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Zhang L, Gao Y, Du Q, Liu L, Li Y, Dey SK, Banerjee S, Liao Z. Genetic Profiles and Three-year Follow-up Study of Chinese Males With Congenital Hypogonadotropic Hypogonadism. J Sex Med 2021; 18:1500-1510. [PMID: 37057435 DOI: 10.1016/j.jsxm.2021.07.001] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2020] [Revised: 06/06/2021] [Accepted: 07/06/2021] [Indexed: 11/19/2022]
Abstract
BACKGROUND The correlation between long-term treatment outcomes with genotypes in congenital hypogonadotropic hypogonadism (CHH) males is rarely reported. AIM To investigate the correlations among genotypes, phenotypes, and treatment outcomes for CHH male patients. METHODS Whole exome sequencing was performed for 73 Chinese CHH males from one academic center. Patients self-selected one of the 4 treatments: pulsatile Gonadorelin pump (PGP), cyclical gonadotropins therapy (CGT), human menopausal gonadotropin monotherapy, or testosterone replacement treatment. Clinical assessments were performed every 3 months for 3 years. OUTCOMES The pathogenicity of variants was determined. Baseline clinical features, spermatogenesis outcomes were analysed. RESULTS 62 variants were identified in 51 patients (69.9%), 17 of which were novel. Among these mutations, variants on FGFR1, PROKR2, CHD7, ANOS1 and NSMF gene were 16.1%, 16.1%, 11.3%, 8.1% and 8.1% respectively. 11 patients followed the oligogenic pattern (21.6%). All CHD7 patients had hearing impairment, or structural deformities of external/ inner ear and were diagnosed as CHARGE syndrome. 24.7% of CHH patients manifested with ear/hearing anomalies. KS patients had higher rates of cryptorchidism history and ear/hearing anomalies than normosmic CHH subjects. Male patients with PROKR2 mutations showed relatively better testicular development, less dental deformity when compared with FGFR1 mutations. About 30% normosmic patients defined by simple olfactory assessment showed olfactory nerve center (ONC) dysplasia under nasal sinus MRI examination. Among the CHH males treated with CGT or PGP, 70.2% reached spermatogenesis within 3 years of treatment. CLINICAL IMPLICATIONS No direct correlation was observed between certain responsible genes and spermatogenic outcomes. When CHH patients were identified with CHD7 variants, ear/hearing evaluation should be carefully performed. The precise assessment of ONC development was advised for normosmic CHH subjects. STRENGTHS & LIMITATIONS This study provided informative long-term treatment data of CHH male patients screened with whole exome sequencing. The limitations included small number of subgroups with multifaceted gene variants, clinical heterogeneity, uncontrolled sperm-inducing treatment method. The seventeen novel mutations worth experimental validation in the future. CONCLUSION The clinical severity is partially related with specific gene variants, and detailed individualized data and outcomes were provided. Ear/hearing anomalies were closely connected with CHD7 variants, and were common problems for CHH patients. Simple olfactory assessment underestimated the true olfactory deficit. L. Zhang, Y. Gao, Q. Du, et al. Genetic Profiles and Three-year Follow-up Study of Chinese Males With Congenital Hypogonadotropic Hypogonadism. J Sex Med 2021;XX:XXX-XXX.
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Affiliation(s)
- Luyao Zhang
- First Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
| | - Yuting Gao
- First Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
| | - Qin Du
- First Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
| | - Liyi Liu
- First Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
| | - Yanbing Li
- First Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
| | - Subrata Kumar Dey
- Department of Biotechnology, Centre for Genetic Studies, School of Biotechnology and Biological Sciences, Maulana Abul Kalam Azad University of Technology (Formerly West Bengal University of Technology), Salt Lake City Kolkata, West Bengal, India
| | - Santasree Banerjee
- Department of Genetics, College of Basic Medical Sciences, Jilin University, Changchun, China
| | - Zhihong Liao
- First Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
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Bosch i Ara L, Katugampola H, Dattani MT. Congenital Hypopituitarism During the Neonatal Period: Epidemiology, Pathogenesis, Therapeutic Options, and Outcome. Front Pediatr 2021; 8:600962. [PMID: 33634051 PMCID: PMC7902025 DOI: 10.3389/fped.2020.600962] [Citation(s) in RCA: 34] [Impact Index Per Article: 11.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/31/2020] [Accepted: 12/31/2020] [Indexed: 12/13/2022] Open
Abstract
Introduction: Congenital hypopituitarism (CH) is characterized by a deficiency of one or more pituitary hormones. The pituitary gland is a central regulator of growth, metabolism, and reproduction. The anterior pituitary produces and secretes growth hormone (GH), adrenocorticotropic hormone, thyroid-stimulating hormone, follicle-stimulating hormone, luteinizing hormone, and prolactin. The posterior pituitary hormone secretes antidiuretic hormone and oxytocin. Epidemiology: The incidence is 1 in 4,000-1 in 10,000. The majority of CH cases are sporadic; however, a small number of familial cases have been identified. In the latter, a molecular basis has frequently been identified. Between 80-90% of CH cases remain unsolved in terms of molecular genetics. Pathogenesis: Several transcription factors and signaling molecules are involved in the development of the pituitary gland. Mutations in any of these genes may result in CH including HESX1, PROP1, POU1F1, LHX3, LHX4, SOX2, SOX3, OTX2, PAX6, FGFR1, GLI2, and FGF8. Over the last 5 years, several novel genes have been identified in association with CH, but it is likely that many genes remain to be identified, as the majority of patients with CH do not have an identified mutation. Clinical manifestations: Genotype-phenotype correlations are difficult to establish. There is a high phenotypic variability associated with different genetic mutations. The clinical spectrum includes severe midline developmental disorders, hypopituitarism (in isolation or combined with other congenital abnormalities), and isolated hormone deficiencies. Diagnosis and treatment: Key investigations include MRI and baseline and dynamic pituitary function tests. However, dynamic tests of GH secretion cannot be performed in the neonatal period, and a diagnosis of GH deficiency may be based on auxology, MRI findings, and low growth factor concentrations. Once a hormone deficit is confirmed, hormone replacement should be started. If onset is acute with hypoglycaemia, cortisol deficiency should be excluded, and if identified this should be rapidly treated, as should TSH deficiency. This review aims to give an overview of CH including management of this complex condition.
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Affiliation(s)
- Laura Bosch i Ara
- Department of Paediatric Endocrinology, Great Ormond Street Hospital for Children, London, United Kingdom
| | - Harshini Katugampola
- Department of Paediatric Endocrinology, Great Ormond Street Hospital for Children, London, United Kingdom
| | - Mehul T. Dattani
- Department of Paediatric Endocrinology, Great Ormond Street Hospital for Children, London, United Kingdom
- Genetics and Genomic Medicine Programme, UCL Great Ormond Street Institute of Child Health, London, United Kingdom
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Jullien N, Saveanu A, Vergier J, Marquant E, Quentien MH, Castinetti F, Galon-Faure N, Brauner R, Marrakchi Turki Z, Tauber M, El Kholy M, Linglart A, Rodien P, Fedala NS, Bergada I, Cortet-Rudelli C, Polak M, Nicolino M, Stuckens C, Barlier A, Brue T, Reynaud R. Clinical lessons learned in constitutional hypopituitarism from two decades of experience in a large international cohort. Clin Endocrinol (Oxf) 2021; 94:277-289. [PMID: 33098107 DOI: 10.1111/cen.14355] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/10/2020] [Revised: 09/04/2020] [Accepted: 09/08/2020] [Indexed: 01/05/2023]
Abstract
CONTEXT The international GENHYPOPIT network collects phenotypical data and screens genetic causes of non-acquired hypopituitarism. AIMS To describe main phenotype patterns and their evolution through life. DESIGN Patients were screened according to their phenotype for coding sequence variations in 8 genes: HESX1, LHX3, LHX4, PROP1, POU1F1, TBX19, OTX2 and PROKR2. RESULTS Among 1213 patients (1143 index cases), the age of diagnosis of hypopituitarism was congenital (24%), in childhood (28%), at puberty (32%), in adulthood (7.2%) or not available (8.8%). Noteworthy, pituitary hormonal deficiencies kept on evolving during adulthood in 49 of patients. Growth Hormone deficiency (GHD) affected 85.8% of patients and was often the first diagnosed deficiency. AdrenoCorticoTropic Hormone deficiency rarely preceded GHD, but usually followed it by over 10 years. Pituitary Magnetic Resonance Imaging (MRI) abnormalities were common (79.7%), with 39.4% pituitary stalk interruption syndrome (PSIS). The most frequently associated extrapituitary malformations were ophthalmological abnormalities (16.1%). Prevalence of identified mutations was 7.3% of index cases (84/1143) and 29.5% in familial cases (n = 146). Genetic analysis in 449 patients without extrapituitary phenotype revealed 36 PROP1, 2 POU1F1 and 17 TBX19 mutations. CONCLUSION This large international cohort highlights atypical phenotypic presentation of constitutional hypopituitarism, such as post pubertal presentation or adult progression of hormonal deficiencies. These results justify long-term follow-up, and the need for systematic evaluation of associated abnormalities. Genetic defects were rarely identified, mainly PROP1 mutations in pure endocrine phenotypes.
