1
|
Damen L, Elizabeth MSM, Donze SH, van den Berg SAA, de Graaff LCG, Hokken-Koelega ACS. Free Insulin-like Growth Factor (IGF)-I in Children with PWS. J Clin Med 2022; 11:jcm11051280. [PMID: 35268371 PMCID: PMC8911349 DOI: 10.3390/jcm11051280] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2022] [Revised: 02/09/2022] [Accepted: 02/24/2022] [Indexed: 11/29/2022] Open
Abstract
In children with Prader−Willi syndrome (PWS), the standard growth hormone (GH) dose often results in high immunoreactive IGF-I levels. These high immunoreactive IGF-I levels lead to concern because their long-term effects are unknown. As a result, clinicians have to lower the GH dose, which worsens body composition and quality of life. As clinical features do not seem to correspond to immunoreactive IGF-I values, it is questionable whether immunoreactive IGF-I is a suitable marker for GH dosing, or whether another parameter better reflects IGF-I bioavailability and bioactivity. We, therefore, investigate serum immunoreactive IGF-I, free IGF-I and IGFBP-3 levels in 70 GH-treated children with PWS. Our study showed that, although immunoreactive IGF-I levels were high (>2 SDS) in the vast majority of prepubertal and pubertal children, free IGF-I SDS levels were <0 SDS in most and <1 SDS in all. Free IGF-I correlated with the immunoreactive IGF-I, IGFBP-3 and IGF-I/IGFBP-3 ratio. We conclude that there is a major discrepancy between immunoreactive and free IGF-I levels. While in the majority of GH-treated children with PWS, immunoreactive IGF-I levels were high, free IGF-I levels were <0 SDS in most. Our data appear to be very reassuring and suggest that free IGF-I levels should also be taken into consideration when the immunoreactive IGF-I levels are >2 SDS in GH-treated children with PWS.
Collapse
Affiliation(s)
- Layla Damen
- Dutch Growth Research Foundation, 3016 AH Rotterdam, The Netherlands; (S.H.D.); (A.C.S.H.-K.)
- Department of Pediatrics, Subdivision of Endocrinology, Erasmus MC University Medical Center-Sophia Children’s Hospital, 3015 CN Rotterdam, The Netherlands
- Dutch Center of Reference for Prader-Willi Syndrome, 3015 GD Rotterdam, The Netherlands;
- Academic Center for Growth Disorders, Erasmus MC University Medical Center, 3015 GD Rotterdam, The Netherlands
- Correspondence: ; Tel.: +31-10-225-1533
| | - Melitza S. M. Elizabeth
- Department of Internal Medicine, Division of Endocrinology, Erasmus MC University Medical Center, 3015 GD Rotterdam, The Netherlands; (M.S.M.E.); (S.A.A.v.d.B.)
| | - Stephany H. Donze
- Dutch Growth Research Foundation, 3016 AH Rotterdam, The Netherlands; (S.H.D.); (A.C.S.H.-K.)
- Department of Pediatrics, Subdivision of Endocrinology, Erasmus MC University Medical Center-Sophia Children’s Hospital, 3015 CN Rotterdam, The Netherlands
- Dutch Center of Reference for Prader-Willi Syndrome, 3015 GD Rotterdam, The Netherlands;
- Academic Center for Growth Disorders, Erasmus MC University Medical Center, 3015 GD Rotterdam, The Netherlands
| | - Sjoerd A. A. van den Berg
- Department of Internal Medicine, Division of Endocrinology, Erasmus MC University Medical Center, 3015 GD Rotterdam, The Netherlands; (M.S.M.E.); (S.A.A.v.d.B.)
- Department of Clinical Chemistry, Erasmus MC University Medical Center, 3015 GD Rotterdam, The Netherlands
| | - Laura C. G. de Graaff
- Dutch Center of Reference for Prader-Willi Syndrome, 3015 GD Rotterdam, The Netherlands;
- Academic Center for Growth Disorders, Erasmus MC University Medical Center, 3015 GD Rotterdam, The Netherlands
- Department of Internal Medicine, Division of Endocrinology, Erasmus MC University Medical Center, 3015 GD Rotterdam, The Netherlands; (M.S.M.E.); (S.A.A.v.d.B.)
| | - Anita C. S. Hokken-Koelega
- Dutch Growth Research Foundation, 3016 AH Rotterdam, The Netherlands; (S.H.D.); (A.C.S.H.-K.)
