RESUMO
SUMMARY We present the unique case of an adult Brazilian woman with severe short stature due to growth hormone deficiency with a heterozygous G to T substitution in the donor splice site of intron 3 of the growth hormone 1 (GH1) gene (c.291+1G>T). In this autosomal dominant form of growth hormone deficiency (type II), exon 3 skipping results in expression of the 17.5 kDa isoform of growth hormone, which has a dominant negative effect over the bioactive isoform, is retained in the endoplasmic reticulum, disrupts the Golgi apparatus, and impairs the secretion of other pituitary hormones in addition to growth hormone deficiency. This mechanism led to the progression of central hypothyroidism in the same patient. After 5 years of growth and thyroid hormone replacement, at the age of 33, laboratory evaluation for increased weight gain revealed high serum and urine cortisol concentrations, which could not be suppressed with dexamethasone. Magnetic resonance imaging of the sella turcica detected a pituitary macroadenoma, which was surgically removed. Histological examination confirmed an adrenocorticotropic hormone (ACTH)-secreting pituitary macroadenoma. A ubiquitin-specific peptidase 8 (USP8) somatic pathogenic variant (c.2159C>G/p.Pro720Arg) was found in the tumor. In conclusion, we report progression of isolated growth hormone deficiency due to a germline GH1 variant to combined pituitary hormone deficiency followed by hypercortisolism due to an ACTH-secreting macroadenoma with a somatic variant in USP8 in the same patient. Genetic studies allowed etiologic diagnosis and prognosis of this unique case.
Assuntos
Humanos , Feminino , Adulto , Hormônio do Crescimento Humano , Hipersecreção Hipofisária de ACTH , Nanismo Hipofisário/genética , Endopeptidases/genética , Ubiquitina Tiolesterase/genética , Complexos Endossomais de Distribuição Requeridos para Transporte/genética , Células Germinativas , MutaçãoRESUMO
We present the unique case of an adult Brazilian woman with severe short stature due to growth hormone deficiency with a heterozygous G to T substitution in the donor splice site of intron 3 of the growth hormone 1 (GH1) gene (c.291+1G>T). In this autosomal dominant form of growth hormone deficiency (type II), exon 3 skipping results in expression of the 17.5 kDa isoform of growth hormone, which has a dominant negative effect over the bioactive isoform, is retained in the endoplasmic reticulum, disrupts the Golgi apparatus, and impairs the secretion of other pituitary hormones in addition to growth hormone deficiency. This mechanism led to the progression of central hypothyroidism in the same patient. After 5 years of growth and thyroid hormone replacement, at the age of 33, laboratory evaluation for increased weight gain revealed high serum and urine cortisol concentrations, which could not be suppressed with dexamethasone. Magnetic resonance imaging of the sella turcica detected a pituitary macroadenoma, which was surgically removed. Histological examination confirmed an adrenocorticotropic hormone (ACTH)-secreting pituitary macroadenoma. A ubiquitin-specific peptidase 8 (USP8) somatic pathogenic variant (c.2159C>G/p.Pro720Arg) was found in the tumor. In conclusion, we report progression of isolated growth hormone deficiency due to a germline GH1 variant to combined pituitary hormone deficiency followed by hypercortisolism due to an ACTH-secreting macroadenoma with a somatic variant in USP8 in the same patient. Genetic studies allowed etiologic diagnosis and prognosis of this unique case.
Assuntos
Nanismo Hipofisário , Hormônio do Crescimento Humano , Hipersecreção Hipofisária de ACTH , Adulto , Nanismo Hipofisário/genética , Endopeptidases/genética , Complexos Endossomais de Distribuição Requeridos para Transporte/genética , Feminino , Células Germinativas , Humanos , Mutação , Ubiquitina Tiolesterase/genéticaRESUMO
Pituitary hormone deficiency occurs in â¼1:4,000 live births. Approximately 3% of the cases are due to mutations in the alpha isoform of POU1F1, a pituitary-specific transcriptional activator. We found four separate heterozygous missense variants in unrelated individuals with hypopituitarism that were predicted to affect a minor isoform, POU1F1 beta, which can act as a transcriptional repressor. These variants retain repressor activity, but they shift splicing to favor the expression of the beta isoform, resulting in dominant-negative loss of function. Using a high-throughput splicing reporter assay, we tested 1,070 single-nucleotide variants in POU1F1. We identified 96 splice-disruptive variants, including 14 synonymous variants. In separate cohorts, we found two additional synonymous variants nominated by this screen that co-segregate with hypopituitarism. This study underlines the importance of evaluating the impact of variants on splicing and provides a catalog for interpretation of variants of unknown significance in POU1F1.