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Affiliation(s)
- Nicolas Jullien
- Aix-Marseille Univ, CNRS, INP, Inst Neurophysiopathol, Marseille, France
| | - Alexandru Saveanu
- Aix-Marseille Université, Institut National de la Santé et de la Recherche Médicale (INSERM), U1251, Marseille Medical Genetics (MMG), Faculté des Sciences médicales et paramédicales, Institut Marseille Maladies Rares (MarMaRa), Marseille, France
- Department of Endocrinology, Centre de Référence des Maladies Rares de l'hypophyse HYPO, Hôpital de la Conception, Assistance Publique-Hôpitaux de Marseille (AP-HM), Marseille, France
- Centre de Référence des Maladies Rares de l'Hypophyse, CHU Conception, Assistance Publique-Hôpitaux de Marseille (APHM), Marseille, France
- Laboratory of Molecular Biology, CHU Conception, Assistance Publique-Hôpitaux de Marseille (APHM), Marseille, France
| | - Julia Vergier
- Paediatric Endocrinology Unit, Department of Paediatrics, CHU Timone Enfants, Assistance Publique-Hôpitaux de Marseille (APHM), Marseille, France
| | - Emeline Marquant
- Paediatric Endocrinology Unit, Department of Paediatrics, CHU Timone Enfants, Assistance Publique-Hôpitaux de Marseille (APHM), Marseille, France
| | - Marie Helene Quentien
- Aix-Marseille Université, Institut National de la Santé et de la Recherche Médicale (INSERM), U1251, Marseille Medical Genetics (MMG), Faculté des Sciences médicales et paramédicales, Institut Marseille Maladies Rares (MarMaRa), Marseille, France
| | - Frederic Castinetti
- Aix-Marseille Université, Institut National de la Santé et de la Recherche Médicale (INSERM), U1251, Marseille Medical Genetics (MMG), Faculté des Sciences médicales et paramédicales, Institut Marseille Maladies Rares (MarMaRa), Marseille, France
- Department of Endocrinology, Centre de Référence des Maladies Rares de l'hypophyse HYPO, Hôpital de la Conception, Assistance Publique-Hôpitaux de Marseille (AP-HM), Marseille, France
- Centre de Référence des Maladies Rares de l'Hypophyse, CHU Conception, Assistance Publique-Hôpitaux de Marseille (APHM), Marseille, France
| | - Noémie Galon-Faure
- Department of Paediatrics, Centre Hospitalier du Pays d'Aix, Aix-En-Provence, France
| | - Raja Brauner
- Fondation Ophtalmologique Adolphe de Rothschild and Université Paris Descartes, Paris, France
| | | | - Maité Tauber
- Paediatric Endocrinology Unit, Department of Paediatrics, Children Hospital, Toulouse University Hospital, Toulouse, France
| | | | - Agnès Linglart
- Paediatric Endocrinology Unit, Department of Paediatrics, Assistance Publique-Hôpitaux de Paris (AP-HP), Le Kremlin-Bicêtre, France
| | - Patrice Rodien
- Endocrinology Department, Angers University Hospital, Angers, France
| | | | - Ignacio Bergada
- Children Hospital "Ricardo Gutierrez", Bueno-Aires, Argentina
| | | | - Michel Polak
- Paediatric Endocrinology Unit, Department of Paediatrics, Hôpital Universitaire Necker Enfants Malades, Assistance Publique-Hôpitaux de Paris (AP-HP), INSERM U1016, Institut IMAGINE, Paris, France
| | - Marc Nicolino
- Paediatric Endocrinology Unit, Department of Paediatrics, Hôpital Femme-Mère-Enfant, Hospices Civils de Lyon (HCL), Bron, France
| | - Chantal Stuckens
- Department of Paediatrics, Hôpital Jeanne de Flandre, Lille University Hospital, Lille, France
| | - Anne Barlier
- Aix-Marseille Université, Institut National de la Santé et de la Recherche Médicale (INSERM), U1251, Marseille Medical Genetics (MMG), Faculté des Sciences médicales et paramédicales, Institut Marseille Maladies Rares (MarMaRa), Marseille, France
- Department of Endocrinology, Centre de Référence des Maladies Rares de l'hypophyse HYPO, Hôpital de la Conception, Assistance Publique-Hôpitaux de Marseille (AP-HM), Marseille, France
- Centre de Référence des Maladies Rares de l'Hypophyse, CHU Conception, Assistance Publique-Hôpitaux de Marseille (APHM), Marseille, France
- Laboratory of Molecular Biology, CHU Conception, Assistance Publique-Hôpitaux de Marseille (APHM), Marseille, France
| | - Thierry Brue
- Aix-Marseille Université, Institut National de la Santé et de la Recherche Médicale (INSERM), U1251, Marseille Medical Genetics (MMG), Faculté des Sciences médicales et paramédicales, Institut Marseille Maladies Rares (MarMaRa), Marseille, France
- Department of Endocrinology, Centre de Référence des Maladies Rares de l'hypophyse HYPO, Hôpital de la Conception, Assistance Publique-Hôpitaux de Marseille (AP-HM), Marseille, France
- Centre de Référence des Maladies Rares de l'Hypophyse, CHU Conception, Assistance Publique-Hôpitaux de Marseille (APHM), Marseille, France
| | - Rachel Reynaud
- Aix-Marseille Université, Institut National de la Santé et de la Recherche Médicale (INSERM), U1251, Marseille Medical Genetics (MMG), Faculté des Sciences médicales et paramédicales, Institut Marseille Maladies Rares (MarMaRa), Marseille, France
- Centre de Référence des Maladies Rares de l'Hypophyse, CHU Conception, Assistance Publique-Hôpitaux de Marseille (APHM), Marseille, France
- Paediatric Endocrinology Unit, Department of Paediatrics, CHU Timone Enfants, Assistance Publique-Hôpitaux de Marseille (APHM), Marseille, France
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Kale S, Gada JV, Jadhav S, Lila AR, Sarathi V, Budyal S, Patt H, Goroshi MR, Thadani PM, Arya S, Kamble AA, Patil VA, Acharya S, Sankhe S, Shivane V, Raghavan V, Bandgar TR, Shah NS. Genetic spectrum and predictors of mutations in four known genes in Asian Indian patients with growth hormone deficiency and orthotopic posterior pituitary: an emphasis on regional genetic diversity. Pituitary 2020; 23:701-715. [PMID: 32894409 DOI: 10.1007/s11102-020-01078-4] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
CONTEXT Regional variation in prevalence of genetic mutations in growth hormone deficiency (GHD) is known. AIM Study phenotype and prevalence of mutations in GH1, GHRHR, POU1F1, PROP1 genes in GHD cohort. METHODS One hundred and two patients {Isolated GHD (IGHD): 79; combined pituitary hormone deficiency (CPHD): 23} with orthotopic posterior pituitary were included. Auxologic, hormonal and radiological details were studied. All four genes were analysed in IGHD patients. POU1F1 and PROP1 were studied in CPHD patients. RESULTS Of 102, 19.6% were familial cases. Height SDS, mean (SD) was - 5.14 (1.63). Peak GH, median (range) was 0.47 ng/ml (0-6.59), 72.5% patients had anterior pituitary hypoplasia (APH). Twenty mutations (novel: 11) were found in 43.1% patients (n = 44, IGHD-36, CPHD-8). GHRHR mutations (n = 32, p.Glu72* = 24) were more common than GH1 mutations (n = 4) in IGHD cohort. POU1F1 mutations (n = 6) were more common than PROP1 mutations (n = 2) in CPHD cohort. With few exceptions, this prevalence pattern is contrary to most studies in world-literature. No patients with peak GH > 4 ng/ml had mutations, signifying it as negative predictor. While many parameters were significant on univariate analysis, only positive family history and lower median peak GH levels were significant predictors of mutations on multivariate analysis in IGHD patients. CONCLUSION At variance with world literature, we found reverse predominance of GHRHR over GH1 mutations, POU1F1 over PROP1 mutations and predominance of GHRHR p.Glu72* mutations thus re-affirming the regional diversity in GHD genetics. We report positive and negative predictors of mutations in GHD.
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Affiliation(s)
- Shantanu Kale
- Department of Endocrinology, Seth G.S. Medical College & KEM Hospital, Parel, Mumbai, Maharashtra, 400012, India
| | - Jugal V Gada
- Department of Endocrinology, Topiwala National Medical College and BYL Nair Hospital, Mumbai, Maharashtra, India
| | - Swati Jadhav
- Department of Endocrinology, Seth G.S. Medical College & KEM Hospital, Parel, Mumbai, Maharashtra, 400012, India
| | - Anurag R Lila
- Department of Endocrinology, Seth G.S. Medical College & KEM Hospital, Parel, Mumbai, Maharashtra, 400012, India
| | - Vijaya Sarathi
- Department of Endocrinology, Vydehi Institute of Medical Sciences and Research Center, Bangalore, Karnataka, India
| | - Sweta Budyal
- Department of Endocrinology, Seth G.S. Medical College & KEM Hospital, Parel, Mumbai, Maharashtra, 400012, India
| | - Hiren Patt
- Department of Endocrinology, Seth G.S. Medical College & KEM Hospital, Parel, Mumbai, Maharashtra, 400012, India
| | | | - Puja M Thadani
- Department of Endocrinology, Seth G.S. Medical College & KEM Hospital, Parel, Mumbai, Maharashtra, 400012, India
| | - Sneha Arya
- Department of Endocrinology, Seth G.S. Medical College & KEM Hospital, Parel, Mumbai, Maharashtra, 400012, India
| | - Aparna A Kamble
- Department of Endocrinology, Seth G.S. Medical College & KEM Hospital, Parel, Mumbai, Maharashtra, 400012, India
| | - Virendra A Patil
- Department of Endocrinology, Seth G.S. Medical College & KEM Hospital, Parel, Mumbai, Maharashtra, 400012, India.
| | - Shrikrishna Acharya
- Department of Endocrinology, K S Hegde Medical Academy, Mangalore, Karnataka, India
| | - Shilpa Sankhe
- Department of Endocrinology, Seth G.S. Medical College & KEM Hospital, Parel, Mumbai, Maharashtra, 400012, India
| | - Vyankatesh Shivane
- Department of Endocrinology, Seth G.S. Medical College & KEM Hospital, Parel, Mumbai, Maharashtra, 400012, India
| | - Vijaya Raghavan
- Department of Endocrinology, Seth G.S. Medical College & KEM Hospital, Parel, Mumbai, Maharashtra, 400012, India
| | - Tushar R Bandgar
- Department of Endocrinology, Seth G.S. Medical College & KEM Hospital, Parel, Mumbai, Maharashtra, 400012, India
| | - Nalini S Shah
- Department of Endocrinology, Seth G.S. Medical College & KEM Hospital, Parel, Mumbai, Maharashtra, 400012, India
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Gregory LC, Dattani MT. The Molecular Basis of Congenital Hypopituitarism and Related Disorders. J Clin Endocrinol Metab 2020; 105:5614788. [PMID: 31702014 DOI: 10.1210/clinem/dgz184] [Citation(s) in RCA: 25] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/10/2019] [Accepted: 11/07/2019] [Indexed: 12/23/2022]
Abstract
CONTEXT Congenital hypopituitarism (CH) is characterized by the presence of deficiencies in one or more of the 6 anterior pituitary (AP) hormones secreted from the 5 different specialized cell types of the AP. During human embryogenesis, hypothalamo-pituitary (HP) development is controlled by a complex spatio-temporal genetic cascade of transcription factors and signaling molecules within the hypothalamus and Rathke's pouch, the primordium of the AP. EVIDENCE ACQUISITION This mini-review discusses the genes and pathways involved in HP development and how mutations of these give rise to CH. This may present in the neonatal period or later on in childhood and may be associated with craniofacial midline structural abnormalities such as cleft lip/palate, visual impairment due to eye abnormalities such as optic nerve hypoplasia (ONH) and microphthalmia or anophthalmia, or midline forebrain neuroradiological defects including agenesis of the septum pellucidum or corpus callosum or the more severe holoprosencephaly. EVIDENCE SYNTHESIS Mutations give rise to an array of highly variable disorders ranging in severity. There are many known causative genes in HP developmental pathways that are routinely screened in CH patients; however, over the last 5 years this list has rapidly increased due to the identification of variants in new genes and pathways of interest by next-generation sequencing. CONCLUSION The majority of patients with these disorders do not have an identified molecular basis, often making management challenging. This mini-review aims to guide clinicians in making a genetic diagnosis based on patient phenotype, which in turn may impact on clinical management.
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Affiliation(s)
- Louise Cheryl Gregory
- Genetics and Genomic Medicine Research and Teaching Department, UCL Great Ormond Street Institute of Child Health, London, United Kingdom
| | - Mehul Tulsidas Dattani
- Genetics and Genomic Medicine Research and Teaching Department, UCL Great Ormond Street Institute of Child Health, London, United Kingdom
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Abstract
The development of the anterior pituitary gland occurs in distinct sequential developmental steps, leading to the formation of a complex organ containing five different cell types secreting six different hormones. During this process, the temporal and spatial expression of a cascade of signaling molecules and transcription factors plays a crucial role in organ commitment, cell proliferation, patterning, and terminal differentiation. The morphogenesis of the gland and the emergence of distinct cell types from a common primordium are governed by complex regulatory networks involving transcription factors and signaling molecules that may be either intrinsic to the developing pituitary or extrinsic, originating from the ventral diencephalon, the oral ectoderm, and the surrounding mesenchyme. Endocrine cells of the pituitary gland are organized into structural and functional networks that contribute to the coordinated response of endocrine cells to stimuli; these cellular networks are formed during embryonic development and are maintained or may be modified in adulthood, contributing to the plasticity of the gland. Abnormalities in any of the steps of pituitary development may lead to congenital hypopituitarism that includes a spectrum of disorders from isolated to combined hormone deficiencies including syndromic disorders such as septo-optic dysplasia. Over the past decade, the acceleration of next-generation sequencing has allowed for rapid analysis of the patient genome to identify novel mutations and novel candidate genes associated with hypothalmo-pituitary development. Subsequent functional analysis using patient fibroblast cells, and the generation of stem cells derived from patient cells, is fast replacing the need for animal models while providing a more physiologically relevant characterization of novel mutations. Furthermore, CRISPR-Cas9 as the method for gene editing is replacing previous laborious and time-consuming gene editing methods that were commonly used, thus yielding knockout cell lines in a fraction of the time. © 2020 American Physiological Society. Compr Physiol 10:389-413, 2020.
