title: Isolated congenital ACTH deficiency: a cleavage enzyme defect?
abstract: The pro-opiomelanocortin (POMC) gene encodes adrenocorticotrophin (ACTH) which is derived from precursors by proteolytic cleavage. Congenital, isolated ACTH deficiency is rare but may be familial and fatal. The aetiology is unknown though defects at both hypothalamus and adenohypophysis have been postulated. We have studied a female presenting with hypoglycaemia in the neonatal period. When studied at 6 weeks of age, ACTH was unmeasurable even after injection of corticotrophin releasing hormone (CRH1-41). ACTH precursors, quantitated by two-site immunoradiometric assay, were clearly measurable prior to treatment and were stimulated by CRH1-41 and suppressed by glucocorticoid administration. Concentrations of POMC, N-terminal pro-opiocortin (N-POC) and beta-endorphin (beta-EP) were within the normal adult range during glucocorticoid replacement therapy; ACTH and beta-lipotrophin remained undetectable. The secretion of glucagon, measured by radioimmunoassay, in response to hypoglycaemia was normal. By sequencing polymerase chain reaction products from the patient's genomic DNA, the entire coding region of the POMC gene was established to be normal. The results are compatible with a cleavage enzyme defect.
authors.affiliation: Department of Cellular and Molecular Sciences, St George's Hospital Medical School, London, UK.
authors.forename: S S
authors.initials: SS
authors.lastname: Nussey
authors.forename: S C
authors.initials: SC
authors.lastname: Soo
authors.forename: S
authors.initials: S
authors.lastname: Gibson
authors.forename: I
authors.initials: I
authors.lastname: Gout
authors.forename: A
authors.initials: A
authors.lastname: White
authors.forename: M
authors.initials: M
authors.lastname: Bain
authors.forename: A P
authors.initials: AP
authors.lastname: Johnstone
mesh_terms: D000302:Adrenal Cortex / Q000503:physiopathology; D000304:Adrenal Cortex Function Tests; D000324:Adrenocorticotropic Hormone / Q000172:deficiency*; D004247:DNA / Q000032:analysis; D004587:Electrophoresis, Agar Gel; D005260:Female; D006801:Humans; D007003:Hypoglycemia / Q000151:congenital* / Q000235:genetics / Q000503:physiopathology; D007223:Infant; D010447:Peptide Hydrolases / Q000378:metabolism*; D010901:Pituitary Function Tests; D010903:Pituitary Gland, Anterior / Q000503:physiopathology; D016133:Polymerase Chain Reaction; D011333:Pro-Opiomelanocortin / Q000235:genetics / Q000378:metabolism*
chemical_list: D011333:Pro-Opiomelanocortin; D000324:Adrenocorticotropic Hormone; D004247:DNA; D010447:Peptide Hydrolases