Assuntos
Ensaios de Triagem em Larga Escala/métodos , Hipopituitarismo/patologia , Mutação , Hormônios Hipofisários/deficiência , Splicing de RNA/genética , Fator de Transcrição Pit-1/genética , Adolescente , Adulto , Criança , Pré-Escolar , Humanos , Hipopituitarismo/etiologia , Hipopituitarismo/metabolismo , Masculino , LinhagemRESUMO
O HESX1 é um gene envolvido na embriogênese cerebral e hipofisária. A primeira mutação (R160C) foi associada à displasia septo óptica e hipopituitarismo, seguida de 4 mutações associadas a fenótipos mais leves. Entre 80 pacientes com deficiência de GH (DGH) isolada ou associada a outras deficiências hormonais, identificamos a mutação N125S, previamente descrita como polimorfismo afro-caribenho, em 4 pacientes com hipopituitarismo e a mutação I26T em uma paciente com hipopituitarismo evolutivo. A mutação I26T localiza-se no domínio eh1 implicado na repressão da transcrição. Nos ensaios de gel shift a mutação I26T apresenta ligação à sonda P3 semelhante a do selvagem e nos experimentos de transfecção transitória ocorre um prejuízo na repressão da transcrição por dificuldade de recrutar o co-repressor TLE-1.HESX1 is a gene involved in cerebral and pituitary embriogenesis. The first mutation (R160C) was associated with septo optic dysplasia and hypopituitarism, followed by 4 mutations associated with mild phenotypes. Among 80 patients with growth hormone deficiency isolated or combined with other hormonal deficiencies, we identified N125S mutation, previously described as afro-caribean polymorphism, in 4 patients with hypopituitarism and 126T mutation in a patient with envolving hypopituitarism. I26T mutation lies on eh1 domain implicated with repression of the transcription. In the gel shift assays, 126T mutation present a similar binding to the P3 probe as the wild type and transient transfection assays show an impaired repression due to difficulty to recruit corepressor...
Assuntos
Humanos , Masculino , Feminino , Hipopituitarismo/diagnóstico , Hipopituitarismo/etiologia , Hormônio do Crescimento/deficiência , Hormônio do Crescimento/genética , Inativação Gênica , Mutação Puntual/genética , FenótipoRESUMO
Os autores relatam um caso de uma paciente do sexo feminino, com idade cronológica de sete anos, idade óssea de 11 anos, aparecimento de mamas Tanner III bilateralmente, cuja investigação diagnóstica confirmou quadro de puberdade precoce dependente de gonadotrofinas, e a ressonância magnética da hipófise evidenciou duplicação da haste e da glândula hipofisária associada a hamartoma hipotalâmico.
The authors report a case of a female patient with chronological age of 7 years and bone age of 11 years, presenting with bilateral breast stage Tanner III and gonadotrophin-dependent precocious puberty. Magnetic resonance imaging of the sellar region demonstrated duplication of the pituitary gland and stalk associated with a hypothalamic hamartoma.
Assuntos
Humanos , Feminino , Criança , Adeno-Hipófise , Hipófise/anormalidades , Hipófise/fisiopatologia , Doenças da Hipófise , Puberdade Precoce/complicações , Leuprolida/administração & dosagem , Imageamento por Ressonância MagnéticaRESUMO
A incidência do Carcinoma adrenocortical é aproximadamente de 1 : 1.7000.000. Isso perfaz somente 0.025 dos tumores malignos. A manifestação clínica depende dos hormônios predominantemente produzidos, estando a sindrome de cushing presente em 30-40 (por cento) dos pacientes com carcinoma adrenocortical e a virilização ocorrendo em 20-30 (por cento) dos adultos. Relatamos o caso de uma paciente que se apresentou com quadro clínico de virilização às custas de carcinoma adrenocortical produtor de andrógenos (principlamente testoterona), associado à produção de cortisol, não tendo sido exuberante o quadro clínico de Síndrome de Cushing, devido ao curto tempo de duração da doença