An intronic growth hormone receptor mutation causing activation of a pseudoexon is associated with a broad spectrum of growth hormone insensitivity phenotypes.
BACKGROUND
Inherited GH insensitivity (GHI) is usually caused by mutations in the GH receptor (GHR). Patients present with short stature associated with high GH and low IGF-I levels and may have midfacial hypoplasia (typical Laron syndrome facial features). We previously described four mildly affected GHI patients with an intronic mutation in the GHR gene (A(-1)-->G(-1) substitution in intron 6), resulting in the activation of a pseudoexon (6Psi) and inclusion of 36 amino acids.


OBJECTIVE
The study aimed to analyze the clinical and genetic characteristics of additional GHI patients with the pseudoexon (6Psi) mutation.


METHODS
Auxological, biochemical, genetic, and haplotype data from seven patients with severe short stature and biochemical evidence of GHI were assessed.


METHODS
We assessed genotype-phenotype relationship.


RESULTS
One patient belongs to the same extended family, previously reported. She has normal facial features, and her IGF-I levels are in the low-normal range for age. The six unrelated patients, four of whom have typical Laron syndrome facial features, have heights ranging from -3.3 to -6.0 sd and IGF-I levels that vary from normal to undetectable. We hypothesize that the marked difference in biochemical and clinical phenotypes might be caused by variations in the splicing efficiency of the pseudoexon.


CONCLUSIONS
Activation of the pseudoexon in the GHR gene can lead to a variety of GHI phenotypes. Therefore, screening for the presence of this mutation should be performed in all GHI patients without mutations in the coding exons.
David
A
A
Centre for Endocrinology, William Harvey Research Institute, University of London, London EC1M 6BQ, United Kingdom.
Camacho-Hübner
C
C
Bhangoo
A
A
Rose
S J
SJ
Miraki-Moud
F
F
Akker
S A
SA
Butler
G E
GE
Ten
S
S
Clayton
P E
PE
Clark
A J L
AJ
Savage
M O
MO
Metherell
L A
LA
D000293:Adolescent; D000328:Adult; D001827:Body Height / Q000235:genetics; D002352:Carrier Proteins / Q000235:genetics* / Q000378:metabolism*; D002648:Child; D004252:DNA Mutational Analysis; D005091:Exons / Q000235:genetics; D005260:Female; D006130:Growth Disorders / Q000235:genetics* / Q000378:metabolism; D006239:Haplotypes; D019382:Human Growth Hormone / Q000378:metabolism*; D006801:Humans; D007438:Introns / Q000235:genetics; D008297:Male; D010375:Pedigree; D010641:Phenotype; D011544:Pseudogenes / Q000502:physiology*; D012326:RNA Splicing; D012720:Severity of Illness Index
D002352:Carrier Proteins; D019382:Human Growth Hormone; C051815:somatotropin-binding protein