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Affiliation(s)
- Kyriaki S Alatzoglou
- Genetics and Genomic Medicine Programme, UCL Great Ormond Street Institute of Child Health, University College London (UCL), London, UK
| | - Louise C Gregory
- Genetics and Genomic Medicine Programme, UCL Great Ormond Street Institute of Child Health, University College London (UCL), London, UK
| | - Mehul T Dattani
- Genetics and Genomic Medicine Programme, UCL Great Ormond Street Institute of Child Health, University College London (UCL), London, UK
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Patti G, Guzzeti C, Di Iorgi N, Maria Allegri AE, Napoli F, Loche S, Maghnie M. Central adrenal insufficiency in children and adolescents. Best Pract Res Clin Endocrinol Metab 2018; 32:425-444. [PMID: 30086867 DOI: 10.1016/j.beem.2018.03.012] [Citation(s) in RCA: 32] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
Central adrenal insufficiency (CAI) is a life-threatening condition caused by either pituitary disease (secondary adrenal insufficiency) or impaired hypothalamic function with inadequate CRH production (tertiary adrenal insufficiency). ACTH deficiency may be isolated or, more frequently, occur in conjunction with other pituitary hormone deficiencies and midline defects. Genetic mutations of the TBX19 causing isolated CAI are rare but a number of genes encoding transcription factors involved in hypothalamic-pituitary gland development, as well as other genes including POMC and PC1, are associated with ACTH deficiency. CAI is frequently identified in congenital, malformative, genetic, and epigenetic syndromes as well as in several acquired conditions of different etiologies. The signs and symptoms vary considerably and depend on the age of onset and the number and severity of associated pituitary defects. They may include hypoglycemia, lethargy, apnea, poor feeding, prolonged cholestatic jaundice, jitteriness, seizures, and sepsis in the neonate, or nonspecific signs such as fatigue, hypotension, vomiting and hyponatremia without hyperkalemia in children. The diagnosis of CAI relies on the measurement of morning cortisol concentrations along with dynamic test for cortisol release with different stimulating agents. Early recognition of CAI and its correct management are mandatory in order to avoid both morbidity and mortality in affected neonates, children and adolescents.
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Affiliation(s)
- Giuseppa Patti
- Departments of Pediatrics, Istituto Giannina Gaslini, University of Genova, Genova, Italy
| | - Chiara Guzzeti
- SSD Endocrinologia Pediatrica, Ospedale Pediatrico Microcitemico "A. Cao", AO Brotzu, Cagliari, Italy
| | - Natascia Di Iorgi
- Departments of Pediatrics, Istituto Giannina Gaslini, University of Genova, Genova, Italy
| | | | - Flavia Napoli
- Departments of Pediatrics, Istituto Giannina Gaslini, University of Genova, Genova, Italy
| | - Sandro Loche
- SSD Endocrinologia Pediatrica, Ospedale Pediatrico Microcitemico "A. Cao", AO Brotzu, Cagliari, Italy
| | - Mohamad Maghnie
- Departments of Pediatrics, Istituto Giannina Gaslini, University of Genova, Genova, Italy.
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Pérez Millán MI, Vishnopolska SA, Daly AZ, Bustamante JP, Seilicovich A, Bergadá I, Braslavsky D, Keselman AC, Lemons RM, Mortensen AH, Marti MA, Camper SA, Kitzman JO. Next generation sequencing panel based on single molecule molecular inversion probes for detecting genetic variants in children with hypopituitarism. Mol Genet Genomic Med 2018; 6:514-525. [PMID: 29739035 PMCID: PMC6081231 DOI: 10.1002/mgg3.395] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2017] [Revised: 02/20/2018] [Accepted: 03/09/2018] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Congenital Hypopituitarism is caused by genetic and environmental factors. Over 30 genes have been implicated in isolated and/or combined pituitary hormone deficiency. The etiology remains unknown for up to 80% of the patients, but most cases have been analyzed by limited candidate gene screening. Mutations in the PROP1 gene are the most common known cause, and the frequency of mutations in this gene varies greatly by ethnicity. We designed a custom array to assess the frequency of mutations in known hypopituitarism genes and new candidates, using single molecule molecular inversion probes sequencing (smMIPS). METHODS We used this panel for the first systematic screening for causes of hypopituitarism in children. Molecular inversion probes were designed to capture 693 coding exons of 30 known genes and 37 candidate genes. We captured genomic DNA from 51 pediatric patients with CPHD (n = 43) or isolated GH deficiency (IGHD) (n = 8) and their parents and conducted next generation sequencing. RESULTS We obtained deep coverage over targeted regions and demonstrated accurate variant detection by comparison to whole-genome sequencing in a control individual. We found a dominant mutation GH1, p.R209H, in a three-generation pedigree with IGHD. CONCLUSIONS smMIPS is an efficient and inexpensive method to detect mutations in patients with hypopituitarism, drastically limiting the need for screening individual genes by Sanger sequencing.
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Affiliation(s)
- María I. Pérez Millán
- Institute of Biomedical Investigations (INBIOMED‐UBA‐CONICET)University of Buenos AiresBuenos AiresArgentina
| | - Sebastian A. Vishnopolska
- Department of Biological Chemistry (IQUIBICEN‐UBA‐CONICET)Faculty of Exact and Natural SciencesUniversity of Buenos AiresBuenos AiresArgentina
| | | | - Juan P. Bustamante
- Department of Biological Chemistry (IQUIBICEN‐UBA‐CONICET)Faculty of Exact and Natural SciencesUniversity of Buenos AiresBuenos AiresArgentina
| | - Adriana Seilicovich
- Institute of Biomedical Investigations (INBIOMED‐UBA‐CONICET)University of Buenos AiresBuenos AiresArgentina
| | - Ignacio Bergadá
- División de EndocrinologíaHospital de Niños Ricardo GutiérrezCentro de Investigaciones Endocrinológicas ‘Dr César Bergadá’ (CEDIE) CONICET – FEIBuenos AiresArgentina
| | - Débora Braslavsky
- División de EndocrinologíaHospital de Niños Ricardo GutiérrezCentro de Investigaciones Endocrinológicas ‘Dr César Bergadá’ (CEDIE) CONICET – FEIBuenos AiresArgentina
| | - Ana C. Keselman
- División de EndocrinologíaHospital de Niños Ricardo GutiérrezCentro de Investigaciones Endocrinológicas ‘Dr César Bergadá’ (CEDIE) CONICET – FEIBuenos AiresArgentina
| | | | | | - Marcelo A. Marti
- Department of Biological Chemistry (IQUIBICEN‐UBA‐CONICET)Faculty of Exact and Natural SciencesUniversity of Buenos AiresBuenos AiresArgentina
| | - Sally A. Camper
- Department of Human GeneticsUniversity of MichiganAnn ArborMIUSA
| | - Jacob O. Kitzman
- Department of Human GeneticsUniversity of MichiganAnn ArborMIUSA
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9
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Brue T, Saveanu A, Jullien N, Fauquier T, Castinetti F, Enjalbert A, Barlier A, Reynaud R. Lessons from monogenic causes of growth hormone deficiency. ANNALES D'ENDOCRINOLOGIE 2017; 78:77-79. [DOI: 10.1016/j.ando.2017.04.001] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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10
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Shimada A, Takagi M, Nagashima Y, Miyai K, Hasegawa Y. A Novel Mutation in OTX2 Causes Combined Pituitary Hormone Deficiency, Bilateral Microphthalmia, and Agenesis of the Left Internal Carotid Artery. Horm Res Paediatr 2017; 86:62-9. [PMID: 27299576 DOI: 10.1159/000446280] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/25/2015] [Accepted: 04/15/2016] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Mutations in OTX2 cause hypopituitarism, ranging from isolated growth hormone deficiency to combined pituitary hormone deficiency (CPHD), which are commonly detected in association with severe eye abnormalities, including anophthalmia or microphthalmia. Pituitary phenotypes of OTX2 mutation carriers are highly variable; however, ACTH deficiency during the neonatal period is not common in previous reports. OBJECTIVE We report a novel missense OTX2 (R89P) mutation in a CPHD patient with severe hypoglycemia in the neonatal period due to ACTH deficiency, bilateral microphthalmia, and agenesis of the left internal carotid artery (ICA). RESULTS We identified a novel heterozygous mutation in OTX2 (c.266G>C, p.R89P). R89P OTX2 showed markedly reduced transcriptional activity of HESX1 and POU1F1 reporters compared with wild-type OTX2. A dominant negative effect was noted only in the transcription analysis with POU1F1 promoter. Electrophoretic mobility shift assay experiments showed that R89P OTX2 abrogated DNA-binding ability. CONCLUSION OTX2 mutations can cause ACTH deficiency in the neonatal period. Our study also shows that OTX2 mutations are associated with agenesis of the ICA. To the best of our knowledge, this is the first report of a transcription factor gene mutation, which was identified due to agenesis of the ICA of a patient with CPHD. This study extends our understanding of the phenotypic features, molecular mechanism, and developmental course associated with mutations in OTX2.
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11
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Cohen E, Maghnie M, Collot N, Leger J, Dastot F, Polak M, Rose S, Touraine P, Duquesnoy P, Tauber M, Copin B, Bertrand AM, Brioude F, Larizza D, Edouard T, González Briceño L, Netchine I, Oliver-Petit I, Sobrier ML, Amselem S, Legendre M. Contribution of LHX4 Mutations to Pituitary Deficits in a Cohort of 417 Unrelated Patients. J Clin Endocrinol Metab 2017; 102:290-301. [PMID: 27820671 DOI: 10.1210/jc.2016-3158] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/01/2016] [Accepted: 11/04/2016] [Indexed: 11/19/2022]
Abstract
CONTEXT LHX4 encodes a LIM-homeodomain transcription factor that is implicated in early pituitary development. In humans, only 13 heterozygous LHX4 mutations have been associated with congenital hypopituitarism. OBJECTIVE The aims of this study were to evaluate the prevalence of LHX4 mutations in patients with hypopituitarism, to define the associated phenotypes, and to characterize the functional impact of the identified variants and the respective role of the 2 LIM domains of LHX4. DESIGN AND PATIENTS We screened 417 unrelated patients with isolated growth hormone deficiency or combined pituitary hormone deficiency associated with ectopic posterior pituitary and/or sella turcica anomalies for LHX4 mutations (Sanger sequencing). In vitro studies were performed to assess the functional consequences of the identified variants. RESULTS We identified 7 heterozygous variations, including p.(Tyr131*), p.(Arg48Thrfs*104), c.606+1G>T, p.Arg65Val, p.Thr163Pro, p.Arg221Gln, and p.Arg235Gln), that were associated with variable expressivity; 5 of the 7 were also associated with incomplete penetrance. The p.(Tyr131*), p.(Arg48Thrfs*104), p.Ala65Val, p.Thr163Pro, and p.Arg221Gln LHX4 variants are unable to transactivate the POU1F1 and GH promoters. As suggested by transactivation, subcellular localization, and protein-protein interaction studies, p.Arg235Gln is probably a rare polymorphism. Coimmunoprecipitation studies identified LHX3 as a potential protein partner of LHX4. As revealed by functional studies of LIM-defective recombinant LHX4 proteins, the LIM1 and LIM2 domains are not redundant. CONCLUSION This study, performed in the largest cohort of patients screened so far for LHX4 mutations, describes 6 disease-causing mutations that are responsible for congenital hypopituitarism. LHX4 mutations were found to be associated with variable expressivity, and most of them with incomplete penetrance; their contribution to pituitary deficits that are associated with an ectopic posterior pituitary and/or a sella turcica defect is ∼1.4% in the 417 probands tested.
