PROP1 mutations cause progressive deterioration of anterior pituitary function including adrenal insufficiency: a longitudinal analysis.
Mutations in the PROP1 gene are the most frequent genetic defects in patients with combined pituitary hormone insufficiency. However, controversy exists about the timing and extent of pituitary insufficiency, and it remains unclear whether adrenal failure is a typical feature of this condition. We performed a retrospective longitudinal analysis of nine patients with PROP1 mutations who were under medical supervision at our clinic for 15.7 +/- 3.4 yr. All patients initially presented with growth failure (height sd score, -3.7 +/- 0.3) at a mean age of 4.9 +/- 0.8 yr. They were first diagnosed with GH and TSH deficiency, and replacement therapy was instituted at 6.1 +/- 1.1 and 6.8 +/- 1.2 yr, respectively. All seven patients who reached pubertal age required sex hormone substitution at 15.0 +/- 0.7 yr. Repeated functional testing of the anterior pituitary axes revealed a progressive decline with age in peak levels of GH, TSH, prolactin, and LH/FSH. All patients developed at least partial adrenal insufficiency, with a gradual decline of the function of the pituitary adrenal axis and eventually required substitution with hydrocortisone at a mean age of 18.4 +/- 3.5 yr. It is concluded that anterior pituitary function in patients with PROP1 mutations deteriorates progressively and includes adrenal insufficiency as a feature of this condition, which has important clinical relevance in childhood and adolescence.
University Hospital for Children and Adolescents, University of Leipzig, Oststrasse 21-25, 04317 Leipzig, Germany. antje.boettner@medizin.uni-leipzig.de
Antje
A
Böttner
Eberhard
E
Keller
Jürgen
J
Kratzsch
Heike
H
Stobbe
Johannes F W
JF
Weigel
Alexandra
A
Keller
Wolfgang
W
Hirsch
Wieland
W
Kiess
Werner F
WF
Blum
Roland W
RW
Pfäffle
D000293:Adolescent; D000309:Adrenal Insufficiency / Q000235:genetics* / Q000503:physiopathology*; D000328:Adult; D002648:Child; D002675:Child, Preschool; D005260:Female; D005500:Follow-Up Studies; D018398:Homeodomain Proteins / Q000235:genetics*; D006801:Humans; D007018:Hypopituitarism / Q000235:genetics / Q000473:pathology / Q000503:physiopathology; D008137:Longitudinal Studies; D008297:Male; D010641:Phenotype; D010900:Pituitary Diseases / Q000235:genetics* / Q000473:pathology / Q000503:physiopathology*; D010903:Pituitary Gland, Anterior / Q000473:pathology
D018398:Homeodomain Proteins; C102134:Prophet of Pit-1 protein