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Burget L, Parera LA, Fernandez-Cancio M, Gräni R, Henzen C, Flück CE. A rare cause of primary adrenal insufficiency due to a homozygous Arg188Cys mutation in the STAR gene. Endocrinol Diabetes Metab Case Rep 2018; 2018:EDM180003. [PMID: 29576868 PMCID: PMC5863243 DOI: 10.1530/edm-18-0003] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2018] [Accepted: 03/06/2018] [Indexed: 11/10/2022] Open
Abstract
Steroidogenic acute regulatory protein (STAR) is a key protein for the intracellular transport of cholesterol to the mitochondrium in endocrine organs (e.g. adrenal gland, ovaries, testes) and essential for the synthesis of all steroid hormones. Several mutations have been described and the clinical phenotype varies strongly and may be grouped into classic lipoid congenital adrenal hyperplasia (LCAH), in which all steroidogenesis is disrupted, and non-classic LCAH, which resembles familial glucocorticoid deficiency (FGD), which affects predominantly adrenal functions. Classic LCAH is characterized by early and potentially life-threatening manifestation of primary adrenal insufficiency (PAI) with electrolyte disturbances and 46,XY disorder of sex development (DSD) in males as well as lack of pubertal development in both sexes. Non-classic LCAH manifests usually later in life with PAI. Nevertheless, life-long follow-up of gonadal function is warranted. We describe a 26-year-old female patient who was diagnosed with PAI early in life without detailed diagnostic work-up. At the age of 14 months, she presented with hyperpigmentation, elevated ACTH and low cortisol levels. As her older brother was diagnosed with PAI two years earlier, she was put on hydrocortisone and fludrocortisone replacement therapy before an Addisonian crisis occurred. Upon review of her case in adulthood, consanguinity was noted in the family. Genetic analysis for PAI revealed a homozygous mutation in the STAR gene (c.562C>T, p.Arg188Cys) in both siblings. This mutation has been previously described in non-classic LCAH. This case illustrates that early onset, familial PAI is likely due to autosomal recessive genetic mutations in known genes causing PAI.
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Affiliation(s)
- Lukas Burget
- Division of Endocrinology and Diabetes, Cantonal Hospital Lucerne, Lucerne, Switzerland
| | - Laura Audí Parera
- Pediatric Endocrinology Research Unit, Vall d`Hebron, Institut de Recerca, CIBERER, Instituto de Salud Carlos III, Barcelona, Spain
| | - Monica Fernandez-Cancio
- Pediatric Endocrinology Research Unit, Vall d`Hebron, Institut de Recerca, CIBERER, Instituto de Salud Carlos III, Barcelona, Spain
| | - Rolf Gräni
- Division of Endocrinology and Diabetes, Cantonal Hospital Lucerne, Lucerne, Switzerland
| | - Christoph Henzen
- Division of Endocrinology and Diabetes, Cantonal Hospital Lucerne, Lucerne, Switzerland
| | - Christa E Flück
- Pediatric Endocrinology, Diabetology and Metabolism, Bern University Children's Hospital and Department of BioMedical Research, University of Bern, Bern, Switzerland
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Prasad R, Hadjidemetriou I, Maharaj A, Meimaridou E, Buonocore F, Saleem M, Hurcombe J, Bierzynska A, Barbagelata E, Bergadá I, Cassinelli H, Das U, Krone R, Hacihamdioglu B, Sari E, Yesilkaya E, Storr HL, Clemente M, Fernandez-Cancio M, Camats N, Ram N, Achermann JC, Van Veldhoven PP, Guasti L, Braslavsky D, Guran T, Metherell LA. Sphingosine-1-phosphate lyase mutations cause primary adrenal insufficiency and steroid-resistant nephrotic syndrome. J Clin Invest 2017; 127:942-953. [PMID: 28165343 PMCID: PMC5330744 DOI: 10.1172/jci90171] [Citation(s) in RCA: 102] [Impact Index Per Article: 14.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2016] [Accepted: 12/12/2016] [Indexed: 12/26/2022] Open
Abstract
Primary adrenal insufficiency is life threatening and can present alone or in combination with other comorbidities. Here, we have described a primary adrenal insufficiency syndrome and steroid-resistant nephrotic syndrome caused by loss-of-function mutations in sphingosine-1-phosphate lyase (SGPL1). SGPL1 executes the final decisive step of the sphingolipid breakdown pathway, mediating the irreversible cleavage of the lipid-signaling molecule sphingosine-1-phosphate (S1P). Mutations in other upstream components of the pathway lead to harmful accumulation of lysosomal sphingolipid species, which are associated with a series of conditions known as the sphingolipidoses. In this work, we have identified 4 different homozygous mutations, c.665G>A (p.R222Q), c.1633_1635delTTC (p.F545del), c.261+1G>A (p.S65Rfs*6), and c.7dupA (p.S3Kfs*11), in 5 families with the condition. In total, 8 patients were investigated, some of whom also manifested other features, including ichthyosis, primary hypothyroidism, neurological symptoms, and cryptorchidism. Sgpl1-/- mice recapitulated the main characteristics of the human disease with abnormal adrenal and renal morphology. Sgpl1-/- mice displayed disrupted adrenocortical zonation and defective expression of steroidogenic enzymes as well as renal histology in keeping with a glomerular phenotype. In summary, we have identified SGPL1 mutations in humans that perhaps represent a distinct multisystemic disorder of sphingolipid metabolism.
