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Reincke M. [Adrenal diseases]. Internist (Berl) 2022; 63:1-3. [PMID: 35029713 PMCID: PMC8758982 DOI: 10.1007/s00108-021-01239-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/10/2021] [Indexed: 11/30/2022]
Affiliation(s)
- Martin Reincke
- Medizinische Klinik und Poliklinik IV, Innenstadt Klinikum der Universität München, Ludwig-Maximilians-Universität München, Ziemssenstr. 1, 80336, München, Deutschland.
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Jang I, Kim SJ, Song RY, Kim K, Choi S, Lee JS, Gwon MK, Seong MW, Lee KE, Kim JH. Clinical and Molecular Characteristics of PRKACA L206R Mutant Cortisol-Producing Adenomas in Korean Patients. Endocrinol Metab (Seoul) 2021; 36:1287-1297. [PMID: 34852451 PMCID: PMC8743585 DOI: 10.3803/enm.2021.1217] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/30/2021] [Accepted: 10/14/2021] [Indexed: 11/11/2022] Open
Abstract
BACKGROUND An activating mutation (c.617A>C/p.Lys206Arg, L206R) in protein kinase cAMP-activated catalytic subunit alpha (PRKACA) has been reported in 35% to 65% of cases of cortisol-producing adenomas (CPAs). We aimed to compare the clinical characteristics and transcriptome analysis between PRKACA L206R mutants and wild-type CPAs in Korea. METHODS We included 57 subjects with CPAs who underwent adrenalectomy at Seoul National University Hospital. Sanger sequencing for PRKACA was conducted in 57 CPA tumor tissues. RNA sequencing was performed in 13 fresh-frozen tumor tissues. RESULTS The prevalence of the PRKACA L206R mutation was 51% (29/57). The mean age of the study subjects was 42±12 years, and 87.7% (50/57) of the patients were female. Subjects with PRKACA L206R mutant CPAs showed smaller adenoma size (3.3±0.7 cm vs. 3.8±1.2 cm, P=0.059) and lower dehydroepiandrosterone sulfate levels (218±180 ng/mL vs. 1,511±3,307 ng/mL, P=0.001) than those with PRKACA wild-type CPAs. Transcriptome profiling identified 244 differentially expressed genes (DEGs) between PRKACA L206R mutant (n=8) and wild-type CPAs (n=5), including five upregulated and 239 downregulated genes in PRKACA L206R mutant CPAs (|fold change| ≥2, P<0.05). Among the upstream regulators of DEGs, CTNNB1 was the most significant transcription regulator. In several pathway analyses, the Wnt signaling pathway was downregulated and the steroid biosynthesis pathway was upregulated in PRKACA mutants. Protein-protein interaction analysis also showed that PRKACA downregulates Wnt signaling and upregulates steroid biosynthesis. CONCLUSION The PRKACA L206R mutation in CPAs causes high hormonal activity with a limited proliferative capacity, as supported by transcriptome profiling.
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Affiliation(s)
- Insoon Jang
- Translational Research Institute, Biomedical Research Institute, Seoul National University Hospital, Seoul,
Korea
- Corresponding authors: Kyu Eun Lee, Department of Surgery, Seoul National University Hospital, Seoul National University College of Medicine, 101 Daehak-ro, Jongno-gu, Seoul 03080, Korea, Tel: +82-2-2072-2081, Fax: +82-2-766-3975, E-mail:
| | - Su-jin Kim
- Department of Surgery, Seoul National University Hospital, Seoul National University College of Medicine, Seoul,
Korea
- Cancer Research Institute, Seoul National University College of Medicine, Seoul,
Korea
- Division of Surgery, Thyroid Center, Seoul National University Cancer Hospital, Seoul,
Korea
- Corresponding authors: Kyu Eun Lee, Department of Surgery, Seoul National University Hospital, Seoul National University College of Medicine, 101 Daehak-ro, Jongno-gu, Seoul 03080, Korea, Tel: +82-2-2072-2081, Fax: +82-2-766-3975, E-mail:
| | - Ra-Young Song
- Department of Surgery, Chung-Ang University Hospital, Seoul,
Korea
| | - Kwangsoo Kim
- Translational Research Institute, Biomedical Research Institute, Seoul National University Hospital, Seoul,
Korea
| | - Seongmin Choi
- Translational Research Institute, Biomedical Research Institute, Seoul National University Hospital, Seoul,
Korea
| | - Jang-Seok Lee
- Translational Research Institute, Biomedical Research Institute, Seoul National University Hospital, Seoul,
Korea
| | - Min-Kyeong Gwon
- Translational Research Institute, Biomedical Research Institute, Seoul National University Hospital, Seoul,
Korea
| | - Moon Woo Seong
- Department of Laboratory Medicine, Seoul National University Hospital, Seoul National University College of Medicine, Seoul,
Korea
| | - Kyu Eun Lee
- Department of Surgery, Seoul National University Hospital, Seoul National University College of Medicine, Seoul,
Korea
- Cancer Research Institute, Seoul National University College of Medicine, Seoul,
Korea
- Division of Surgery, Thyroid Center, Seoul National University Cancer Hospital, Seoul,
Korea
| | - Jung Hee Kim
- Department of Internal Medicine, Seoul National University Hospital, Seoul National University College of Medicine, Seoul,
Korea
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Abstract
During the last 20 years, a significant body of literature has accumulated regarding subclinical hypercortisolism in patients with adrenal incidentalomas. Retrospective studies have indicated these patients have an increase in cardiovascular events and mortality. Current recommendations for patients with adrenal incidentalomas include an overnight low-dose dexamethasone suppression test and a thorough evaluation of cardiovascular and metabolic risk factors. Further hormonal testing and close monitoring are necessary in patients with incomplete suppression. Unilateral adrenalectomy may be beneficial in cases with abnormal suppression and comorbidities related to hypercortisolemia. Prospective studies are need for a better risk stratification and tailored therapy.