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Affiliation(s)
- Enzo Cohen
- Sorbonne Universités, Université Pierre et Marie Curie, Université Paris 06, Unité Mixte de Recherche S933, F-75012, Paris, France
- INSERM, Unité Mixte de Recherche S933, F-75012, Paris, France
| | - Mohamad Maghnie
- Pediatrics, Istituto di Ricovero e Cura a Carattere Scientifico G. Gaslini, University of Genoa, I-16147, Genoa, Italy
| | - Nathalie Collot
- Assistance Publique-Hôpitaux de Paris, Hôpital Trousseau, Service de Génétique et d'Embryologie Médicales, F-75012, Paris, France
| | - Juliane Leger
- Assistance Publique-Hôpitaux de Paris, Hôpital Robert Debré, Service d'Endocrinologie Pédiatrique, F-75019, Paris, France
| | - Florence Dastot
- Assistance Publique-Hôpitaux de Paris, Hôpital Trousseau, Service de Génétique et d'Embryologie Médicales, F-75012, Paris, France
| | - Michel Polak
- Assistance Publique-Hôpitaux de Paris, Hôpital Necker, Service d'Endocrinologie Pédiatrique, F-75015, Paris, France
| | - Sophie Rose
- Assistance Publique-Hôpitaux de Paris, Hôpital Trousseau, Service de Génétique et d'Embryologie Médicales, F-75012, Paris, France
| | - Philippe Touraine
- Assistance Publique-Hôpitaux de Paris, Hôpital Pitié Salpêtrière, Service d'Endocrinologie Pédiatrique, F-75013, Paris, France
| | | | - Maïté Tauber
- Centre Hospitalier Universitaire de Toulouse, Hôpital des Enfants, Service d'Endocrinologie et Génétique, F-70000, Toulouse, France
| | - Bruno Copin
- INSERM, Unité Mixte de Recherche S933, F-75012, Paris, France
- Assistance Publique-Hôpitaux de Paris, Hôpital Trousseau, Service de Génétique et d'Embryologie Médicales, F-75012, Paris, France
| | - Anne-Marie Bertrand
- Centre Hospitalier Universitaire de Besançon, Service de Pédiatrie Endocrinologie, F-25000, Besançon, France
| | - Frederic Brioude
- Assistance Publique-Hôpitaux de Paris, Hôpital Trousseau, Explorations Fonctionnelles Endocriniennes, F-75012, Paris, France
| | - Daniela Larizza
- Pediatric Endocrinology Unit, Department of Maternal and Children's Health, Istituto di Ricovero e Cura a Carattere Scientifico Policlinico San Matteo Pavia and Department of Internal Medicine, University of Pavia, I-27100, Pavia, Italy
| | - Thomas Edouard
- Centre Hospitalier Universitaire de Toulouse, Hôpital des Enfants, Service d'Endocrinologie et Génétique, F-70000, Toulouse, France
| | - Laura González Briceño
- Assistance Publique-Hôpitaux de Paris, Hôpital Necker, Service d'Endocrinologie Pédiatrique, F-75015, Paris, France
| | - Irène Netchine
- Assistance Publique-Hôpitaux de Paris, Hôpital Trousseau, Explorations Fonctionnelles Endocriniennes, F-75012, Paris, France
| | - Isabelle Oliver-Petit
- Centre Hospitalier Universitaire de Toulouse, Hôpital des Enfants, Service d'Endocrinologie et Génétique, F-70000, Toulouse, France
| | | | - Serge Amselem
- Sorbonne Universités, Université Pierre et Marie Curie, Université Paris 06, Unité Mixte de Recherche S933, F-75012, Paris, France
- INSERM, Unité Mixte de Recherche S933, F-75012, Paris, France
- Assistance Publique-Hôpitaux de Paris, Hôpital Trousseau, Service de Génétique et d'Embryologie Médicales, F-75012, Paris, France
| | - Marie Legendre
- INSERM, Unité Mixte de Recherche S933, F-75012, Paris, France
- Assistance Publique-Hôpitaux de Paris, Hôpital Trousseau, Service de Génétique et d'Embryologie Médicales, F-75012, Paris, France
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12
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Fang Q, George AS, Brinkmeier ML, Mortensen AH, Gergics P, Cheung LYM, Daly AZ, Ajmal A, Pérez Millán MI, Ozel AB, Kitzman JO, Mills RE, Li JZ, Camper SA. Genetics of Combined Pituitary Hormone Deficiency: Roadmap into the Genome Era. Endocr Rev 2016; 37:636-675. [PMID: 27828722 PMCID: PMC5155665 DOI: 10.1210/er.2016-1101] [Citation(s) in RCA: 107] [Impact Index Per Article: 13.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/19/2016] [Accepted: 10/31/2016] [Indexed: 02/08/2023]
Abstract
The genetic basis for combined pituitary hormone deficiency (CPHD) is complex, involving 30 genes in a variety of syndromic and nonsyndromic presentations. Molecular diagnosis of this disorder is valuable for predicting disease progression, avoiding unnecessary surgery, and family planning. We expect that the application of high throughput sequencing will uncover additional contributing genes and eventually become a valuable tool for molecular diagnosis. For example, in the last 3 years, six new genes have been implicated in CPHD using whole-exome sequencing. In this review, we present a historical perspective on gene discovery for CPHD and predict approaches that may facilitate future gene identification projects conducted by clinicians and basic scientists. Guidelines for systematic reporting of genetic variants and assigning causality are emerging. We apply these guidelines retrospectively to reports of the genetic basis of CPHD and summarize modes of inheritance and penetrance for each of the known genes. In recent years, there have been great improvements in databases of genetic information for diverse populations. Some issues remain that make molecular diagnosis challenging in some cases. These include the inherent genetic complexity of this disorder, technical challenges like uneven coverage, differing results from variant calling and interpretation pipelines, the number of tolerated genetic alterations, and imperfect methods for predicting pathogenicity. We discuss approaches for future research in the genetics of CPHD.
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Affiliation(s)
- Qing Fang
- Department of Human Genetics (Q.F., A.S.G., M.L.B., A.H.M., P.G., L.Y.M.C., A.Z.D., M.I.P.M., A.B.O., J.O.K., R.E.M., J.Z.L., S.A.C.), Graduate Program in Bioinformatics (A.S.G.), Endocrine Division, Department of Internal Medicine (A.A.), and Department of Computational Medicine and Bioinformatics (J.O.K., R.E.M., J.Z.L.), University of Michigan, Ann Arbor, Michigan 48109
| | - Akima S George
- Department of Human Genetics (Q.F., A.S.G., M.L.B., A.H.M., P.G., L.Y.M.C., A.Z.D., M.I.P.M., A.B.O., J.O.K., R.E.M., J.Z.L., S.A.C.), Graduate Program in Bioinformatics (A.S.G.), Endocrine Division, Department of Internal Medicine (A.A.), and Department of Computational Medicine and Bioinformatics (J.O.K., R.E.M., J.Z.L.), University of Michigan, Ann Arbor, Michigan 48109
| | - Michelle L Brinkmeier
- Department of Human Genetics (Q.F., A.S.G., M.L.B., A.H.M., P.G., L.Y.M.C., A.Z.D., M.I.P.M., A.B.O., J.O.K., R.E.M., J.Z.L., S.A.C.), Graduate Program in Bioinformatics (A.S.G.), Endocrine Division, Department of Internal Medicine (A.A.), and Department of Computational Medicine and Bioinformatics (J.O.K., R.E.M., J.Z.L.), University of Michigan, Ann Arbor, Michigan 48109
| | - Amanda H Mortensen
- Department of Human Genetics (Q.F., A.S.G., M.L.B., A.H.M., P.G., L.Y.M.C., A.Z.D., M.I.P.M., A.B.O., J.O.K., R.E.M., J.Z.L., S.A.C.), Graduate Program in Bioinformatics (A.S.G.), Endocrine Division, Department of Internal Medicine (A.A.), and Department of Computational Medicine and Bioinformatics (J.O.K., R.E.M., J.Z.L.), University of Michigan, Ann Arbor, Michigan 48109
| | - Peter Gergics
- Department of Human Genetics (Q.F., A.S.G., M.L.B., A.H.M., P.G., L.Y.M.C., A.Z.D., M.I.P.M., A.B.O., J.O.K., R.E.M., J.Z.L., S.A.C.), Graduate Program in Bioinformatics (A.S.G.), Endocrine Division, Department of Internal Medicine (A.A.), and Department of Computational Medicine and Bioinformatics (J.O.K., R.E.M., J.Z.L.), University of Michigan, Ann Arbor, Michigan 48109
| | - Leonard Y M Cheung
- Department of Human Genetics (Q.F., A.S.G., M.L.B., A.H.M., P.G., L.Y.M.C., A.Z.D., M.I.P.M., A.B.O., J.O.K., R.E.M., J.Z.L., S.A.C.), Graduate Program in Bioinformatics (A.S.G.), Endocrine Division, Department of Internal Medicine (A.A.), and Department of Computational Medicine and Bioinformatics (J.O.K., R.E.M., J.Z.L.), University of Michigan, Ann Arbor, Michigan 48109
| | - Alexandre Z Daly
- Department of Human Genetics (Q.F., A.S.G., M.L.B., A.H.M., P.G., L.Y.M.C., A.Z.D., M.I.P.M., A.B.O., J.O.K., R.E.M., J.Z.L., S.A.C.), Graduate Program in Bioinformatics (A.S.G.), Endocrine Division, Department of Internal Medicine (A.A.), and Department of Computational Medicine and Bioinformatics (J.O.K., R.E.M., J.Z.L.), University of Michigan, Ann Arbor, Michigan 48109
| | - Adnan Ajmal
- Department of Human Genetics (Q.F., A.S.G., M.L.B., A.H.M., P.G., L.Y.M.C., A.Z.D., M.I.P.M., A.B.O., J.O.K., R.E.M., J.Z.L., S.A.C.), Graduate Program in Bioinformatics (A.S.G.), Endocrine Division, Department of Internal Medicine (A.A.), and Department of Computational Medicine and Bioinformatics (J.O.K., R.E.M., J.Z.L.), University of Michigan, Ann Arbor, Michigan 48109
| | - María Ines Pérez Millán
- Department of Human Genetics (Q.F., A.S.G., M.L.B., A.H.M., P.G., L.Y.M.C., A.Z.D., M.I.P.M., A.B.O., J.O.K., R.E.M., J.Z.L., S.A.C.), Graduate Program in Bioinformatics (A.S.G.), Endocrine Division, Department of Internal Medicine (A.A.), and Department of Computational Medicine and Bioinformatics (J.O.K., R.E.M., J.Z.L.), University of Michigan, Ann Arbor, Michigan 48109
| | - A Bilge Ozel
- Department of Human Genetics (Q.F., A.S.G., M.L.B., A.H.M., P.G., L.Y.M.C., A.Z.D., M.I.P.M., A.B.O., J.O.K., R.E.M., J.Z.L., S.A.C.), Graduate Program in Bioinformatics (A.S.G.), Endocrine Division, Department of Internal Medicine (A.A.), and Department of Computational Medicine and Bioinformatics (J.O.K., R.E.M., J.Z.L.), University of Michigan, Ann Arbor, Michigan 48109
| | - Jacob O Kitzman
- Department of Human Genetics (Q.F., A.S.G., M.L.B., A.H.M., P.G., L.Y.M.C., A.Z.D., M.I.P.M., A.B.O., J.O.K., R.E.M., J.Z.L., S.A.C.), Graduate Program in Bioinformatics (A.S.G.), Endocrine Division, Department of Internal Medicine (A.A.), and Department of Computational Medicine and Bioinformatics (J.O.K., R.E.M., J.Z.L.), University of Michigan, Ann Arbor, Michigan 48109
| | - Ryan E Mills
- Department of Human Genetics (Q.F., A.S.G., M.L.B., A.H.M., P.G., L.Y.M.C., A.Z.D., M.I.P.M., A.B.O., J.O.K., R.E.M., J.Z.L., S.A.C.), Graduate Program in Bioinformatics (A.S.G.), Endocrine Division, Department of Internal Medicine (A.A.), and Department of Computational Medicine and Bioinformatics (J.O.K., R.E.M., J.Z.L.), University of Michigan, Ann Arbor, Michigan 48109
| | - Jun Z Li
- Department of Human Genetics (Q.F., A.S.G., M.L.B., A.H.M., P.G., L.Y.M.C., A.Z.D., M.I.P.M., A.B.O., J.O.K., R.E.M., J.Z.L., S.A.C.), Graduate Program in Bioinformatics (A.S.G.), Endocrine Division, Department of Internal Medicine (A.A.), and Department of Computational Medicine and Bioinformatics (J.O.K., R.E.M., J.Z.L.), University of Michigan, Ann Arbor, Michigan 48109
| | - Sally A Camper
- Department of Human Genetics (Q.F., A.S.G., M.L.B., A.H.M., P.G., L.Y.M.C., A.Z.D., M.I.P.M., A.B.O., J.O.K., R.E.M., J.Z.L., S.A.C.), Graduate Program in Bioinformatics (A.S.G.), Endocrine Division, Department of Internal Medicine (A.A.), and Department of Computational Medicine and Bioinformatics (J.O.K., R.E.M., J.Z.L.), University of Michigan, Ann Arbor, Michigan 48109
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13
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Castinetti F, Reynaud R, Saveanu A, Jullien N, Quentien MH, Rochette C, Barlier A, Enjalbert A, Brue T. MECHANISMS IN ENDOCRINOLOGY: An update in the genetic aetiologies of combined pituitary hormone deficiency. Eur J Endocrinol 2016; 174:R239-47. [PMID: 26733480 DOI: 10.1530/eje-15-1095] [Citation(s) in RCA: 40] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/06/2015] [Accepted: 01/05/2016] [Indexed: 01/08/2023]
Abstract
Over the last 5 years, new actors involved in the pathogenesis of combined pituitary hormone deficiency in humans have been reported: they included a member of the immunoglobulin superfamily glycoprotein and ciliary G protein-coupled receptors, as well as new transcription factors and signalling molecules. New modes of inheritance for alterations of genes encoding transcription factors have also been described. Finally, actors known to be involved in a very specific phenotype (hypogonadotroph hypogonadism for instance) have been identified in a wider range of phenotypes. These data thus suggest that new mechanisms could explain the low rate of aetiological identification in this heterogeneous group of diseases. Taking into account the fact that several reviews have been published in recent years on classical aetiologies of CPHD such as mutations of POU1F1 or PROP1, we focused the present overview on the data published in the last 5 years, to provide the reader with an updated review on this rapidly evolving field of knowledge.
