scholarly journals Four Novel Mutations of the LHX3 Gene Cause Combined Pituitary Hormone Deficiencies with or without Limited Neck Rotation

2007 ◽  
Vol 92 (5) ◽  
pp. 1909-1919 ◽  
Author(s):  
Roland W. Pfaeffle ◽  
Jesse J. Savage ◽  
Chad S. Hunter ◽  
Christina Palme ◽  
Martina Ahlmann ◽  
...  
Keyword(s):  
Dna Binding ◽  
Gh Deficiency ◽  
Gene Activation ◽  
Gene Mutations ◽  
Biochemical Properties ◽  
Hormone Deficiency ◽  
Pituitary Hormone ◽  
Molecular Defects ◽  
Recessive Mutations ◽  
Neck Rotation

Abstract Context: The Lhx3 LIM-homeodomain transcription factor gene is required for development of the pituitary and motoneurons in mice. Human LHX3 gene mutations have been reported in five subjects with a phenotype consisting of GH, prolactin, TSH, LH, and FSH deficiency; abnormal pituitary morphology; and limited neck rotation. Objective: The objective of the study was to determine the frequency and nature of LHX3 mutations in patients with isolated GH deficiency or combined pituitary hormone deficiency (CPHD) and characterize the molecular consequences of mutations. Design: The LHX3 sequence was determined. The biochemical properties of aberrant LHX3 proteins resulting from observed mutations were characterized using reporter gene and DNA binding experiments. Patients: The study included 366 patients with isolated GH deficiency or CPHD. Results: In seven patients with CPHD from four consanguineous pedigrees, four novel, recessive mutations were identified: a deletion of the entire gene (del/del), mutations causing truncated proteins (E173ter, W224ter), and a mutation causing a substitution in the homeodomain (A210V). The mutations were associated with diminished DNA binding and pituitary gene activation, consistent with observed hormone deficiencies. Whereas subjects with del/del, E173ter, and A210V mutations had limited neck rotation, patients with the W224ter mutation did not. Conclusions: LHX3 mutations are a rare cause of CPHD involving deficiencies for GH, prolactin, TSH, and LH/FSH in all patients. Whereas most patients have a severe hormone deficiency manifesting after birth, milder forms can be observed, and limited neck rotation is not a universal feature of patients with LHX3 mutations. This study extends the known molecular defects and range of phenotypes found in LHX3-associated diseases.

scholarly journals Three Novel Missense Mutations within the LHX4 Gene Are Associated with Variable Pituitary Hormone Deficiencies

2008 ◽  
Vol 93 (3) ◽  
pp. 1062-1071 ◽  
Author(s):  
Roland W. Pfaeffle ◽  
Chad S. Hunter ◽  
Jesse J. Savage ◽  
Mario Duran-Prado ◽  
Rachel D. Mullen ◽  
...  
Keyword(s):  
Dna Binding ◽  
Gh Deficiency ◽  
Gene Activation ◽  
Nervous System Development ◽  
Hormone Deficiency ◽  
Pituitary Hormone ◽  
Gene Promoters ◽  
Missense Mutations ◽  
Pituitary Hormone Deficiency ◽  
Combined Pituitary Hormone Deficiency