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Affiliation(s)
- Rathi Prasad
- Centre for Endocrinology, William Harvey Research Institute, John Vane Science Centre, Queen Mary, University of London, Charterhouse Square, London, United Kingdom
| | - Irene Hadjidemetriou
- Centre for Endocrinology, William Harvey Research Institute, John Vane Science Centre, Queen Mary, University of London, Charterhouse Square, London, United Kingdom
| | - Avinaash Maharaj
- Centre for Endocrinology, William Harvey Research Institute, John Vane Science Centre, Queen Mary, University of London, Charterhouse Square, London, United Kingdom
| | - Eirini Meimaridou
- Centre for Endocrinology, William Harvey Research Institute, John Vane Science Centre, Queen Mary, University of London, Charterhouse Square, London, United Kingdom
| | - Federica Buonocore
- Genetics and Genomic Medicine, UCL Great Ormond Street Institute of Child Health, University College London, London, United Kingdom
| | - Moin Saleem
- Children’s and Academic Renal Unit, University of Bristol, Bristol, United Kingdom
| | - Jenny Hurcombe
- Children’s and Academic Renal Unit, University of Bristol, Bristol, United Kingdom
| | - Agnieszka Bierzynska
- Children’s and Academic Renal Unit, University of Bristol, Bristol, United Kingdom
| | - Eliana Barbagelata
- Servicio de Nefrología, Hospital de Niños “Ricardo Gutiérrez,” Buenos Aires, Argentina
| | - Ignacio Bergadá
- Centro de Investigaciones Endocrinológicas “Dr. Cesar Bergadá” (CEDIE) – CONICET – FEI – División de Endocrinología, Hospital de Niños “Ricardo Gutiérrez,” Buenos Aires, Argentina
| | - Hamilton Cassinelli
- Centro de Investigaciones Endocrinológicas “Dr. Cesar Bergadá” (CEDIE) – CONICET – FEI – División de Endocrinología, Hospital de Niños “Ricardo Gutiérrez,” Buenos Aires, Argentina
| | - Urmi Das
- Alderhey Children’s Hospital NHS Foundation Trust, Eaton Road, Liverpool, United Kingdom
| | - GOSgene
- Genetics and Genomic Medicine, UCL Great Ormond Street Institute of Child Health, University College London, London, United Kingdom
- The center is detailed in the Supplemental Acknowledgments
| | - Ruth Krone
- Birmingham Children’s Hospital, Birmingham, United Kingdom
| | - Bulent Hacihamdioglu
- Health Sciences University, Suleymaniye Maternity and Children’s Training and Research Hospital, Department of Paediatric Endocrinology and Diabetes, Istanbul, Turkey
| | - Erkan Sari
- Gulhane Military Medical School Department of Paediatric Endocrinology and Diabetes, Ankara, Turkey
| | - Ediz Yesilkaya
- Gulhane Military Medical School Department of Paediatric Endocrinology and Diabetes, Ankara, Turkey
| | - Helen L. Storr
- Centre for Endocrinology, William Harvey Research Institute, John Vane Science Centre, Queen Mary, University of London, Charterhouse Square, London, United Kingdom
| | - Maria Clemente
- Growth and Development Research Unit, Vall d’Hebron Research Institute (VHIR), Hospital Vall d’Hebron, CIBERER, Instituto de Salud Carlos III, Barcelona, Spain
| | - Monica Fernandez-Cancio
- Growth and Development Research Unit, Vall d’Hebron Research Institute (VHIR), Hospital Vall d’Hebron, CIBERER, Instituto de Salud Carlos III, Barcelona, Spain
| | - Nuria Camats
- Growth and Development Research Unit, Vall d’Hebron Research Institute (VHIR), Hospital Vall d’Hebron, CIBERER, Instituto de Salud Carlos III, Barcelona, Spain
| | - Nanik Ram