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Affiliation(s)
- Frederic Castinetti
- Aix-Marseille UniversitéCNRS, Centre de Recherche en Neurobiologie et Neurophysiologie de Marseille CRN2M UMR 7286, 13344 cedex 15 Marseille, FranceDepartment of EndocrinologyAPHM, Hôpital La Conception, Service d'Endocrinologie, Diabète et Maladies Métaboliques, 13385 cedex 5 Marseille, FranceCentre de Référence des Maladies Rares d'Origine Hypophysaire DEFHY13385 cedex 15 Marseille, FranceAPHMHôpital Timone Enfants, Service de Pédiatrie Multidisciplinaire, 13385 cedex 5 Marseille, FranceAPHMHôpital de la Conception, Laboratoire de Biologie Moléculaire, 13005 Marseille, France Aix-Marseille UniversitéCNRS, Centre de Recherche en Neurobiologie et Neurophysiologie de Marseille CRN2M UMR 7286, 13344 cedex 15 Marseille, FranceDepartment of EndocrinologyAPHM, Hôpital La Conception, Service d'Endocrinologie, Diabète et Maladies Métaboliques, 13385 cedex 5 Marseille, FranceCentre de Référence des Maladies Rares d'Origine Hypophysaire DEFHY13385 cedex 15 Marseille, FranceAPHMHôpital Timone Enfants, Service de Pédiatrie Multidisciplinaire, 13385 cedex 5 Marseille, FranceAPHMHôpital de la Conception, Laboratoire de Biologie Moléculaire, 13005 Marseille, France Aix-Marseille UniversitéCNRS, Centre de Recherche en Neurobiologie et Neurophysiologie de Marseille CRN2M UMR 7286, 13344 cedex 15 Marseille, FranceDepartment of EndocrinologyAPHM, Hôpital La Conception, Service d'Endocrinologie, Diabète et Maladies Métaboliques, 13385 cedex 5 Marseille, FranceCentre de Référence des Maladies Rares d'Origine Hypophysaire DEFHY13385 cedex 15 Marseille, FranceAPHMHôpital Timone Enfants, Service de Pédiatrie Multidisciplinaire, 13385 cedex 5 Marseille, FranceAPHMHôpital de la Conception, Laboratoire de Biologie Moléculaire, 13005 Marseille, France
| | - Rachel Reynaud
- Aix-Marseille UniversitéCNRS, Centre de Recherche en Neurobiologie et Neurophysiologie de Marseille CRN2M UMR 7286, 13344 cedex 15 Marseille, FranceDepartment of EndocrinologyAPHM, Hôpital La Conception, Service d'Endocrinologie, Diabète et Maladies Métaboliques, 13385 cedex 5 Marseille, FranceCentre de Référence des Maladies Rares d'Origine Hypophysaire DEFHY13385 cedex 15 Marseille, FranceAPHMHôpital Timone Enfants, Service de Pédiatrie Multidisciplinaire, 13385 cedex 5 Marseille, FranceAPHMHôpital de la Conception, Laboratoire de Biologie Moléculaire, 13005 Marseille, France Aix-Marseille UniversitéCNRS, Centre de Recherche en Neurobiologie et Neurophysiologie de Marseille CRN2M UMR 7286, 13344 cedex 15 Marseille, FranceDepartment of EndocrinologyAPHM, Hôpital La Conception, Service d'Endocrinologie, Diabète et Maladies Métaboliques, 13385 cedex 5 Marseille, FranceCentre de Référence des Maladies Rares d'Origine Hypophysaire DEFHY13385 cedex 15 Marseille, FranceAPHMHôpital Timone Enfants, Service de Pédiatrie Multidisciplinaire, 13385 cedex 5 Marseille, FranceAPHMHôpital de la Conception, Laboratoire de Biologie Moléculaire, 13005 Marseille, France Aix-Marseille UniversitéCNRS, Centre de Recherche en Neurobiologie et Neurophysiologie de Marseille CRN2M UMR 7286, 13344 cedex 15 Marseille, FranceDepartment of EndocrinologyAPHM, Hôpital La Conception, Service d'Endocrinologie, Diabète et Maladies Métaboliques, 13385 cedex 5 Marseille, FranceCentre de Référence des Maladies Rares d'Origine Hypophysaire DEFHY13385 cedex 15 Marseille, FranceAPHMHôpital Timone Enfants, Service de Pédiatrie Multidisciplinaire, 13385 cedex 5 Marseille, FranceAPHMHôpital de la Conception, Laboratoire de Biologie Moléculaire, 13005 Marseille, France
| | - Alexandru Saveanu
- Aix-Marseille UniversitéCNRS, Centre de Recherche en Neurobiologie et Neurophysiologie de Marseille CRN2M UMR 7286, 13344 cedex 15 Marseille, FranceDepartment of EndocrinologyAPHM, Hôpital La Conception, Service d'Endocrinologie, Diabète et Maladies Métaboliques, 13385 cedex 5 Marseille, FranceCentre de Référence des Maladies Rares d'Origine Hypophysaire DEFHY13385 cedex 15 Marseille, FranceAPHMHôpital Timone Enfants, Service de Pédiatrie Multidisciplinaire, 13385 cedex 5 Marseille, FranceAPHMHôpital de la Conception, Laboratoire de Biologie Moléculaire, 13005 Marseille, France Aix-Marseille UniversitéCNRS, Centre de Recherche en Neurobiologie et Neurophysiologie de Marseille CRN2M UMR 7286, 13344 cedex 15 Marseille, FranceDepartment of EndocrinologyAPHM, Hôpital La Conception, Service d'Endocrinologie, Diabète et Maladies Métaboliques, 13385 cedex 5 Marseille, FranceCentre de Référence des Maladies Rares d'Origine Hypophysaire DEFHY13385 cedex 15 Marseille, FranceAPHMHôpital Timone Enfants, Service de Pédiatrie Multidisciplinaire, 13385 cedex 5 Marseille, FranceAPHMHôpital de la Conception, Laboratoire de Biologie Moléculaire, 13005 Marseille, France Aix-Marseille UniversitéCNRS, Centre de Recherche en Neurobiologie et Neurophysiologie de Marseille CRN2M UMR 7286, 13344 cedex 15 Marseille, FranceDepartment of EndocrinologyAPHM, Hôpital La Conception, Service d'Endocrinologie, Diabète et Maladies Métaboliques, 13385 cedex 5 Marseille, FranceCentre de Référence des Maladies Rares d'Origine Hypophysaire DEFHY13385 cedex 15 Marseille, FranceAPHMHôpital Timone Enfants, Service de Pédiatrie Multidisciplinaire, 13385 cedex 5 Marseille, FranceAPHMHôpital de la Conception, Laboratoire de Biologie Moléculaire, 13005 Marseille, France Aix-Marseille UniversitéCNRS, Centre de Recherche en Neurobiologie et Neurophysiologie de Marseille CRN2M UMR 7286, 13344 cedex 15 Marseille, FranceDepartment of EndocrinologyAPHM, Hôpital La Conception, Service d
| | - Nicolas Jullien
- Aix-Marseille UniversitéCNRS, Centre de Recherche en Neurobiologie et Neurophysiologie de Marseille CRN2M UMR 7286, 13344 cedex 15 Marseille, FranceDepartment of EndocrinologyAPHM, Hôpital La Conception, Service d'Endocrinologie, Diabète et Maladies Métaboliques, 13385 cedex 5 Marseille, FranceCentre de Référence des Maladies Rares d'Origine Hypophysaire DEFHY13385 cedex 15 Marseille, FranceAPHMHôpital Timone Enfants, Service de Pédiatrie Multidisciplinaire, 13385 cedex 5 Marseille, FranceAPHMHôpital de la Conception, Laboratoire de Biologie Moléculaire, 13005 Marseille, France
| | - Marie Helene Quentien
- Aix-Marseille UniversitéCNRS, Centre de Recherche en Neurobiologie et Neurophysiologie de Marseille CRN2M UMR 7286, 13344 cedex 15 Marseille, FranceDepartment of EndocrinologyAPHM, Hôpital La Conception, Service d'Endocrinologie, Diabète et Maladies Métaboliques, 13385 cedex 5 Marseille, FranceCentre de Référence des Maladies Rares d'Origine Hypophysaire DEFHY13385 cedex 15 Marseille, FranceAPHMHôpital Timone Enfants, Service de Pédiatrie Multidisciplinaire, 13385 cedex 5 Marseille, FranceAPHMHôpital de la Conception, Laboratoire de Biologie Moléculaire, 13005 Marseille, France
| | - Claire Rochette
- Aix-Marseille UniversitéCNRS, Centre de Recherche en Neurobiologie et Neurophysiologie de Marseille CRN2M UMR 7286, 13344 cedex 15 Marseille, FranceDepartment of EndocrinologyAPHM, Hôpital La Conception, Service d'Endocrinologie, Diabète et Maladies Métaboliques, 13385 cedex 5 Marseille, FranceCentre de Référence des Maladies Rares d'Origine Hypophysaire DEFHY13385 cedex 15 Marseille, FranceAPHMHôpital Timone Enfants, Service de Pédiatrie Multidisciplinaire, 13385 cedex 5 Marseille, FranceAPHMHôpital de la Conception, Laboratoire de Biologie Moléculaire, 13005 Marseille, France Aix-Marseille UniversitéCNRS, Centre de Recherche en Neurobiologie et Neurophysiologie de Marseille CRN2M UMR 7286, 13344 cedex 15 Marseille, FranceDepartment of EndocrinologyAPHM, Hôpital La Conception, Service d'Endocrinologie, Diabète et Maladies Métaboliques, 13385 cedex 5 Marseille, FranceCentre de Référence des Maladies Rares d'Origine Hypophysaire DEFHY13385 cedex 15 Marseille, FranceAPHMHôpital Timone Enfants, Service de Pédiatrie Multidisciplinaire, 13385 cedex 5 Marseille, FranceAPHMHôpital de la Conception, Laboratoire de Biologie Moléculaire, 13005 Marseille, France Aix-Marseille UniversitéCNRS, Centre de Recherche en Neurobiologie et Neurophysiologie de Marseille CRN2M UMR 7286, 13344 cedex 15 Marseille, FranceDepartment of EndocrinologyAPHM, Hôpital La Conception, Service d'Endocrinologie, Diabète et Maladies Métaboliques, 13385 cedex 5 Marseille, FranceCentre de Référence des Maladies Rares d'Origine Hypophysaire DEFHY13385 cedex 15 Marseille, FranceAPHMHôpital Timone Enfants, Service de Pédiatrie Multidisciplinaire, 13385 cedex 5 Marseille, FranceAPHMHôpital de la Conception, Laboratoire de Biologie Moléculaire, 13005 Marseille, France
| | - Anne Barlier
- Aix-Marseille UniversitéCNRS, Centre de Recherche en Neurobiologie et Neurophysiologie de Marseille CRN2M UMR 7286, 13344 cedex 15 Marseille, FranceDepartment of EndocrinologyAPHM, Hôpital La Conception, Service d'Endocrinologie, Diabète et Maladies Métaboliques, 13385 cedex 5 Marseille, FranceCentre de Référence des Maladies Rares d'Origine Hypophysaire DEFHY13385 cedex 15 Marseille, FranceAPHMHôpital Timone Enfants, Service de Pédiatrie Multidisciplinaire, 13385 cedex 5 Marseille, FranceAPHMHôpital de la Conception, Laboratoire de Biologie Moléculaire, 13005 Marseille, France Aix-Marseille UniversitéCNRS, Centre de Recherche en Neurobiologie et Neurophysiologie de Marseille CRN2M UMR 7286, 13344 cedex 15 Marseille, FranceDepartment of EndocrinologyAPHM, Hôpital La Conception, Service d'Endocrinologie, Diabète et Maladies Métaboliques, 13385 cedex 5 Marseille, FranceCentre de Référence des Maladies Rares d'Origine Hypophysaire DEFHY13385 cedex 15 Marseille, FranceAPHMHôpital Timone Enfants, Service de Pédiatrie Multidisciplinaire, 13385 cedex 5 Marseille, FranceAPHMHôpital de la Conception, Laboratoire de Biologie Moléculaire, 13005 Marseille, France Aix-Marseille UniversitéCNRS, Centre de Recherche en Neurobiologie et Neurophysiologie de Marseille CRN2M UMR 7286, 13344 cedex 15 Marseille, FranceDepartment of EndocrinologyAPHM, Hôpital La Conception, Service d'Endocrinologie, Diabète et Maladies Métaboliques, 13385 cedex 5 Marseille, FranceCentre de Référence des Maladies Rares d'Origine Hypophysaire DEFHY13385 cedex 15 Marseille, FranceAPHMHôpital Timone Enfants, Service de Pédiatrie Multidisciplinaire, 13385 cedex 5 Marseille, FranceAPHMHôpital de la Conception, Laboratoire de Biologie Moléculaire, 13005 Marseille, France Aix-Marseille UniversitéCNRS, Centre de Recherche en Neurobiologie et Neurophysiologie de Marseille CRN2M UMR 7286, 13344 cedex 15 Marseille, FranceDepartment of EndocrinologyAPHM, Hôpital La Conception, Service d
| | - Alain Enjalbert
