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Martinerie L, Bouligand J, North MO, Bertherat J, Assié G, Espiard S. Consensus statement by the French Society of Endocrinology (SFE) and French Society of Pediatric Endocrinology & Diabetology (SFEDP) for the diagnosis of Cushing's syndrome: Genetics of Cushing's syndrome. ANNALES D'ENDOCRINOLOGIE 2024; 85:284-293. [PMID: 38253221 DOI: 10.1016/j.ando.2024.01.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/20/2023] [Accepted: 01/08/2024] [Indexed: 01/24/2024]
Abstract
Cushing's syndrome is due to overproduction of cortisol, leading to abnormal and prolonged exposure to cortisol. The most common etiology is Cushing disease, while adrenal causes are rarer. Knowledge of the genetics of Cushing's syndrome, and particularly the adrenal causes, has improved considerably over the last 10 years, thanks in particular to technical advances in high-throughput sequencing. The present study, by a group of experts from the French Society of Endocrinology and the French Society of Pediatric Endocrinology and Diabetology, reviewed the literature on germline genetic alterations leading to a predisposition to develop Cushing's syndrome. The review led to a consensus statement on genetic screening for Cushing disease and adrenal Cushing's syndrome.
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Affiliation(s)
- Laetitia Martinerie
- Department of Pediatric Endocrinology, CHU Robert-Debré, AP-HP, Paris, France
| | - Jérôme Bouligand
- Faculté de médecine Paris-Saclay, Inserm Unit UMRS1185 Endocrine Physiology and Physiopathology, Paris, France
| | - Marie-Odile North
- Department of Genetics and Molecular Biology, hôpital Cochin, AP-HP, University of Paris, Paris, France
| | - Jérôme Bertherat
- Endocrinology Department, centre de référence maladies rares de la surrénale (CRMRS), hôpital Cochin, AP-HP, University of Paris, Paris, France
| | - Guillaume Assié
- Endocrinology Department, centre de référence maladies rares de la surrénale (CRMRS), hôpital Cochin, AP-HP, University of Paris, Paris, France
| | - Stéphanie Espiard
- Service d'endocrinologie, diabétologie, métabolisme et nutrition, CHU de Lille, 59000 Lille, France.
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Kubo H, Tsurutani Y, Sugisawa C, Sunouchi T, Hirose R, Saito J. Phenotypic Variability in a Family with Carney Complex Accompanied by a Novel Mutation Involving PRKAR1A. TOHOKU J EXP MED 2022; 257:337-345. [PMID: 35732416 DOI: 10.1620/tjem.2022.j051] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Affiliation(s)
- Haremaru Kubo
- Endocrinology and Diabetes Center, Yokohama Rosai Hospital
| | - Yuya Tsurutani
- Endocrinology and Diabetes Center, Yokohama Rosai Hospital
| | - Chiho Sugisawa
- Endocrinology and Diabetes Center, Yokohama Rosai Hospital.,Division of Endocrinology and Metabolism, Department of Internal Medicine, Showa University Fujigaoka Hospital
| | | | - Rei Hirose
- Endocrinology and Diabetes Center, Yokohama Rosai Hospital
| | - Jun Saito
- Endocrinology and Diabetes Center, Yokohama Rosai Hospital
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Abstract
Somatic mutations in PRKACA, coding for the catalytic α subunit of protein kinase A (PKA), have been recently identified as the most frequent genetic alteration in cortisol-secreting adrenocortical adenomas, which are responsible for adrenal Cushing's syndrome. The mutations identified so far lie at the interface between the catalytic (C) and regulatory (R) subunit of PKA. Detailed functional studies of the most frequent of these mutations (L206R) as well as of another one in the same region of the C subunit (199_200insW) have revealed that these mutations cause constitutive activation of PKA and lack of regulation by cAMP. This is due to interference with the binding of the R subunit, which keeps the C subunit inactive in the absence of cyclic AMP. Here, we review these recent findings, with a particular focus on the mechanisms of action of PRKACA mutations.