- Department of Medicine, Aga Khan University Hospital, Karachi, Pakistan
| | - John C. Achermann
- Genetics and Genomic Medicine, UCL Great Ormond Street Institute of Child Health, University College London, London, United Kingdom
| | - Paul P. Van Veldhoven
- Laboratory of Lipid Biochemistry and Protein Interactions (LIPIT), Campus Gasthuisberg, KU Leuven, Leuven, Belgium
| | - Leonardo Guasti
- Centre for Endocrinology, William Harvey Research Institute, John Vane Science Centre, Queen Mary, University of London, Charterhouse Square, London, United Kingdom
| | - Debora Braslavsky
- Centro de Investigaciones Endocrinológicas “Dr. Cesar Bergadá” (CEDIE) – CONICET – FEI – División de Endocrinología, Hospital de Niños “Ricardo Gutiérrez,” Buenos Aires, Argentina
| | - Tulay Guran
- Marmara University, Department of Paediatric Endocrinology and Diabetes, Istanbul, Turkey
| | - Louise A. Metherell
- Centre for Endocrinology, William Harvey Research Institute, John Vane Science Centre, Queen Mary, University of London, Charterhouse Square, London, United Kingdom
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Akcay T, Fernandez-Cancio M, Turan S, Güran T, Audi L, Bereket A. AR and SRD5A2 gene mutations in a series of 51 Turkish 46,XY DSD children with a clinical diagnosis of androgen insensitivity. Andrology 2014; 2:572-8. [PMID: 24737579 DOI: 10.1111/j.2047-2927.2014.00215.x] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2013] [Revised: 02/19/2014] [Accepted: 03/18/2014] [Indexed: 11/27/2022]
Abstract
46,XY disorders of sex development (DSD) are caused by disorders of gonadal development, androgen biosynthesis and receptor (AR) defects. Although, clinical/biochemical features help in distinguishing specific aetiologies, there are overlaps which necessitate molecular analyses for the definitive diagnosis. To test precision of our clinical diagnosis of androgen insensitivity (AIS) by analysing AR and then SRD5A2 genes, patients were recruited at Marmara University Hospital and molecular analyses were performed at Vall d'Hebron Research Institute. Among 101 46,XY DSD patients, 46 index and five siblings (nine complete, 42 partial) with clinical/biochemical data suggestive of AIS and stimulated T/DHT ratio <25 were selected. AR and then SRD5A2 genes were sequenced. We detected AR mutations in 11 patients [seven index and four siblings (22% of all and 15% of index patients)] and SRD5A2 mutations in six [five index and one sibling (12% of all and 11% of index)]. AR mutation detection rate was 6/9 in all CAIS and 4/7 in the index (67 and 57% respectively) and 5/42 in all PAIS and 3/40 in the index (12 and 7.5% respectively). The eight mutations detected in the AR gene were as follows: p.Q58L, p.P392S, p.R609K, p.R775H, p.R856H, p.A871A, p.V890M and p.F892L, with p.A871A and p.F892L being novel. Further six patients had SRD5A2 mutations which were as follows: p.L73WfsX59, p.Y91H, p.R171S and p.G196S, the first being novel. Hormonal data in those with AR mutations, SRD5A2 mutations and no mutations were not statistically different. In conclusion, a significant proportion of children with presumptive diagnosis of AIS has a normal AR gene. The less severe the phenotype, the less likely is the chance of demonstrating a mutation. Furthermore, a significant number of children with presumptive diagnosis of AIS have mutations in SRD5A2 gene and are clinically and biochemically indistinguishable from AIS.
