title: Molecular analysis of PROP1, PIT1, HESX1, LHX3, and LHX4 shows high frequency of PROP1 mutations in patients with familial forms of combined pituitary hormone deficiency.
abstract: Combined Pituitary Hormone Deficiency (CPHD) is a prevalent disease in Neuroendocrinology services. The genetic form of CPHD may originate from mutations in pituitary transcription factor (PTF) genes and the pituitary image in these cases may give a clue of what PTF is most probably mutated: defects in LHX4 are usually associated with ectopic posterior pituitary (EPP); defects in LHX3, PIT1, and PROP1, with normally placed posterior pituitary (NPPP); HESX1 mutations are associated with both.
  
  
  OBJECTIVE
  To identify mutations in PTF genes in patients with idiopathic hypopituitarism followed in our service, based on the presence or absence of EPP on sellar MRI.
  
  
  METHODS
  Forty patients with idiopathic hypopituitarism (36 families, 9 consanguineous), followed in the Neuroendocrinology Outpatient Clinic of UNIFESP, Brazil, were submitted to sequencing analyses of PTF genes as follows: LHX3, HESX1, PIT1, and PROP1 were sequenced in patients with NPPP (26/40) and HESX1 and LHX4 in patients with EPP (14/40).
  
  
  RESULTS
  We identified only PROP1 mutations in 9 out of 26 patients with CPHD and NPPP (35%). Since eight of them came from 4 consanguineous families, the prevalence of PROP1 mutations was higher when only consanguineous families were considered (44%, 4/9). At the end of the study, we decided to sequence PROP1 in patients with EPP, just to confirm that they were not candidates for PROP1 mutations. No patients with EPP had PROP1 or other PTF mutations.
  
  
  CONCLUSIONS
  Patients with idiopathic CPHD and NPPP, born from consanguineous parents, are the strong candidates for PROP1 mutations. Other developmental gene(s) may be involved in the genesis of idiopathic hypopituitarism associated with EPP.
authors.affiliation: Division of Endocrinology, Department of Medicine, Universidade Federal de São Paulo, São Paulo, SP.
authors.forename: Teresa C
authors.initials: TC
authors.lastname: Vieira
authors.forename: Valter T
authors.initials: VT
authors.lastname: Boldarine
authors.forename: Julio
authors.initials: J
authors.lastname: Abucham
mesh_terms: D000293:Adolescent; D000328:Adult; D002648:Child; D004252:DNA Mutational Analysis; D005260:Female; D020022:Genetic Predisposition to Disease / Q000235:genetics; D018398:Homeodomain Proteins / Q000235:genetics*; D006801:Humans; D007018:Hypopituitarism / Q000175:diagnosis / Q000235:genetics*; D060850:LIM-Homeodomain Proteins; D008279:Magnetic Resonance Imaging; D008297:Male; D020125:Mutation, Missense; D010909:Pituitary Hormones, Posterior / Q000172:deficiency / Q000235:genetics; D017422:Sequence Analysis, DNA; D050817:Transcription Factor Pit-1 / Q000235:genetics*; D014157:Transcription Factors / Q000235:genetics*
chemical_list: C489736:HESX1 protein, human; D018398:Homeodomain Proteins; C486362:LHX4 protein, human; D060850:LIM-Homeodomain Proteins; C094898:Lhx3 protein; D010909:Pituitary Hormones, Posterior; C102134:Prophet of Pit-1 protein; D050817:Transcription Factor Pit-1; D014157:Transcription Factors