Abstract Context: The LHX4 LIM-homeodomain transcription factor has essential roles in pituitary gland and nervous system development. Heterozygous mutations in LHX4 are associated with combined pituitary hormone deficiency. Objectives: Our objectives were to determine the nature and frequency of LHX4 mutations in patients with pituitary hormone deficiency and to examine the functional outcomes of observed mutations. Design: The LHX4 gene sequence was determined from patient DNA. The biochemical and gene regulatory properties of aberrant LHX4 proteins were characterized using structural predictions, pituitary gene transcription assays, and DNA binding experiments. Patients: A total of 253 patients from 245 pedigrees with GH deficiency and deficiency of at least one additional pituitary hormone was included in the study. Results: In five patients, three types of heterozygous missense mutations in LHX4 that result in substitution of conserved amino acids were identified. One substitution is between the LIM domains (R84C); the others are in the homeodomain (L190R; A210P). The patients have GH deficiency; some also display reductions in TSH, LH, FSH, or ACTH, and aberrant pituitary morphology. Structural models predict that the aberrant L190R and A210P LHX4 proteins would have impaired DNA binding and gene activation properties. Consistent with these models, EMSAs and transfection experiments using pituitary gene promoters demonstrate that whereas the R84C form has reduced activity, the L190R and A210P proteins are inactive. Conclusions: LHX4 mutations are a relatively rare cause of combined pituitary hormone deficiency. This report extends the range of phenotypes associated with LHX4 gene mutations and describes three novel exonic mutations in the gene.

scholarly journals Clinical and genetic features of patients with multiple anterior pituitary hormone deficiency caused by mutations in the PROP1 gene; the efficacy of recombinant growth hormone therapy

2017 ◽  
Vol 63 (2) ◽  
pp. 72-81 ◽  
Author(s):  
Anna E. Gavrilova ◽  
Elena V. Nagaeva ◽  
Tatiana Yu. Shiryaeva ◽  
Olga Yu. Rebrova ◽  
Anatoly N. Tiulpakov ◽  
...  
Keyword(s):  
Growth Hormone ◽  
Gh Deficiency ◽  
Final Height ◽  
Gene Mutations ◽  
Hormone Deficiency ◽  
Pituitary Hormone ◽  
Recombinant Growth Hormone ◽  
Secondary Hypothyroidism ◽  
Prop1 Gene ◽  
Secondary Hypogonadism

Rationale. One of the most common causes of multiple anterior pituitary hormone deficiency (MPHD) is genetic defects in the PROP1 gene. PROP1 deficiency leads to malfunction of somatotrophs, lactotrophs, thyrotrophs, corticotrophs, and gonadotrophs. Now, there is an opportunity to conduct large-scale population studies of patients with genetic MPHD, describe their clinical and genetic heterogeneity, and evaluate the efficacy of long-term therapy of these patients with a recombinant growth hormone (rGH). Aim. The study aim was to assess the spectrum of PROP1 gene mutations in the Russian population of MPHD patients, rate and expected age of hypopituitarism components, and efficacy of rGH therapy. Material and methods. We analyzed the data of 27 patients diagnosed with MPHD and genetically confirmed mutations in the PROP1 gene who were treated at the Institute of Pediatric Endocrinology of the Endocrinology Research Center (ERC) in 1978―2016. MPHD was diagnosed based on laboratory data and stimulatory tests characterizing the functional activity of the pituitary gland. The molecular genetic study was performed using high-performance parallel sequencing. We used a custom Ampliseq_HP primer panel developed at the Department of Hereditary Endocrinopathies of the ERC, which included coding regions of the following genes: ARNT2, GH1, GHRH, GHRHR, GHSR, GLI2, HESX1, LHX3, LHX4, OTX2, PAX6, POU1F1, PROP1, SHH, SOX2, and SOX3. All patients received rGH therapy at a growth-stimulating dose from the time of GH deficiency diagnosis until final height completion. We evaluated the efficacy of therapy by comparing the achieved final height with the genetically expected one. Results. Non-familial cases prevailed (N=23) in the study cohort of patients with MPHD caused by mutations in the PROP1 gene; only two patients were monochorionic twin sisters; the other two patients were siblings. An analysis of the distribution of PROP1 gene mutations revealed a hot-point mutation c.301_302delAG in 24 patients (89%, 95% CI 71%; 98%). A mutation in the c.150delA locus occurred in 11 patients (41%, 95% CI 22%; 61%). Two patients had other mutations (c.629delC and c.43_49delGGGCGAG). Total GH deficiency was detected in all patients. The rate of secondary hypothyroidism (SHT) in patients of the study sample was 78% (95% CI 58%; 91%) at the time of diagnosis of GH deficiency and 100% (95% CI 81%; 100%) at the time of final height. The rate of secondary hypogonadism (SHG) at the time of final height was 100% (95% CI 81%; 100%), and the rate of secondary hypocorticism (SHC) was 41% (95% CI 22%; 61%). The normal level of prolactin was detected in 83% (95% CI 65%; 94%) of patients. At the time of growth plate closure, patients receiving rGH therapy at the growth-stimulating dose achieved the genetically expected final height. Conclusion. According to our findings, the most common mutation in the PROP1 gene is a deletion of AG nucleotides in the 101 codon (c.301_302 delAG), which is found in 89% (95% CI 71%; 98) patients. Patients with MPHD caused by mutations in the PROP1 gene have total GH deficiency and are diagnosed with secondary hypothyroidism and secondary hypogonadism in 100% of cases. The possibility of delayed manifestation of hypopituitarism components requires regular screening of tropic hormone levels for the timely start of substitution therapy and prevention of life-threatening conditions. rGH therapy is highly effective for GH deficiency caused by PROP1 gene mutations and allows patients to achieve the genetically expected height in the case of early diagnosis of growth hormone deficiency.