- Aix-Marseille UniversitéCNRS, Centre de Recherche en Neurobiologie et Neurophysiologie de Marseille CRN2M UMR 7286, 13344 cedex 15 Marseille, FranceDepartment of EndocrinologyAPHM, Hôpital La Conception, Service d'Endocrinologie, Diabète et Maladies Métaboliques, 13385 cedex 5 Marseille, FranceCentre de Référence des Maladies Rares d'Origine Hypophysaire DEFHY13385 cedex 15 Marseille, FranceAPHMHôpital Timone Enfants, Service de Pédiatrie Multidisciplinaire, 13385 cedex 5 Marseille, FranceAPHMHôpital de la Conception, Laboratoire de Biologie Moléculaire, 13005 Marseille, France Aix-Marseille UniversitéCNRS, Centre de Recherche en Neurobiologie et Neurophysiologie de Marseille CRN2M UMR 7286, 13344 cedex 15 Marseille, FranceDepartment of EndocrinologyAPHM, Hôpital La Conception, Service d'Endocrinologie, Diabète et Maladies Métaboliques, 13385 cedex 5 Marseille, FranceCentre de Référence des Maladies Rares d'Origine Hypophysaire DEFHY13385 cedex 15 Marseille, FranceAPHMHôpital Timone Enfants, Service de Pédiatrie Multidisciplinaire, 13385 cedex 5 Marseille, FranceAPHMHôpital de la Conception, Laboratoire de Biologie Moléculaire, 13005 Marseille, France Aix-Marseille UniversitéCNRS, Centre de Recherche en Neurobiologie et Neurophysiologie de Marseille CRN2M UMR 7286, 13344 cedex 15 Marseille, FranceDepartment of EndocrinologyAPHM, Hôpital La Conception, Service d'Endocrinologie, Diabète et Maladies Métaboliques, 13385 cedex 5 Marseille, FranceCentre de Référence des Maladies Rares d'Origine Hypophysaire DEFHY13385 cedex 15 Marseille, FranceAPHMHôpital Timone Enfants, Service de Pédiatrie Multidisciplinaire, 13385 cedex 5 Marseille, FranceAPHMHôpital de la Conception, Laboratoire de Biologie Moléculaire, 13005 Marseille, France
| | - Thierry Brue
- Aix-Marseille UniversitéCNRS, Centre de Recherche en Neurobiologie et Neurophysiologie de Marseille CRN2M UMR 7286, 13344 cedex 15 Marseille, FranceDepartment of EndocrinologyAPHM, Hôpital La Conception, Service d'Endocrinologie, Diabète et Maladies Métaboliques, 13385 cedex 5 Marseille, FranceCentre de Référence des Maladies Rares d'Origine Hypophysaire DEFHY13385 cedex 15 Marseille, FranceAPHMHôpital Timone Enfants, Service de Pédiatrie Multidisciplinaire, 13385 cedex 5 Marseille, FranceAPHMHôpital de la Conception, Laboratoire de Biologie Moléculaire, 13005 Marseille, France Aix-Marseille UniversitéCNRS, Centre de Recherche en Neurobiologie et Neurophysiologie de Marseille CRN2M UMR 7286, 13344 cedex 15 Marseille, FranceDepartment of EndocrinologyAPHM, Hôpital La Conception, Service d'Endocrinologie, Diabète et Maladies Métaboliques, 13385 cedex 5 Marseille, FranceCentre de Référence des Maladies Rares d'Origine Hypophysaire DEFHY13385 cedex 15 Marseille, FranceAPHMHôpital Timone Enfants, Service de Pédiatrie Multidisciplinaire, 13385 cedex 5 Marseille, FranceAPHMHôpital de la Conception, Laboratoire de Biologie Moléculaire, 13005 Marseille, France Aix-Marseille UniversitéCNRS, Centre de Recherche en Neurobiologie et Neurophysiologie de Marseille CRN2M UMR 7286, 13344 cedex 15 Marseille, FranceDepartment of EndocrinologyAPHM, Hôpital La Conception, Service d'Endocrinologie, Diabète et Maladies Métaboliques, 13385 cedex 5 Marseille, FranceCentre de Référence des Maladies Rares d'Origine Hypophysaire DEFHY13385 cedex 15 Marseille, FranceAPHMHôpital Timone Enfants, Service de Pédiatrie Multidisciplinaire, 13385 cedex 5 Marseille, FranceAPHMHôpital de la Conception, Laboratoire de Biologie Moléculaire, 13005 Marseille, France
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14
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De Rienzo F, Mellone S, Bellone S, Babu D, Fusco I, Prodam F, Petri A, Muniswamy R, De Luca F, Salerno M, Momigliano-Richardi P, Bona G, Giordano M. Frequency of genetic defects in combined pituitary hormone deficiency: a systematic review and analysis of a multicentre Italian cohort. Clin Endocrinol (Oxf) 2015; 83:849-60. [PMID: 26147833 DOI: 10.1111/cen.12849] [Citation(s) in RCA: 54] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/16/2015] [Revised: 03/22/2015] [Accepted: 07/02/2015] [Indexed: 01/16/2023]
Abstract
OBJECTIVE Combined pituitary hormonal deficiency (CPHD) can result from mutations within genes that encode transcription factors. This study evaluated the frequency of mutations in these genes in a cohort of 144 unrelated Italian patients with CPHD and estimated the overall prevalence of mutations across different populations using a systematic literature review. MATERIAL AND METHODS A multicentre study of adult and paediatric patients with CPHD was performed. The PROP1, POU1F1, HESX1, LHX3 and LHX4 genes were analysed for the presence of mutations using direct sequencing. We systematically searched PubMed with no date restrictions for studies that reported genetic screening of CPHD cohorts. We only considered genetic screenings with at least 10 individuals. Data extraction was conducted in accordance with the guidelines set by the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA). RESULTS Global mutation frequency in Italian patients with CPHD was 2·9% (4/136) in sporadic cases and 12·5% (1/8) in familial cases. The worldwide mutation frequency for the five genes calculated from 21 studies was 12·4%, which ranged from 11·2% in sporadic to 63% in familial cases. PROP1 was the most frequently mutated gene in sporadic (6·7%) and familial cases (48·5%). CONCLUSION The frequency of defects in genes encoding pituitary transcription factors is quite low in Italian patients with CPHD and other western European countries, especially in sporadic patients. The decision of which genes should be tested and in which order should be guided by hormonal and imaging phenotype, the presence of extrapituitary abnormalities and the frequency of mutation for each gene in the patient-referring population.
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Affiliation(s)
- Francesca De Rienzo
- Unit of Paediatrics, Department of Health Sciences, University of Eastern Piedmont, Novara, Italy
| | - Simona Mellone
- Laboratory of Genetics, Department of Health Sciences, University of Eastern Piedmont and IRCAD, Novara, Italy
| | - Simonetta Bellone
- Unit of Paediatrics, Department of Health Sciences, University of Eastern Piedmont, Novara, Italy
| | - Deepak Babu
- Laboratory of Genetics, Department of Health Sciences, University of Eastern Piedmont and IRCAD, Novara, Italy
| | - Ileana Fusco
- Laboratory of Genetics, Department of Health Sciences, University of Eastern Piedmont and IRCAD, Novara, Italy
| | - Flavia Prodam
- Unit of Paediatrics, Department of Health Sciences, University of Eastern Piedmont, Novara, Italy
| | - Antonella Petri
- Unit of Paediatrics, Department of Health Sciences, University of Eastern Piedmont, Novara, Italy
| | - Ranjith Muniswamy
- Laboratory of Genetics, Department of Health Sciences, University of Eastern Piedmont and IRCAD, Novara, Italy
| | - Filippo De Luca
- Department of Paediatrics, University of Messina, Messina, Italy
| | - Mariacarolina Salerno
- Paediatric Section, Department of Translational Medical Sciences, Federico II University, Naples, Italy
| | | | - Gianni Bona
- Unit of Paediatrics, Department of Health Sciences, University of Eastern Piedmont, Novara, Italy
| | - Mara Giordano
- Laboratory of Genetics, Department of Health Sciences, University of Eastern Piedmont and IRCAD, Novara, Italy
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15
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Mao J, Xu H, Wang X, Huang B, Liu Z, Zhen J, Nie M, Min L, Wu X. Congenital combined pituitary hormone deficiency patients have better responses to gonadotrophin-induced spermatogenesis than idiopathic hypogonadotropic hypogonadism patients. Hum Reprod 2015; 30:2031-7. [PMID: 26141714 DOI: 10.1093/humrep/dev158] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2015] [Accepted: 06/04/2015] [Indexed: 12/18/2022] Open
Abstract
STUDY QUESTION Do patients with congenital combined pituitary hormone deficiency (CCPHD) have different responses to gonadotrophin-induced spermatogenesis compared with those with idiopathic hypogonadotropic hypogonadism (IHH)? SUMMARY ANSWER CCPHD patients have a better response to gonadotrophin therapy than IHH patients. WHAT IS KNOWN ALREADY Gonadotrophins are effective in inducing spermatogenesis in patients with hypogonadotropic hypogonadism. DESIGN, SIZE AND DURATION This retrospective cohort study included 75 patients, 53 of whom had IHH and 22 CCPHD. They were diagnosed, treated and followed up between January 2008 and December 2013. PARTICIPANTS/MATERIALS, SETTING AND METHODS Combined gonadotrophin therapy, consisting of human chorionic gonadotrophin and human menopausal gonadotrophin, was administered for 24 months. The success rate of spermatogenesis (≥1 sperm in ejaculate), serum total testosterone level, testicle size and sperm concentration during the treatment, as well as the first time sperm were detected in the ejaculate, were compared between the two diagnostic groups. All patients were treated in Peking Union Medical College Hospital. MAIN RESULTS AND THE ROLE OF CHANCE Spermatogenesis was successfully induced in 85% of IHH patients and 100% of CCPHD patients after 24-month combined gonadotrophin treatment (P = 0.03). In comparison with IHH, CCPHD patients had larger mean testicle sizes during the gonadotrophin treatment at 6, 12, 18 and 24 months (all P < 0.05). The initial time for sperm appearance in IHH group (n = 45) and CCPHD group (n = 22) was 13.2 ± 5.9 versus 10.4 ± 3.8 months (P = 0.045). Generally, CCPHD patients had higher sperm counts [median (quartiles)] than IHH patients during the treatment, but the difference was only statistically significant at 12 months of treatment, 3.3 (1.8, 12.0) versus 1.0 (0.0, 4.6) million/ml, P = 0.001. There was a higher level of serum total testosterone [mean (SD)] in the CCPHD group than the IHH group (676 ± 245 versus 555 ± 209 ng/dl, P = 0.035). LIMITATIONS, REASONS FOR CAUTION First, the inherent nature of a retrospective designed study was a main shortcoming. Secondly, pathological gene mutations in IHH and CCPHD patients should be further investigated. Clarification of the underlying mechanisms between cryptorchidism and mutated genes may provide more information for the divergent therapeutic responses between two groups. Only a minority of patients were actively seeking to have children so information about fertility is limited. WIDER IMPLICATIONS OF THE FINDINGS CCPHD patients had a lower incidence of cryptorchidism and a better response to gonadotrophin therapy than IHH patients, reflecting multiple defects on the different levels of reproduction axis in IHH. Furthermore, growth hormone is not indispensable for spermatogenesis in CCPHD patients. STUDY FUNDING/COMPETING INTERESTS The study was supported by Natural Science Foundation of China (No: 81100416). None of the authors has any conflicts of interest to declare.