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Affiliation(s)
- D Calebiro
- Institute of Pharmacology and Toxicology, University Hospital, University of Würzburg, Würzburg, Germany
| | - K Bathon
- Institute of Pharmacology and Toxicology, University Hospital, University of Würzburg, Würzburg, Germany
| | - I Weigand
- Department of Medicine I, Endocrine and Diabetes Unit, University Hospital, University of Würzburg, Würzburg, Germany
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Rhayem Y, Le Stunff C, Abdel Khalek W, Auzan C, Bertherat J, Linglart A, Couvineau A, Silve C, Clauser E. Functional Characterization of PRKAR1A Mutations Reveals a Unique Molecular Mechanism Causing Acrodysostosis but Multiple Mechanisms Causing Carney Complex. J Biol Chem 2015; 290:27816-28. [PMID: 26405036 PMCID: PMC4646027 DOI: 10.1074/jbc.m115.656553] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2015] [Indexed: 02/05/2023] Open
Abstract
The main target of cAMP is PKA, the main regulatory subunit of which (PRKAR1A) presents mutations in two genetic disorders: acrodysostosis and Carney complex. In addition to the initial recurrent mutation (R368X) of the PRKAR1A gene, several missense and nonsense mutations have been observed recently in acrodysostosis with hormonal resistance. These mutations are located in one of the two cAMP-binding domains of the protein, and their functional characterization is presented here. Expression of each of the PRKAR1A mutants results in a reduction of forskolin-induced PKA activation (measured by a reporter assay) and an impaired ability of cAMP to dissociate PRKAR1A from the catalytic PKA subunits by BRET assay. Modeling studies and sensitivity to cAMP analogs specific for domain A (8-piperidinoadenosine 3',5'-cyclic monophosphate) or domain B (8-(6-aminohexyl)aminoadenosine-3',5'-cyclic monophosphate) indicate that the mutations impair cAMP binding locally in the domain containing the mutation. Interestingly, two of these mutations affect amino acids for which alternative amino acid substitutions have been reported to cause the Carney complex phenotype. To decipher the molecular mechanism through which homologous substitutions can produce such strikingly different clinical phenotypes, we studied these mutations using the same approaches. Interestingly, the Carney mutants also demonstrated resistance to cAMP, but they expressed additional functional defects, including accelerated PRKAR1A protein degradation. These data demonstrate that a cAMP binding defect is the common molecular mechanism for resistance of PKA activation in acrodysosotosis and that several distinct mechanisms lead to constitutive PKA activation in Carney complex.
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Affiliation(s)
- Yara Rhayem
- From the INSERM U970, Université Paris Descartes, Paris Centre de Recherche Cardiovasculaire, 56 Rue Leblanc, 75015 Paris, France, the Service de Biochimie et Génétique Moléculaire and
| | - Catherine Le Stunff
- INSERM U1169, Université Paris Sud, Hôpital Bicêtre, 94270 Le Kremlin Bicêtre, France
| | - Waed Abdel Khalek
- From the INSERM U970, Université Paris Descartes, Paris Centre de Recherche Cardiovasculaire, 56 Rue Leblanc, 75015 Paris, France
| | - Colette Auzan
- From the INSERM U970, Université Paris Descartes, Paris Centre de Recherche Cardiovasculaire, 56 Rue Leblanc, 75015 Paris, France
| | - Jerome Bertherat
- Service d'Endocrinologie, Hôpital Cochin, Assistance Publique, Hôpitaux de Paris, 75014 Paris, France, the Institut Cochin, INSERM U1060, Université Paris Descartes, 75014 Paris, France
| | - Agnès Linglart
- the Service d'Endocrinologie Pédiatrique, Hôpital Bicêtre, Assistance Publique, Hôpitaux de Paris, 94270 Le Kremlin Bicêtre, France, and
| | - Alain Couvineau
- UMR 1149 INSERM, Université Paris Diderot, ERL CNRS 8252, Faculté de Médecine Site Bichat, 75018 Paris, France