Growth hormone replacement for patients with adult onset growth hormone deficiency—what have we learned?

2004 ◽  
Vol 16 (4) ◽  
pp. 1-6
Author(s):  
Monique Piersanti
Keyword(s):  
Growth Hormone ◽  
Gh Deficiency ◽  
Hormone Replacement ◽  
Hormone Deficiency ◽  
Pituitary Hormone ◽  
Adult Onset ◽  
Gh Replacement ◽  
Term Benefit

Growth hormone (GH) deficiency is a condition recognized to occur in individuals who have had multiple pituitary hormone deficiencies as a result of pathological processes or neurosurgical interventions. The indications, benefits, and risks of GH replacement therapy will be reviewed with an emphasis on those patients who were adults with the deficiency first emerged. The results of this analysis indicate that, although a measurable improvement can be detected in the patient's quality of life, body composition, and some cardiovascular parameters, the larger questions of long-term benefit and patient selection currently remain unanswered.

scholarly journals A Novel Mutation in the LHX3 Gene is Responsible for Combined Pituitary Hormone Deficiency, Hearing Impairment, and Vertebral Malformations

Endocrinology ◽  
2009 ◽  
Vol 150 (2) ◽  
pp. 1069-1069 ◽  
Author(s):  
Berit Kriström ◽  
Anna-Maija Zdunek ◽  
Anders Rydh ◽  
Håkan Jonsson ◽  
Petra Sehlin ◽  
...  
Keyword(s):  
Hearing Impairment ◽  
Novel Mutation ◽  
Hormone Deficiency ◽  
Splice Acceptor Site ◽  
Candidate Gene Approach ◽  
Pituitary Hormone ◽  
Acceptor Site ◽  
Pituitary Hormone Deficiency ◽  
Combined Pituitary Hormone Deficiency ◽  
Neck Rotation

Abstract Context: The LHX3 LIM-homeodomain transcription factor gene, found in both man and mouse, is required for development of the pituitary and motor neurons and is also expressed in the auditory system. Objective: The objective of this study was to determine the cause of, and further explore, the phenotype in six patients (aged 6 months to 22 years) with combined pituitary hormone deficiency (CPHD), restricted neck rotation, scoliosis and congenital hearing impairment. Three of the patients also have mild autistic-like behaviour. Design: As patients with CPHD and restricted neck rotation have previously been shown to have mutations in the LHX3 gene, a candidate gene approach was applied and the gene was sequenced. Neck anatomy was explored by computed tomography and magnetic resonance imaging, including three-dimensional reformatting. Results: A novel, recessive, splice-acceptor site mutation was found. The predicted protein encoded by the mutated gene lacks the homeodomain and carboxyl terminus of the normal, functional protein. Genealogical studies revealed a common gene source for all six families dating back to the seventeenth century. Anatomical abnormalities in the occipito–atlanto–axial joints in combination with a basilar impression of the dens axis were found in all patients assessed. Conclusions: This study extends both the mutations known to be responsible for LHX3-associated syndromes and their possible phenotypic consequences. Previously reported traits include CPHD and restricted neck rotation; patients examined in the present study also show a severe hearing defect. Additionally the existence of cervical vertebral malformations are revealed, responsible for the rigid neck and the development of scoliosis.