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Affiliation(s)
- Jiangfeng Mao
- Key Laboratory of Endocrinology, Ministry of Health, Department of Endocrinology, Peking Union Medical College Hospital, Beijing 100730, China
| | - Hongli Xu
- Key Laboratory of Endocrinology, Ministry of Health, Department of Endocrinology, Peking Union Medical College Hospital, Beijing 100730, China
| | - Xi Wang
- Key Laboratory of Endocrinology, Ministry of Health, Department of Endocrinology, Peking Union Medical College Hospital, Beijing 100730, China
| | - Bingkun Huang
- Key Laboratory of Endocrinology, Ministry of Health, Department of Endocrinology, Peking Union Medical College Hospital, Beijing 100730, China
| | - Zhaoxiang Liu
- Key Laboratory of Endocrinology, Ministry of Health, Department of Endocrinology, Peking Union Medical College Hospital, Beijing 100730, China
| | - Junjie Zhen
- Key Laboratory of Endocrinology, Ministry of Health, Department of Endocrinology, Peking Union Medical College Hospital, Beijing 100730, China
| | - Min Nie
- Key Laboratory of Endocrinology, Ministry of Health, Department of Endocrinology, Peking Union Medical College Hospital, Beijing 100730, China
| | - Le Min
- Division of Endocrinology, Diabetes, and Hypertension, Brigham and Women's Hospital, Harvard Medical School, Boston, MA 02115, USA
| | - Xueyan Wu
- Key Laboratory of Endocrinology, Ministry of Health, Department of Endocrinology, Peking Union Medical College Hospital, Beijing 100730, China
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16
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Gregory LC, Humayun KN, Turton JPG, McCabe MJ, Rhodes SJ, Dattani MT. Novel Lethal Form of Congenital Hypopituitarism Associated With the First Recessive LHX4 Mutation. J Clin Endocrinol Metab 2015; 100:2158-64. [PMID: 25871839 PMCID: PMC4454798 DOI: 10.1210/jc.2014-4484] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
BACKGROUND LHX4 encodes a member of the LIM-homeodomain family of transcription factors that is required for normal development of the pituitary gland. To date, only incompletely penetrant heterozygous mutations in LHX4 have been described in patients with variable combined pituitary hormone deficiencies. OBJECTIVE/HYPOTHESIS To report a unique family with a novel recessive variant in LHX4 associated with a lethal form of congenital hypopituitarism that was identified through screening a total of 97 patients. METHOD We screened 97 unrelated patients with combined pituitary hormone deficiency, including 65% with an ectopic posterior pituitary, for variants in the LHX4 gene using Sanger sequencing. Control databases (1000 Genomes, dbSNP, Exome Variant Server, ExAC Browser) were consulted upon identification of variants. RESULTS We identified the first novel homozygous missense variant (c.377C>T, p.T126M) in two deceased male patients of Pakistani origin with severe panhypopituitarism associated with anterior pituitary aplasia and posterior pituitary ectopia. Both were born small for gestational age with a small phallus, undescended testes, and mid-facial hypoplasia. The parents' first-born child was a female with mid-facial hypoplasia (DNA was unavailable). Despite rapid commencement of hydrocortisone and T4 in the brothers, all three children died within the first week of life. The LHX4(p.T126M) variant is located within the LIM2 domain, in a highly conserved location. The absence of homozygosity for the variant in over 65 000 controls suggests that it is likely to be responsible for the phenotype. CONCLUSION We report, for the first time to our knowledge, a novel homozygous mutation in LHX4 associated with a lethal phenotype, implying that recessive mutations in LHX4 may be incompatible with life.
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Affiliation(s)
- L C Gregory
- Developmental Endocrinology Research Group (L.C.G., J.P.G.T., M.J.M., M.T.D.), Genetics and Epigenetics in Health and Disease Unit, Genetic and Genomic Medicine Programme, UCL Institute of Child Health, London WC1N 1EH, United Kingdom; Department of Pediatrics and Child Health (K.N.H.), Aga Khan University, Karachi 74800, Pakistan; and Department of Biology (S.J.R.), Indiana University-Purdue University Indianapolis, Indianapolis, Indiana 46202
| | - K N Humayun
- Developmental Endocrinology Research Group (L.C.G., J.P.G.T., M.J.M., M.T.D.), Genetics and Epigenetics in Health and Disease Unit, Genetic and Genomic Medicine Programme, UCL Institute of Child Health, London WC1N 1EH, United Kingdom; Department of Pediatrics and Child Health (K.N.H.), Aga Khan University, Karachi 74800, Pakistan; and Department of Biology (S.J.R.), Indiana University-Purdue University Indianapolis, Indianapolis, Indiana 46202
| | - J P G Turton
- Developmental Endocrinology Research Group (L.C.G., J.P.G.T., M.J.M., M.T.D.), Genetics and Epigenetics in Health and Disease Unit, Genetic and Genomic Medicine Programme, UCL Institute of Child Health, London WC1N 1EH, United Kingdom; Department of Pediatrics and Child Health (K.N.H.), Aga Khan University, Karachi 74800, Pakistan; and Department of Biology (S.J.R.), Indiana University-Purdue University Indianapolis, Indianapolis, Indiana 46202
| | - M J McCabe
- Developmental Endocrinology Research Group (L.C.G., J.P.G.T., M.J.M., M.T.D.), Genetics and Epigenetics in Health and Disease Unit, Genetic and Genomic Medicine Programme, UCL Institute of Child Health, London WC1N 1EH, United Kingdom; Department of Pediatrics and Child Health (K.N.H.), Aga Khan University, Karachi 74800, Pakistan; and Department of Biology (S.J.R.), Indiana University-Purdue University Indianapolis, Indianapolis, Indiana 46202
| | - S J Rhodes
- Developmental Endocrinology Research Group (L.C.G., J.P.G.T., M.J.M., M.T.D.), Genetics and Epigenetics in Health and Disease Unit, Genetic and Genomic Medicine Programme, UCL Institute of Child Health, London WC1N 1EH, United Kingdom; Department of Pediatrics and Child Health (K.N.H.), Aga Khan University, Karachi 74800, Pakistan; and Department of Biology (S.J.R.), Indiana University-Purdue University Indianapolis, Indianapolis, Indiana 46202
| | - M T Dattani
- Developmental Endocrinology Research Group (L.C.G., J.P.G.T., M.J.M., M.T.D.), Genetics and Epigenetics in Health and Disease Unit, Genetic and Genomic Medicine Programme, UCL Institute of Child Health, London WC1N 1EH, United Kingdom; Department of Pediatrics and Child Health (K.N.H.), Aga Khan University, Karachi 74800, Pakistan; and Department of Biology (S.J.R.), Indiana University-Purdue University Indianapolis, Indianapolis, Indiana 46202
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17
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Rochette C, Jullien N, Saveanu A, Caldagues E, Bergada I, Braslavsky D, Pfeifer M, Reynaud R, Herman JP, Barlier A, Brue T, Enjalbert A, Castinetti F. Identifying the Deleterious Effect of Rare LHX4 Allelic Variants, a Challenging Issue. PLoS One 2015; 10:e0126648. [PMID: 25955177 PMCID: PMC4425544 DOI: 10.1371/journal.pone.0126648] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2015] [Accepted: 04/06/2015] [Indexed: 11/18/2022] Open
Abstract
LHX4 is a LIM homeodomain transcription factor involved in the early steps of pituitary ontogenesis. To date, 8 heterozygous LHX4 mutations have been reported as responsible of combined pituitary hormone deficiency (CPHD) in Humans. We identified 4 new LHX4 heterozygous allelic variants in patients with congenital hypopituitarism: W204X, delK242, N271S and Q346R. Our objective was to determine the role of LHX4 variants in patients’ phenotypes. Heterologous HEK293T cells were transfected with plasmids encoding for wild-type or mutant LHX4. Protein expression was analysed by Western Blot, and DNA binding by electro-mobility shift assay experiments. Target promoters of LHX4 were cotransfected with wild type or mutant LHX4 to test the transactivating abilities of each variant. Our results show that the W204X mutation was associated with early GH and TSH deficiencies and later onset ACTH deficiency. It led to a truncated protein unable to bind to alpha-Gsu promoter binding consensus sequence. W204X was not able to activate target promoters in vitro. Cotransfection experiments did not favour a dominant negative effect. In contrast, all other mutants were able to bind the promoters and led to an activation similar as that observed with wild type LHX4, suggesting that they were likely polymorphisms. To conclude, our study underlines the need for functional in vitro studies to ascertain the role of rare allelic variants of LHX4 in disease phenotypes. It supports the causative role of the W204X mutation in CPHD and adds up childhood onset ACTH deficiency to the clinical spectrum of the various phenotypes related to LHX4 mutations.
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Affiliation(s)
- Claire Rochette
- Aix Marseille University, CNRS UMR7286, CRN2M, Faculté de médecine, Marseille, France and Reference Center for Rare Pituitary Diseases DEFHY, La Timone Hospital, Marseille, France
| | - Nicolas Jullien
- Aix Marseille University, CNRS UMR7286, CRN2M, Faculté de médecine, Marseille, France and Reference Center for Rare Pituitary Diseases DEFHY, La Timone Hospital, Marseille, France
| | - Alexandru Saveanu
- Aix Marseille University, CNRS UMR7286, CRN2M, Faculté de médecine, Marseille, France and Reference Center for Rare Pituitary Diseases DEFHY, La Timone Hospital, Marseille, France
- Laboratory of Molecular Endocrinology, La Conception Hospital, Assistance Publique Hôpitaux de Marseille, Marseille, France
| | | | - Ignacio Bergada
- Centro de Investigaciones Endocrinologicas (CEDIE) « Dr. César Bergada » Division de Endocrinologia, Hospital de Ninos Ricardo Guttierrez, Buenos Aires, Argentina
| | - Debora Braslavsky
- Centro de Investigaciones Endocrinologicas (CEDIE) « Dr. César Bergada » Division de Endocrinologia, Hospital de Ninos Ricardo Guttierrez, Buenos Aires, Argentina
| | - Marija Pfeifer
- Univ med center Ljubjana, Department Endocrinology, Zaloska 7, Ljubjana, Slovenia
| | - Rachel Reynaud
- Aix Marseille University, CNRS UMR7286, CRN2M, Faculté de médecine, Marseille, France and Reference Center for Rare Pituitary Diseases DEFHY, La Timone Hospital, Marseille, France
| | - Jean-Paul Herman
- Aix Marseille University, CNRS UMR7286, CRN2M, Faculté de médecine, Marseille, France and Reference Center for Rare Pituitary Diseases DEFHY, La Timone Hospital, Marseille, France
| | - Anne Barlier
- Aix Marseille University, CNRS UMR7286, CRN2M, Faculté de médecine, Marseille, France and Reference Center for Rare Pituitary Diseases DEFHY, La Timone Hospital, Marseille, France
- Laboratory of Molecular Endocrinology, La Conception Hospital, Assistance Publique Hôpitaux de Marseille, Marseille, France
| | - Thierry Brue
- Aix Marseille University, CNRS UMR7286, CRN2M, Faculté de médecine, Marseille, France and Reference Center for Rare Pituitary Diseases DEFHY, La Timone Hospital, Marseille, France
| | - Alain Enjalbert
- Aix Marseille University, CNRS UMR7286, CRN2M, Faculté de médecine, Marseille, France and Reference Center for Rare Pituitary Diseases DEFHY, La Timone Hospital, Marseille, France
- Laboratory of Molecular Endocrinology, La Conception Hospital, Assistance Publique Hôpitaux de Marseille, Marseille, France
| | - Frederic Castinetti
- Aix Marseille University, CNRS UMR7286, CRN2M, Faculté de médecine, Marseille, France and Reference Center for Rare Pituitary Diseases DEFHY, La Timone Hospital, Marseille, France
- * E-mail:
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Takagi M, Nagasaki K, Fujiwara I, Ishii T, Amano N, Asakura Y, Muroya K, Hasegawa Y, Adachi M, Hasegawa T. Heterozygous defects in PAX6 gene and congenital hypopituitarism. Eur J Endocrinol 2015; 172:37-45. [PMID: 25342853 DOI: 10.1530/eje-14-0255] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
BACKGROUND The prevalence of congenital hypopituitarism (CH) attributable to known transcription factor mutations appears to be rare and other causative genes for CH remain to be identified. Due to the sporadic occurrence of CH, de novo chromosomal rearrangements could be one of the molecular mechanisms participating in its etiology, especially in syndromic cases. OBJECTIVE To identify the role of copy number variations (CNVs) in the etiology of CH and to identify novel genes implicated in CH. SUBJECTS AND METHODS We enrolled 88 (syndromic: 30; non-syndromic: 58) Japanese CH patients. We performed an array comparative genomic hybridization screening in the 30 syndromic CH patients. For all the 88 patients, we analyzed PAX6 by PCR-based sequencing. RESULTS We identified one heterozygous 310-kb deletion of the PAX6 enhancer region in one patient showing isolated GH deficiency (IGHD), cleft palate, and optic disc cupping. We also identified one heterozygous 6.5-Mb deletion encompassing OTX2 in a patient with bilateral anophthalmia and multiple pituitary hormone deficiency. We identified a novel PAX6 mutation, namely p.N116S in one non-syndromic CH patient showing IGHD. The p.N116S PAX6 was associated with an impairment of the transactivation capacities of the PAX6-binding elements. CONCLUSIONS This study showed that heterozygous PAX6 mutations are associated with CH patients. PAX6 mutations may be associated with diverse clinical features ranging from severely impaired ocular and pituitary development to apparently normal phenotype. Overall, this study identified causative CNVs with a possible role in the etiology of CH in <10% of syndromic CH patients.