| | - Caroline Silve
- the Service de Biochimie et Génétique Moléculaire and INSERM U1169, Université Paris Sud, Hôpital Bicêtre, 94270 Le Kremlin Bicêtre, France
| | - Eric Clauser
- From the INSERM U970, Université Paris Descartes, Paris Centre de Recherche Cardiovasculaire, 56 Rue Leblanc, 75015 Paris, France, the Service de Biochimie et Génétique Moléculaire and
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Iwata T, Tamanaha T, Koezuka R, Tochiya M, Makino H, Kishimoto I, Mizusawa N, Ono S, Inoshita N, Yamada S, Shimatsu A, Yoshimoto K. Germline deletion and a somatic mutation of the PRKAR1A gene in a Carney complex-related pituitary adenoma. Eur J Endocrinol 2015; 172:K5-10. [PMID: 25336503 DOI: 10.1530/eje-14-0685] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
OBJECTIVE The objective was to assess involvement of loss of the PRKAR1A gene encoding a type 1α regulatory subunit of cAMP-dependent protein kinase A located on 17q24 in a Carney complex (CNC)-related pituitary adenoma. DESIGN We investigated aberrations of the PRKAR1A gene in a CNC patient with a GH-producing pituitary adenoma, whose family has three other members with probable CNC. METHODS A gene mutation was identified by a standard DNA sequencing method based on PCR. DNA copy number was measured to evaluate allelic loss on 17q24 by quantitative PCR. The breakpoints of deletion were determined by cloning a rearranged region in the deleted allele. RESULTS A PRKAR1A mutation of c.751_758del8 (p.S251LfsX16) was found in genomic DNA obtained from a pituitary adenoma, but not leukocytes from the patient. Reduced DNA copy number at loci including the PRKAR1A gene on 17q24 was detected in both the tumor and leukocytes, suggesting a deletion at the loci at the germline level. The deletion size was determined to be ∼ 0.5 Mb and this large deletion was also found in two other family members. CONCLUSION This is the first case showing a CNC-related pituitary adenoma with the combination of somatic mutation and a large inherited deletion of the PRKAR1A gene. Biallelic inactivation of PRKAR1A appears to be necessary for the development of CNC-related pituitary adenoma.
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Affiliation(s)
- T Iwata
- Department of Medical PharmacologyInstitute of Health Biosciences, The University of Tokushima Graduate School, Kuramoto-cho 3-18-15, Tokushima 770-8504, JapanDepartment of Endocrinology and MetabolismNational Cerebral and Cardiovascular Center, Osaka, JapanDepartments of PathologyHypothalamic and Pituitary SurgeryToranomon Hospital, Tokyo, JapanClinical Research InstituteNational Hospital Organization Kyoto Medical Center, Kyoto, Japan
| | - T Tamanaha
- Department of Medical PharmacologyInstitute of Health Biosciences, The University of Tokushima Graduate School, Kuramoto-cho 3-18-15, Tokushima 770-8504, JapanDepartment of Endocrinology and MetabolismNational Cerebral and Cardiovascular Center, Osaka, JapanDepartments of PathologyHypothalamic and Pituitary SurgeryToranomon Hospital, Tokyo, JapanClinical Research InstituteNational Hospital Organization Kyoto Medical Center, Kyoto, Japan
| | - R Koezuka
- Department of Medical PharmacologyInstitute of Health Biosciences, The University of Tokushima Graduate School, Kuramoto-cho 3-18-15, Tokushima 770-8504, JapanDepartment of Endocrinology and MetabolismNational Cerebral and Cardiovascular Center, Osaka, JapanDepartments of PathologyHypothalamic and Pituitary SurgeryToranomon Hospital, Tokyo, JapanClinical Research InstituteNational Hospital Organization Kyoto Medical Center, Kyoto, Japan
| | - M Tochiya
- Department of Medical PharmacologyInstitute of Health Biosciences, The University of Tokushima Graduate School, Kuramoto-cho 3-18-15, Tokushima 770-8504, JapanDepartment of Endocrinology and MetabolismNational Cerebral and Cardiovascular Center, Osaka, JapanDepartments of PathologyHypothalamic and Pituitary SurgeryToranomon Hospital, Tokyo, JapanClinical Research InstituteNational Hospital Organization Kyoto Medical Center, Kyoto, Japan