scholarly journals Novel Mutations within the POU1F1 Gene Associated with Variable Combined Pituitary Hormone Deficiency

2005 ◽  
Vol 90 (8) ◽  
pp. 4762-4770 ◽  
Author(s):  
James P. G. Turton ◽  
Rachel Reynaud ◽  
Ameeta Mehta ◽  
John Torpiano ◽  
Alexandru Saveanu ◽  
...  
Keyword(s):  
Dna Binding ◽  
Mutational Analysis ◽  
Hot Spot ◽  
Dominant Negative ◽  
Hormone Deficiency ◽  
Pituitary Hormone ◽  
Novel Mutations ◽  
Pituitary Hormone Deficiency ◽  
Combined Pituitary Hormone Deficiency ◽  
Functional Studies

Context: Mutations within the gene encoding the pituitary-specific transcription factor POU1F1 are associated with combined pituitary hormone deficiency (CPHD). Most of the affected individuals manifest GH, prolactin, and TSH deficiency. Objective: We have now screened 129 individuals with CPHD and isolated GH deficiency for mutations within POU1F1. Results: Causative mutations were identified in 10 of 129 individuals (7.8%). Of these, five patients harbored the dominant negative R271W mutation, which is a well-recognized mutational hot spot. We have also identified a second frequently occurring mutation, E230K, which appears to be common in Maltese patients. Additionally, we describe two novel mutations within POU1F1, an insertion of a single base pair (ins778A) and a missense mutation (R172Q). Functional studies have revealed that POU1F1 (E230K) is associated with a reduction in transactivation, although DNA-binding affinity is similar to the wild-type protein. On the other hand, POU1F1 (R172Q) is associated with a reduction in DNA binding and transactivation, whereas POU1F1 (ins778A) is associated with loss of DNA binding and a reduction in transactivation. Conclusions: Our data suggest that the phenotype associated with POU1F1 mutations may be more variable, with the occasional preservation of TSH secretion. Additionally, our data revealed POU1F1 mutations in three patients who were diagnosed as having ACTH deficiency but who, on further evaluation, were found to have normal cortisol secretion. Hence, elucidation of the genotype led to further evaluation of the phenotype, with the cessation of cortisol replacement that had been commenced unnecessarily. These data reflect the importance of mutational analysis in patients with CPHD.

scholarly journals Pituitary Stalk Interruption Syndrome and Isolated Pituitary Hypoplasia May Be Caused by Mutations in Holoprosencephaly-Related Genes

2013 ◽  
Vol 98 (4) ◽  
pp. E779-E784 ◽  
Author(s):  
Christina Tatsi ◽  
Amalia Sertedaki ◽  
Antonis Voutetakis ◽  
Eleni Valavani ◽  
Maria-Alexandra Magiakou ◽  
...  
Keyword(s):  
Phenotypic Variability ◽  
Gene Mutations ◽  
Pituitary Stalk ◽  
Hormone Deficiency ◽  
Molecular Defect ◽  
Pituitary Hormone ◽  
Developmental Defect ◽  
Central Incisor ◽  
Related Gene ◽  
Pituitary Hypoplasia