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Affiliation(s)
- Guido Zavatta
- Division of Endocrinology, Department of Medical and Surgical Sciences, Alma Mater Studiorum University of Bologna, S. Orsola-Malpighi Hospital, Via Massarenti 9, Bologna 40138, Italy
| | - Guido Di Dalmazi
- Division of Endocrinology, Department of Medical and Surgical Sciences, Alma Mater Studiorum University of Bologna, S. Orsola-Malpighi Hospital, Via Massarenti 9, Bologna 40138, Italy.
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Abstract
Recent advances in the molecular pathogenesis and the natural history of Cushing's syndrome have improved the understanding of the management of this disease. The long-term efficacy of several cortisol-lowering medical treatments is currently under evaluation. However, adrenalectomy is a safe option for the treatment of patients affected by Cushing's syndrome. Unilateral adrenalectomy is the gold standard for treatment of adrenocortical adenomas associated with hypercortisolism. Bilateral adrenalectomy has been widely used in the past as definitive treatment of bilateral macronodular hyperplasia and persistent or recurrent Cushing's disease. The indication and the potential applications of this technique have been recently critically analyzed.
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Affiliation(s)
- Guido Di Dalmazi
- Division of Endocrinology, Department of Medical and Surgical Sciences, Alma Mater Studiorum University of Bologna, S. Orsola-Malpighi Hospital, Via Massarenti 9, Bologna 40138, Italy
| | - Martin Reincke
- Department of Medicine IV, Klinikum der Universität, Ludwig-Maximilians-Universität München, Ziemssenstraße 1, München 80336, Germany.
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Stratakis CA. Cyclic AMP-dependent protein kinase catalytic subunit A (PRKACA): the expected, the unexpected, and what might be next. J Pathol 2018; 244:257-259. [PMID: 29205368 DOI: 10.1002/path.5014] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2017] [Accepted: 11/10/2017] [Indexed: 12/23/2022]
Abstract
Protein kinase A (PKA) or cyclic-AMP (cAMP)-dependent kinase was among the first serine-threonine kinases to be molecularly and functionally characterized. For years, it was investigated as the enzyme that mediates cAMP functions in almost all cell systems and organisms studied to date. Despite PKA's critical role in signaling and the long history of investigations of cAMP in oncogenesis (dating back to the 1970s), it was not until relatively recently that PKA defects were found to be directly involved in tumor predisposition. First, PKA's main regulatory subunit, PRKAR1A, was found to be mutated in Carney complex, a genetic syndrome that predisposes to heart tumors (cardiac myxomas) and a variety of other lesions of the endocrine system, including the adrenal cortex, and several cancers, including liver carcinoma. Then, PKA's main catalytic subunit, PRKACA, was found to be mutated in sporadic adrenal tumors and fibrolamellar liver carcinoma. Not surprisingly, therefore, a new research study published in The Journal of Pathology showed PRKACA mutations in sporadic cardiac myxomas. The real question is what other pathologies will be found to be due to PRKACA (or other PKA subunit) defects. The possibilities abound and may show the way for a totally new class of medications that target cAMP signaling to be useful in fighting the corresponding tumors. Published 2017. This article is a U.S. Government work and is in the public domain in the USA.
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Affiliation(s)
- Constantine A Stratakis
- Eunice Kennedy Shriver National Institute of Child Health and Human Development (NICHD), NIH and Section on Endocrinology and Genetics (SEGEN), NICHD, NIH, Bethesda, USA
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Stratakis CA, Kelestimur F, Bertherat J. PDE 2015: cAMP Signaling, Protein Kinase A (PKA) and Phosphodiesterases (PDEs): How Genetics Changed the Way We Look at One of the Most Studied Signaling Pathways. Horm Metab Res 2017; 49:237-239. [PMID: 28427096 DOI: 10.1055/s-0043-106858] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
This special issue of Hormone and Metabolic Research presents the proceedings of the 4th international workshop (PDE 2015) on cyclic AMP (cAMP)/protein kinase A (PKA) signaling and phosphodiesterases (PDEs). The meeting took place at Erciyes University, in Kayseri, Turkey, (Fig. 1) and followed the previous workshops that were held in Paris, France, and in Bethesda, MD 1 2. We are indebted to the host, one of the newest and most advanced universities in Turkey, an example of how science can be inclusive and bridge not only disciplines, but also cultures. We visited the historic Cappadocia region with its rich Greek heritage, and enjoyed the local food and traditions, as well as the beautiful Ottoman architecture of Kayseri and its surroundings.
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Affiliation(s)
- Constantine A Stratakis
- Section on Endocrinology & Genetics, Program on Developmental Endocrinology & Genetics, Eunice Kennedy Shriver National Institute of Child Health & Human Development, National Institutes of Health, Bethesda, USA
| | | | - Jérôme Bertherat
- Endocrinology Department, Hôpital Cochin, AP-HP, & Institut Cochin, INSERM U1016, Université Paris Descartes, Paris, France
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