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Affiliation(s)
- T Akcay
- Division of Pediatric Endocrinology, Department of Pediatrics, Marmara University School of Medicine, İstanbul, Turkey
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Hirsch A, Meimaridou E, Fernandez-Cancio M, Pandey AV, Clemente M, Audi L, Clark AJL, Flück CE. Loss of the C terminus of melanocortin receptor 2 (MC2R) results in impaired cell surface expression and ACTH insensitivity. J Clin Endocrinol Metab 2011; 96:E65-72. [PMID: 20962024 DOI: 10.1210/jc.2010-1056] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/12/2023]
Abstract
OBJECTIVE Mutations in melanocortin receptor 2 (MC2R) and its related melanocortin receptor accessory protein (MRAP) cause familial glucocorticoid deficiency. We identified a novel MC2R mutation, K289fs. This unique mutation in the C terminus of MC2R is located in the intracellular part of the protein for which the exact function is unknown. SETTING A 6-wk-old boy presented with severe hypoglycemia, unmeasurable cortisol, and grossly elevated ACTH but normal electrolytes. Genetic analysis revealed homozygote K289fs mutation in MC2R. His parents and siblings were heterozygous but phenotypically normal. INTERVENTION AND RESULTS The role of the C terminus of MC2R was studied in two cell systems. Because the K289fs mutant changes the last eight amino acids of the protein and leads to protein elongation, wild-type MC2R and C-terminally mutated constructs were tested for activity to respond to ACTH in an OS3 cell-based reporter assay. Wild-type and alanine-substituted constructs responded normally to ACTH. By contrast K289fs and M290X had a total loss of activity. Cell surface assays and confocal localization studies revealed that K289fs and M290X receptors were not found at the cell surface, indicating that their transport from the endoplasmic reticulum to the cell membrane is disrupted. Interestingly, coimmunoprecipitation experiments showed no alteration in the interaction of mutant MC2R with MRAP, suggesting that interaction between these two proteins does not guarantee normal localization. CONCLUSIONS Loss of the C terminus of MC2R impairs cell surface expression and ACTH sensitivity but does not disrupt interaction of MC2R with MRAP. These findings highlight the extreme sensitivity of MC2R to structural disruption.
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Affiliation(s)
- Andrea Hirsch
- Pediatric Endocrinology and Diabetology, University Children's Hospital Bern, Bern, Switzerland
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Fernandez-Cancio M, Esteban C, Carrascosa A, Toran N, Andaluz P, Audi L. IGF-I and not IGF-II expression is regulated by glucocorticoids in human fetal epiphyseal chondrocytes. Growth Horm IGF Res 2008; 18:497-505. [PMID: 18515166 DOI: 10.1016/j.ghir.2008.04.004] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/17/2007] [Revised: 03/12/2008] [Accepted: 04/21/2008] [Indexed: 10/22/2022]
Abstract
OBJECTIVE To elucidate the involvement of IGF axis components and the potential effects of glucocorticoids (GCs) in human fetal growth regulation. DESIGN We studied the regulation by dexamethasone (Dx) and IGF-I of proliferation and IGF axis components and matrix protein gene expression in human fetal epiphyseal chondrocytes. RESULTS High Dx concentration (10(-7)-10(-6)M) inhibited (3)H-thymidine incorporation, mifepristone (MF) 10(-6)M limited inhibition by Dx, and IGF-I (100 ng/ml) significantly stimulated proliferation and completely opposed inhibition by Dx. Dx dose-dependently (10(-9)-10(-6)M) inhibited IGF-I, IGFBP3 and SOX9 gene expression and expression of GHR, COL2A1 and aggrecan from 10(-7)M to 10(-6)M whereas it stimulated IGF-IR expression. By contrast, Dx had no significant effect on IGF-II expression. IGF-I stimulated IGF-I, IGFBP3, SOX9, COL2A1 and aggrecan expression whereas it inhibited IGF-IR expression. IGF-I could oppose COL2A1 and aggrecan gene expression inhibition by Dx. CONCLUSIONS We demonstrated for the first time by real-time quantitative PCR that human fetal epiphyseal chondrocytes expressed IGF axis components, such as IGF-I, IGF-II, IGFBP3, IGF-IR and GHR and SOX9, COL2A1 and aggrecan, and that their expression was regulated by Dx and IGF-I. Among IGFs, IGF-I and not IGF-II expression was demonstrated to be down-regulated by GCs whereas IGF-I expression was up-regulated by itself.
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Affiliation(s)
- M Fernandez-Cancio
- Pediatric Endocrinology Research Unit, Hospital Vall d'Hebron, Autonomous University, Barcelona, Spain.
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