Context: Holoprosencephaly (HPE) is a developmental defect characterized by wide phenotypic variability, ranging from minor midline malformations (eg, single central incisor) to severe deformities. In 10–15% of HPE patients, mutations in specific genes have been identified (eg, SHH, TGIF, SIX3). Pituitary stalk interruption syndrome (PSIS) constitutes a distinct abnormality of unknown pathogenesis, whereas isolated pituitary hypoplasia (IPH) has been linked to various developmental genes. Objective: Three of our patients with PSIS had a single central incisor, a malformation encountered in some HPE cases. Based on this observation, we initiated a search for mutations in HPE-associated genes in 30 patients with PSIS or IPH. Design and Participants: The entire coding region of the TGIF, SHH, and SIX3 genes was sequenced in patients with combined pituitary hormone deficiency associated with either PSIS or IPH and in healthy controls. Results: Two novel mutations in the HPE-related genes were detected (ie, c.799 C>T, p.Q267X in the TGIF gene, and c.1279G>A, p.G427R in the SHH gene) in 2 of our patients. The overall incidence of HPE-related gene mutations in our nonsyndromic and nonchromosomal patients was 6.6%. No molecular defect in the SIX3 gene was detected in our cohort. Conclusions: The data suggest that HPE-related gene mutations are implicated in the etiology of isolated pituitary defects (PSIS or IPH). Alternatively, PSIS or IPH may constitute mild forms of an expanded HPE spectrum.

scholarly journals Molecular analysis of the PROP1 and HESX1 genes in patients with septo-optic dysplasia and/or pituitary hormone deficiency

2010 ◽  
Vol 54 (5) ◽  
pp. 482-487 ◽  
Author(s):  
Juliana B. Cruz ◽  
Vania S. Nunes ◽  
Sueli A. Clara ◽  
Denise Perone ◽  
Peter Kopp ◽  
...  
Keyword(s):  
Gene Mutations ◽  
Genetic Alterations ◽  
Hormone Deficiency ◽  
Pituitary Hormone ◽  
Pituitary Hormone Deficiency ◽  
Exon 1 ◽  
Genetic Mechanisms ◽  
Direct Sequence Analysis ◽  
Prop1 Gene ◽  
Pathogenic Process

OBJECTIVE: The present study aimed at evaluating the PROP1 and HESX1 genes in a group of patients with septo-optic dysplasia (SOD) and pituitary hormone deficiency (combined - CPHD; isolated GH deficiency - GHD). Eleven patients with a clinical and biochemical presentation consistent with CPHD, GHD or SOD were evaluated. SUBJECTS AND METHODS: In all patients, the HESX1 gene was analyzed by direct sequence analysis and in cases of CPHD the PROP1 gene was also sequenced. RESULTS: A polymorphism (1772 A > G; N125S) was identified in a patient with SOD. We found three patients carrying the allelic variants 27 T > C; A9A and 59 A > G; N20S in exon 1 of the PROP1 gene. Mutations in the PROP1 and HESX1 genes were not identified in these patients with sporadic GHD, CPHD and SOD. CONCLUSION: Genetic alterations in one or several other genes, or non-genetic mechanisms, must be implicated in the pathogenic process.

scholarly journals From isolated GH deficiency to multiple pituitary hormone deficiency: an evolving continuum – a KIMS analysis

2009 ◽  
Vol 161 (suppl_1) ◽  
pp. S75-S83 ◽  
Author(s):  
M Klose ◽  
B Jonsson ◽  
R Abs ◽  
V Popovic ◽  
M Koltowska-Häggström ◽  
...  
Keyword(s):  
Clinical Presentation ◽  
Gh Deficiency ◽  
Dynamic Condition ◽  
Hormone Deficiency ◽  
Pituitary Hormone ◽  
Multiple Pituitary Hormone Deficiency ◽  
Pituitary Hormone Deficiency ◽  
Gh Replacement ◽  
Baseline Characteristics