- Department of Pediatrics, Subdivision of Endocrinology, Erasmus MC University Medical Center-Sophia Children’s Hospital, 3015 CN Rotterdam, The Netherlands
- Dutch Center of Reference for Prader-Willi Syndrome, 3015 GD Rotterdam, The Netherlands;
- Academic Center for Growth Disorders, Erasmus MC University Medical Center, 3015 GD Rotterdam, The Netherlands
| |
Collapse
|
2
|
Elizabeth MSM, Verkerk AJMH, Hokken-Koelega ACS, Verlouw JAM, Argente J, Pfaeffle R, Neggers SJCMM, Visser JA, de Graaff LCG. Congenital hypopituitarism in two brothers with a duplication of the 'acrogigantism gene' GPR101: clinical findings and review of the literature. Pituitary 2021; 24:229-241. [PMID: 33184694 PMCID: PMC7966638 DOI: 10.1007/s11102-020-01101-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 10/23/2020] [Indexed: 11/21/2022]
Abstract
PURPOSE Congenital hypopituitarism (CH) can cause significant morbidity or even mortality. In the majority of patients, the etiology of CH is unknown. Understanding the etiology of CH is important for anticipation of clinical problems and for genetic counselling. Our previous studies showed that only a small proportion of cases have mutations in the known 'CH genes'. In the current project, we present the results of SNP array based copy number variant analysis in a family with unexplained congenital hypopituitarism. METHODS DNA samples of two affected brothers with idiopathic CH and their mother were simultaneously analyzed by SNP arrays for copy number variant analysis and Whole Exome Sequencing (WES) for mutation screening. DNA of the father was not available. RESULTS We found a 6 Mb duplication including GPR101 and SOX3 on the X-chromosome (Xq26.2-q27.1) in the two siblings and their mother, leading to 2 copies of this region in the affected boys and 3 copies in the mother. Duplications of GPR101 are associated with X-linked acrogigantism (the phenotypic 'opposite' of the affected brothers), whereas alterations in SOX3 are associated with X-linked hypopituitarism. CONCLUSION In our patients with hypopituitarism we found a 6 Mb duplication which includes GPR101, a gene associated with X- linked gigantism, and SOX3, a gene involved in early pituitary organogenesis that is associated with variable degrees of hypopituitarism. Our findings show that in duplications containing both GPR101 and SOX3, the growth hormone deficiency phenotype is dominant. This suggests that, if GPR101 is duplicated, it might not be expressed phenotypically when early patterning of the embryonic pituitary is affected due to SOX3 duplication. These results, together with the review of the literature, shed a new light on the role of GPR101 and SOX3 in pituitary function.
Collapse
Affiliation(s)
- Melitza S M Elizabeth
- Department of Internal Medicine, Section of Endocrinology, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands.
- Department of Pediatrics, Subdiv. Endocrinology, Erasmus MC Rotterdam, Rotterdam, The Netherlands.
- Dutch Growth Research Foundation, Rotterdam, The Netherlands.