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Affiliation(s)
- Masaki Takagi
- Department of Endocrinology and MetabolismTokyo Metropolitan Children's Medical Center, Tokyo, JapanDepartment of PediatricsSchool of Medicine, Keio University, 35 Shinanomachi, Shinjuku-ku, Tokyo 160-8582, JapanDivision of PediatricsDepartment of Homeostatic Regulation and Development, Graduate School of Medicine and Dental Sciences, Niigata University, Niigata, JapanDepartment of PediatricsSchool of Medicine, Tohoku University, Miyagi, JapanDepartment of Endocrinology and MetabolismKanagawa Children's Medical Center, Yokohama, Japan Department of Endocrinology and MetabolismTokyo Metropolitan Children's Medical Center, Tokyo, JapanDepartment of PediatricsSchool of Medicine, Keio University, 35 Shinanomachi, Shinjuku-ku, Tokyo 160-8582, JapanDivision of PediatricsDepartment of Homeostatic Regulation and Development, Graduate School of Medicine and Dental Sciences, Niigata University, Niigata, JapanDepartment of PediatricsSchool of Medicine, Tohoku University, Miyagi, JapanDepartment of Endocrinology and MetabolismKanagawa Children's Medical Center, Yokohama, Japan
| | - Keisuke Nagasaki
- Department of Endocrinology and MetabolismTokyo Metropolitan Children's Medical Center, Tokyo, JapanDepartment of PediatricsSchool of Medicine, Keio University, 35 Shinanomachi, Shinjuku-ku, Tokyo 160-8582, JapanDivision of PediatricsDepartment of Homeostatic Regulation and Development, Graduate School of Medicine and Dental Sciences, Niigata University, Niigata, JapanDepartment of PediatricsSchool of Medicine, Tohoku University, Miyagi, JapanDepartment of Endocrinology and MetabolismKanagawa Children's Medical Center, Yokohama, Japan
| | - Ikuma Fujiwara
- Department of Endocrinology and MetabolismTokyo Metropolitan Children's Medical Center, Tokyo, JapanDepartment of PediatricsSchool of Medicine, Keio University, 35 Shinanomachi, Shinjuku-ku, Tokyo 160-8582, JapanDivision of PediatricsDepartment of Homeostatic Regulation and Development, Graduate School of Medicine and Dental Sciences, Niigata University, Niigata, JapanDepartment of PediatricsSchool of Medicine, Tohoku University, Miyagi, JapanDepartment of Endocrinology and MetabolismKanagawa Children's Medical Center, Yokohama, Japan
| | - Tomohiro Ishii
- Department of Endocrinology and MetabolismTokyo Metropolitan Children's Medical Center, Tokyo, JapanDepartment of PediatricsSchool of Medicine, Keio University, 35 Shinanomachi, Shinjuku-ku, Tokyo 160-8582, JapanDivision of PediatricsDepartment of Homeostatic Regulation and Development, Graduate School of Medicine and Dental Sciences, Niigata University, Niigata, JapanDepartment of PediatricsSchool of Medicine, Tohoku University, Miyagi, JapanDepartment of Endocrinology and MetabolismKanagawa Children's Medical Center, Yokohama, Japan
| | - Naoko Amano
- Department of Endocrinology and MetabolismTokyo Metropolitan Children's Medical Center, Tokyo, JapanDepartment of PediatricsSchool of Medicine, Keio University, 35 Shinanomachi, Shinjuku-ku, Tokyo 160-8582, JapanDivision of PediatricsDepartment of Homeostatic Regulation and Development, Graduate School of Medicine and Dental Sciences, Niigata University, Niigata, JapanDepartment of PediatricsSchool of Medicine, Tohoku University, Miyagi, JapanDepartment of Endocrinology and MetabolismKanagawa Children's Medical Center, Yokohama, Japan
| | - Yumi Asakura
- Department of Endocrinology and MetabolismTokyo Metropolitan Children's Medical Center, Tokyo, JapanDepartment of PediatricsSchool of Medicine, Keio University, 35 Shinanomachi, Shinjuku-ku, Tokyo 160-8582, JapanDivision of PediatricsDepartment of Homeostatic Regulation and Development, Graduate School of Medicine and Dental Sciences, Niigata University, Niigata, JapanDepartment of PediatricsSchool of Medicine, Tohoku University, Miyagi, JapanDepartment of Endocrinology and MetabolismKanagawa Children's Medical Center, Yokohama, Japan
| | - Koji Muroya
- Department of Endocrinology and MetabolismTokyo Metropolitan Children's Medical Center, Tokyo, JapanDepartment of PediatricsSchool of Medicine, Keio University, 35 Shinanomachi, Shinjuku-ku, Tokyo 160-8582, JapanDivision of PediatricsDepartment of Homeostatic Regulation and Development, Graduate School of Medicine and Dental Sciences, Niigata University, Niigata, JapanDepartment of PediatricsSchool of Medicine, Tohoku University, Miyagi, JapanDepartment of Endocrinology and MetabolismKanagawa Children's Medical Center, Yokohama, Japan
| | - Yukihiro Hasegawa
- Department of Endocrinology and MetabolismTokyo Metropolitan Children's Medical Center, Tokyo, JapanDepartment of PediatricsSchool of Medicine, Keio University, 35 Shinanomachi, Shinjuku-ku, Tokyo 160-8582, JapanDivision of PediatricsDepartment of Homeostatic Regulation and Development, Graduate School of Medicine and Dental Sciences, Niigata University, Niigata, JapanDepartment of PediatricsSchool of Medicine, Tohoku University, Miyagi, JapanDepartment of Endocrinology and MetabolismKanagawa Children's Medical Center, Yokohama, Japan
| | - Masanori Adachi
- Department of Endocrinology and MetabolismTokyo Metropolitan Children's Medical Center, Tokyo, JapanDepartment of PediatricsSchool of Medicine, Keio University, 35 Shinanomachi, Shinjuku-ku, Tokyo 160-8582, JapanDivision of PediatricsDepartment of Homeostatic Regulation and Development, Graduate School of Medicine and Dental Sciences, Niigata University, Niigata, JapanDepartment of PediatricsSchool of Medicine, Tohoku University, Miyagi, JapanDepartment of Endocrinology and MetabolismKanagawa Children's Medical Center, Yokohama, Japan
| | - Tomonobu Hasegawa
- Department of Endocrinology and MetabolismTokyo Metropolitan Children's Medical Center, Tokyo, JapanDepartment of PediatricsSchool of Medicine, Keio University, 35 Shinanomachi, Shinjuku-ku, Tokyo 160-8582, JapanDivision of PediatricsDepartment of Homeostatic Regulation and Development, Graduate School of Medicine and Dental Sciences, Niigata University, Niigata, JapanDepartment of PediatricsSchool of Medicine, Tohoku University, Miyagi, JapanDepartment of Endocrinology and MetabolismKanagawa Children's Medical Center, Yokohama, Japan
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19
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Tajima T, Ishizu K, Nakamura A. Molecular and Clinical Findings in Patients with LHX4 and OTX2 Mutations. Clin Pediatr Endocrinol 2013; 22:15-23. [PMID: 23990694 DOI: 10.1292/cpe.22.15] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/19/2012] [Accepted: 12/28/2012] [Indexed: 11/22/2022] Open
Abstract
The pituitary gland produces hormones that play important roles in both the development and homeostasis of the body. Ontogeny of the anterior and posterior pituitary is orchestrated by inputs from neighboring tissues, cellular signaling molecules and transcription factors. Disruption of expression or function of these factors has been implicated in the etiology of combined pituitary hormone deficiency (CPHD). These include the transcription factors HESX1, PROP1, POU1F1, LHX3, LHX4, OTX2, SOX2, SOX3 and GLI2. This review focuses on summarizing most recent mutations in LHX4 and OTX2 responsible for pituitary hormone deficiency. In both genetic defects of LHX4 and OTX2, there is high variability in clinical manifestations even in the same family. In addition, there is no clear phenotype-genotype correlation. These findings indicate that the other genetic and/or environmental factors influence the phenotype. In addition, the variability might reflect a plasticity during pituitary development and maintenance. Over the past two decades, a genetic basis for pituitary hormone deficiency and the mechanism of pituitary development have been clarified. It should be kept in mind that this review is not comprehensive, and defects of other transcriptional factors have been described in patients with CPHD. Furthermore, the causes in many patients with CPHD have not yet been determined. Therefore, continuing efforts for the clarification of the etiology are necessary.
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Affiliation(s)
- Toshihiro Tajima
- Department of Pediatrics, Hokkaido University School of Medicine, Hokkaido, Japan
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20
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Abstract
The pituitary gland produces hormones that play
important roles in both the development and homeostasis of the body. Ontogeny of the
anterior and posterior pituitary is orchestrated by inputs from neighboring tissues,
cellular signaling molecules and transcription factors. Disruption of expression or
function of these factors has been implicated in the etiology of combined pituitary
hormone deficiency (CPHD). These include the transcription factors HESX1, PROP1, POU1F1,
LHX3, LHX4, OTX2, SOX2, SOX3 and GLI2. This review focuses on summarizing most recent
mutations in LHX4 and OTX2 responsible for pituitary
hormone deficiency. In both genetic defects of LHX4 and
OTX2, there is high variability in clinical manifestations even in the
same family. In addition, there is no clear phenotype-genotype correlation. These findings
indicate that the other genetic and/or environmental factors influence the phenotype. In
addition, the variability might reflect a plasticity during pituitary development and
maintenance. Over the past two decades, a genetic basis for pituitary hormone deficiency
and the mechanism of pituitary development have been clarified. It should be kept in mind
that this review is not comprehensive, and defects of other transcriptional factors have
been described in patients with CPHD. Furthermore, the causes in many patients with CPHD
have not yet been determined. Therefore, continuing efforts for the clarification of the
etiology are necessary.
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Affiliation(s)
- Toshihiro Tajima
- Department of Pediatrics, Hokkaido University School of Medicine, Hokkaido, Japan
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