ObjectiveTo describe baseline clinical presentation, treatment effects and evolution of isolated GH deficiency (IGHD) to multiple pituitary hormone deficiency (MPHD) in adult-onset (AO) GHD.DesignObservational prospective study.MethodsBaseline characteristics were recorded in 4110 patients with organic AO-GHD, who were GH naïve prior to entry into the Pfizer International Metabolic Database (KIMS; 283 (7%) IGHD, 3827 MPHD). The effect of GH replacement after 2 years was assessed in those with available follow-up data (133 IGHD, 2207 MPHD), and development of new deficiencies in those with available data on concomitant medication (165 IGHD, 3006 MPHD).ResultsIGHD and MPHD patients had similar baseline clinical presentation, and both groups responded similarly to 2 years of GH therapy, with favourable changes in lipid profile and improved quality of life. New deficiencies were observed in 35% of IGHD patients, which was similar to MPHD patients with one additional deficit other than GH. New deficiencies most often presented within the first year but were observed up to 6 years after GH commencement. Conversion of IGHD into MPHD was not predicted by aetiology, baseline characteristics, surgery or radiotherapy, whereas in MPHD additional deficits were predicted by age (P<0.001) and pituitary disease duration (P<0.01).ConclusionBoth AO-IGHD and -MPHD patients have similar baseline clinical presentation and respond equally well to 2 years of GH replacement. Hypopituitarism in adults seems to be a dynamic condition where new deficiencies can appear years after the initial diagnosis, and careful endocrine follow-up of all hypopituitary patients, including those with IGHD, is warranted.

Growth hormone-releasing activity of growth hormone-releasing peptide-1 (a synthetic heptapeptide) in children and adolescents

1993 ◽  
Vol 129 (5) ◽  
pp. 424-426 ◽  
Author(s):  
Zvi Laron ◽  
Cyril Y Bowers ◽  
Daniel Hirsch ◽  
Antonio Selman Almonte ◽  
Moshe Pelz ◽  
...  
Keyword(s):  
Growth Hormone ◽  
Children And Adolescents ◽  
Normal Values ◽  
Gh Deficiency ◽  
Clinical Applications ◽  
Hormone Deficiency ◽  
Pituitary Hormone ◽  
Pituitary Insufficiency ◽  
Healthy Children ◽  
Plasma Prolactin

The heptapeptide growth hormone-releasing peptide-1 (GHRP-1 ), one of a series of recently synthesized small growth hormone (GH)-releasing peptides, was administered as an iv bolus (1 μg/kg) to 15 (six prepubertal, nine pubertal) short but healthy children and adolescents and to eight juvenile patients with pituitary insufficiency (four with isolated growth hormone deficiency, two with multiple pituitary hormone deficiencies, one with partial GH deficiency and one with GH-releasing hormone (GHRH) deficiency). Eleven out of 23 subjects also underwent an iv GHRH (1–29) test (1 μg/kg). All the healthy children responded with a progressive rise in plasma human GH (hGH) peaking at 15–30 min, with a significantly higher rise (p<0.05) in the pubertal than prepubertal group. The hGH response to GHRH (1–29) in these children was similar or slightly higher. Six hypopituitary patients had no response to either GHRP-1 or GHRH; the patient with partial GH deficiency had a hGH peak of 6.5 μg/l (at 5 min) to GHRP-1 and 9.2 μg/l (at 1 5 min) to GHRH. One patient had no response of hGH to hypoglycemia, clonidine and GHRP-1, but the plasma hGH rose to 10 μg/l after GHRH. Following the GHRP-1 bolus there was a significant (p <0.01) rise in plasma free thyroxine and a decrease of thyrotropin (p <0.01), both in the limits of normal values. There was also a transitory rise of plasma cortisol (p <0.05). Plasma prolactin, luteinizing hormone and follicle-stimulating hormone did not change. It is concluded that GHRP-1 is a potent GH-releasing drug because it acts also when administered orally and has great pharmaceutical and clinical applications.

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