| | - H Makino
- Department of Medical PharmacologyInstitute of Health Biosciences, The University of Tokushima Graduate School, Kuramoto-cho 3-18-15, Tokushima 770-8504, JapanDepartment of Endocrinology and MetabolismNational Cerebral and Cardiovascular Center, Osaka, JapanDepartments of PathologyHypothalamic and Pituitary SurgeryToranomon Hospital, Tokyo, JapanClinical Research InstituteNational Hospital Organization Kyoto Medical Center, Kyoto, Japan
| | - I Kishimoto
- Department of Medical PharmacologyInstitute of Health Biosciences, The University of Tokushima Graduate School, Kuramoto-cho 3-18-15, Tokushima 770-8504, JapanDepartment of Endocrinology and MetabolismNational Cerebral and Cardiovascular Center, Osaka, JapanDepartments of PathologyHypothalamic and Pituitary SurgeryToranomon Hospital, Tokyo, JapanClinical Research InstituteNational Hospital Organization Kyoto Medical Center, Kyoto, Japan
| | - N Mizusawa
- Department of Medical PharmacologyInstitute of Health Biosciences, The University of Tokushima Graduate School, Kuramoto-cho 3-18-15, Tokushima 770-8504, JapanDepartment of Endocrinology and MetabolismNational Cerebral and Cardiovascular Center, Osaka, JapanDepartments of PathologyHypothalamic and Pituitary SurgeryToranomon Hospital, Tokyo, JapanClinical Research InstituteNational Hospital Organization Kyoto Medical Center, Kyoto, Japan
| | - S Ono
- Department of Medical PharmacologyInstitute of Health Biosciences, The University of Tokushima Graduate School, Kuramoto-cho 3-18-15, Tokushima 770-8504, JapanDepartment of Endocrinology and MetabolismNational Cerebral and Cardiovascular Center, Osaka, JapanDepartments of PathologyHypothalamic and Pituitary SurgeryToranomon Hospital, Tokyo, JapanClinical Research InstituteNational Hospital Organization Kyoto Medical Center, Kyoto, Japan
| | - N Inoshita
- Department of Medical PharmacologyInstitute of Health Biosciences, The University of Tokushima Graduate School, Kuramoto-cho 3-18-15, Tokushima 770-8504, JapanDepartment of Endocrinology and MetabolismNational Cerebral and Cardiovascular Center, Osaka, JapanDepartments of PathologyHypothalamic and Pituitary SurgeryToranomon Hospital, Tokyo, JapanClinical Research InstituteNational Hospital Organization Kyoto Medical Center, Kyoto, Japan
| | - S Yamada
- Department of Medical PharmacologyInstitute of Health Biosciences, The University of Tokushima Graduate School, Kuramoto-cho 3-18-15, Tokushima 770-8504, JapanDepartment of Endocrinology and MetabolismNational Cerebral and Cardiovascular Center, Osaka, JapanDepartments of PathologyHypothalamic and Pituitary SurgeryToranomon Hospital, Tokyo, JapanClinical Research InstituteNational Hospital Organization Kyoto Medical Center, Kyoto, Japan
| | - A Shimatsu
- Department of Medical PharmacologyInstitute of Health Biosciences, The University of Tokushima Graduate School, Kuramoto-cho 3-18-15, Tokushima 770-8504, JapanDepartment of Endocrinology and MetabolismNational Cerebral and Cardiovascular Center, Osaka, JapanDepartments of PathologyHypothalamic and Pituitary SurgeryToranomon Hospital, Tokyo, JapanClinical Research InstituteNational Hospital Organization Kyoto Medical Center, Kyoto, Japan
| | - K Yoshimoto
- Department of Medical PharmacologyInstitute of Health Biosciences, The University of Tokushima Graduate School, Kuramoto-cho 3-18-15, Tokushima 770-8504, JapanDepartment of Endocrinology and MetabolismNational Cerebral and Cardiovascular Center, Osaka, JapanDepartments of PathologyHypothalamic and Pituitary SurgeryToranomon Hospital, Tokyo, JapanClinical Research InstituteNational Hospital Organization Kyoto Medical Center, Kyoto, Japan
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