| | - Annemieke J M H Verkerk
- Department of Internal Medicine, Section of Endocrinology, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - Anita C S Hokken-Koelega
- Department of Pediatrics, Subdiv. Endocrinology, Erasmus MC Rotterdam, Rotterdam, The Netherlands
- Dutch Growth Research Foundation, Rotterdam, The Netherlands
- Academic Center for Rare Growth Disorders, Erasmus MC Rotterdam, Rotterdam, The Netherlands
| | - Joost A M Verlouw
- Department of Internal Medicine, Section of Endocrinology, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - Jesús Argente
- Department of Endocrinology, Fundación Investigación Biomédica del Hospital Infantil Universitario Niño Jesús, Instituto de Investigación Biomédica la Princesa, Madrid, Spain
- Centro de Investigación Biomédica en Red Fisiología de la Obesidad y Nutrición (CIBEROBN), Madrid, Spain
- IMDEA Food Institute, Campus of International Excellence (CEI) UAM + CSIC, Madrid, Spain
- Department of Pediatrics, University Autonoma de Madrid, Madrid, Spain
| | - Roland Pfaeffle
- Hospital for Children and Adolescents, University of Leipzig, Leipzig, Germany
| | - Sebastian J C M M Neggers
- Department of Internal Medicine, Section of Endocrinology, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - Jenny A Visser
- Department of Internal Medicine, Section of Endocrinology, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - Laura C G de Graaff
- Department of Internal Medicine, Section of Endocrinology, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands
- Academic Center for Rare Growth Disorders, Erasmus MC Rotterdam, Rotterdam, The Netherlands
| |
Collapse
|
3
|
Elizabeth MSM, Verkerk AJMH, Hokken-Koelega ACS, Verlouw JAM, Argente J, Pfaeffle R, Visser TJ, Peeters RP, De Graaff LCG. Unique near-complete deletion of GLI2 in a patient with combined pituitary hormone deficiency and post-axial polydactyly. Growth Horm IGF Res 2020; 50:35-41. [PMID: 31862539 DOI: 10.1016/j.ghir.2019.10.002] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/03/2019] [Revised: 09/26/2019] [Accepted: 10/04/2019] [Indexed: 12/29/2022]
Abstract
INTRODUCTION Combined pituitary hormone deficiency (CPHD) can cause a broad spectrum of health problems, ranging from short stature only, to convulsions or even death. In the majority of patients, the cause is unknown. METHODS The idex case had unexplained CPHD, pituitary anomalies on MRI and polydactyly. In the patients and her unaffected parents, we performed SNP array analysis and Whole Exome Sequencing, after candidate gene analysis turned out negative. RESULTS We found a unique de novo heterozygous 229.9 kb deletion in the index case on chr. 2q14.2. This deletion covered 12 out of the 13 coding exons of the GLI2 gene, a transcription factor involved in midline formation and previously associated with CPHD. As reported GLI2 deletions and mutations show a large phenotypic variability, we performed a genotype-phenotype analysis. This revealed that GLI2 missense mutations usually present with a 'ppp-only' phenotype (pituitary anomalies ± postaxial polydactyly without brain phenotype), whereas the 'ppp-plus' phenotype (with major brain malformations and/or intellectual disabilities) is more frequent in patients with larger deletions, and those with frameshift mutations/point mutations or splice variants resulting in a stop codon (p < .001). CONCLUSION The present case shows that a deletion of the GLI2 gene only (not affecting any of the adjacent genes) causes pituitary anomalies without brain phenotype. This suggests that brain phenotype only occurs when additional genes adjacent to GLI2 are deleted, or when mutations result in truncated GLI2 mRNA/protein. However, due to the lack of functional data for many GLI2 mutations and based on the available information regarding variable penetrance, phenotype-genotype correlations need to be made with caution.
Collapse
Affiliation(s)
| | | | - Anita C S Hokken-Koelega
- Erasmus MC Rotterdam, Academic Center for Rare Growth Disorders, the Netherlands; Erasmus MC Rotterdam, Dept of Pediatrics, Subdiv. Endocrinology, the Netherlands
| | - Joost A M Verlouw
- Erasmus MC Rotterdam, Dept of Internal Medicine, Genetic laboratory, the Netherlands
| | - Jesús Argente
- Hospital Infantil Universitario Niño Jesús, Department of Endocrinology, Instituto de Investigación La Princesa, Universidad Autónoma de Madrid, Department of Pediatrics, Madrid, Spain; CIBER de Fisiopatologia de la Obesidad y Nutriciόn (CIBEROBN), Instituto de Salud Carlos III, IMDEA Food Institute, CEIUAM+CSIC, Madrid, Spain
| | - Roland Pfaeffle
- Hospital for Children and Adolescents, University of Leipzig, Pediatrics, Germany
| | - Theo J Visser
- Erasmus MC Rotterdam, Academic Center for Thyroid Diseases, the Netherlands
| | - Robin P Peeters
- Erasmus MC Rotterdam, Department of Internal Medicine, Subdiv. Endocrinology, the Netherlands; Erasmus MC Rotterdam, Academic Center for Thyroid Diseases, the Netherlands
| | - Laura C G De Graaff
- Erasmus MC Rotterdam, Department of Internal Medicine, Subdiv. Endocrinology, the Netherlands; Erasmus MC Rotterdam, Academic Center for Rare Growth Disorders, the Netherlands
| |
Collapse
|