of Liège, Domaine Universitaire du Sart-Tilman, 4000 Liège, BelgiumPediatric Endocrinology UnitUniversité Catholique de Louvain, Avenue Hippocrate 10, 1200 Brussels, BelgiumCliniques Universitaires Saint Luc and Department of PathologyUniversité Catholique de Louvain, Avenue Hippocrate 10, 1200 Brussels, BelgiumLaboratory of Molecular BiologyAPHM, Hôpital la Conception, 13385, Marseille, FranceAix Marseille UniversitéCRNS, CRN2M-UMR 7286, 13344, Marseille, FranceSection on Endocrinology and GeneticsProgram on Developmental Endocrinology and Genetics (PDEGEN) and Pediatric Endocrinology Inter-institute Training Program, Eunice Kennedy Shriver National Institute of Child Health and Human Development (NICHD), National Institutes of Health (NIH), Bethesda, Maryland 20892, USALaboratoire d'Hormonologie - CBPEGroupement Hospitalier Est, Hospices Civils de Lyon, 59 bd Pinel - 69677 Bron Cedex, FranceUniversité Catholique de LouvainPole d'endocrinologie, diabete et nutrition (EDIN), Brussels, BelgiumDepartment of NeurosurgeryUniversité Catholique de Louvain, Brussels, Belgium Department of EndocrinologyCentre Hospitalier Universitaire de Liège, University of Liège, Domaine Universitaire du Sart-Tilman, 4000 Liège, BelgiumDepartment of Human GeneticsCentre Hospitalier Universitaire de Liège, University of Liège, Domaine Universitaire du Sart-Tilman, 4000 Liège, BelgiumPediatric Endocrinology UnitUniversité Catholique de Louvain, Avenue Hippocrate 10, 1200 Brussels, BelgiumCliniques Universitaires Saint Luc and Department of PathologyUniversité Catholique de Louvain, Avenue Hippocrate 10, 1200 Brussels, BelgiumLaboratory of Molecular BiologyAPHM, Hôpital la Conception, 13385, Marseille, FranceAix Marseille UniversitéCRNS, CRN2M-
| | - Albert Beckers
- Department of EndocrinologyCentre Hospitalier Universitaire de Liège, University of Liège, Domaine Universitaire du Sart-Tilman, 4000 Liège, BelgiumDepartment of Human GeneticsCentre Hospitalier Universitaire de Liège, University of Liège, Domaine Universitaire du Sart-Tilman, 4000 Liège, BelgiumPediatric Endocrinology UnitUniversité Catholique de Louvain, Avenue Hippocrate 10, 1200 Brussels, BelgiumCliniques Universitaires Saint Luc and Department of PathologyUniversité Catholique de Louvain, Avenue Hippocrate 10, 1200 Brussels, BelgiumLaboratory of Molecular BiologyAPHM, Hôpital la Conception, 13385, Marseille, FranceAix Marseille UniversitéCRNS, CRN2M-UMR 7286, 13344, Marseille, FranceSection on Endocrinology and GeneticsProgram on Developmental Endocrinology and Genetics (PDEGEN) and Pediatric Endocrinology Inter-institute Training Program, Eunice Kennedy Shriver National Institute of Child Health and Human Development (NICHD), National Institutes of Health (NIH), Bethesda, Maryland 20892, USALaboratoire d'Hormonologie - CBPEGroupement Hospitalier Est, Hospices Civils de Lyon, 59 bd Pinel - 69677 Bron Cedex, FranceUniversité Catholique de LouvainPole d'endocrinologie, diabete et nutrition (EDIN), Brussels, BelgiumDepartment of NeurosurgeryUniversité Catholique de Louvain, Brussels, Belgium
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Zakir JCDO, Casulari LA, Rosa JWC, Rosa JWC, de Mello PA, de Magalhães AV, Naves LA. Prognostic Value of Invasion, Markers of Proliferation, and Classification of Giant Pituitary Tumors, in a Georeferred Cohort in Brazil of 50 Patients, with a Long-Term Postoperative Follow-Up. Int J Endocrinol 2016; 2016:7964523. [PMID: 27635138 PMCID: PMC5007336 DOI: 10.1155/2016/7964523] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/27/2015] [Revised: 03/09/2016] [Accepted: 06/30/2016] [Indexed: 11/18/2022] Open
Abstract
Although some pituitary adenomas may have an aggressive behavior, the vast majority are benign. There are still controversies about predictive factors regarding the biological behavior of these particular tumors. This study evaluated potential markers of invasion and proliferation compared to current classification patterns and epidemiogeographical parameters. The study included 50 patients, operated on for tumors greater than 30 mm, with a mean postoperative follow-up of 15.2 ± 4.8 years. Pituitary magnetic resonance was used to evaluate regrowth, invasion, and extension to adjacent tissue. Three tissue biomarkers were analyzed: p53, Ki-67, and c-erbB2. Tumors were classified according to a combination of histological and radiological features, ranging from noninvasive and nonproliferative (grade 1A) to invasive-proliferative (grade 2B). Tumors grades 2A and 2B represented 42% and 52%, respectively. Ki-67 (p = 0.23) and c-erbB2 (p = 0.71) had no significant relation to tumor progression status. P53 (p = 0.003), parasellar invasion (p = 0.03), and classification, grade 2B (p = 0.01), were associated with worse clinical outcome. Parasellar invasion prevails as strong predictive factor of tumor recurrence. Severe suprasellar extension should be considered as invasion parameter and could impact prognosis. No environmental factors or geographical cluster were associated with tumor behavior.
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Affiliation(s)
| | - Luiz Augusto Casulari
- Department of Endocrinology, Faculty of Medicine, University of Brasilia, Brasilia, Brazil
| | | | | | - Paulo Andrade de Mello
- Department of Neurosurgery, Faculty of Medicine, University of Brasilia, Brasilia, Brazil
| | | | - Luciana Ansaneli Naves
- Department of Endocrinology, Faculty of Medicine, University of Brasilia, Brasilia, Brazil
- *Luciana Ansaneli Naves:
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