title: Influence of the fibroblast growth factor receptor 4 expression and the G388R functional polymorphism on Cushing's disease outcome.
abstract: BACKGROUND
  Abnormal FGFR4 expression has been detected in pituitary tumors, especially in larger and invasive adenomas. In addition, the FGFR4 functional polymorphism G388R has been associated with poor outcome in several human malignancies. Then, we hypothesized that FGFR4 expression and genotype could be markers of adverse outcome of Cushing's disease after transsphenoidal surgery.
  
  
  OBJECTIVE
  The objective was to investigate whether there is an association between the postoperative outcome of Cushing's disease (remission/recurrence) and the FGFR4 G388R genotype or the FGFR4 expression in corticotrophinomas.
  
  
  METHODS
  Clinical, hormonal, and pathological data of 76 patients who underwent the first transsphenoidal surgery were retrospectively reviewed. All patients were genotyped for G388R polymorphism. FGFR4 expression was assessed by real-time PCR in 18 corticotrophinomas.
  
  
  METHODS
  The outcome measures included the FGFR4 G388R genotype and FGFR4 expression in postoperative remission and recurrence of Cushing's disease.
  
  
  RESULTS
  Homozygosis for FGFR4 glycine (Gly(388)) allele was associated with reduced disease-free survival, in the univariate analysis (hazard ratio of 6.91; 95% confidence interval of 1.14-11.26; P = 0.028). Male gender (P = 0.036), lack of pathology confirmation (P = 0.009), and cortisol levels more than 2 μg/dl in the early postoperative period (P < 0.001) were also significant predictors of Cushing's disease recurrence in the univariate analysis. FGFR4 overexpression was found in 44% of the corticotrophinomas, and it was associated with lower postoperative remission rate (P = 0.009).
  
  
  CONCLUSIONS
  Our data suggest that homozygosis for FGFR4 Gly(388) allele and FGFR4 overexpression are associated with higher frequency of postoperative recurrence and persistence of Cushing's disease, respectively.
authors.affiliation: Unidade de Endocrinologia do Desenvolvimento, Laboratorio de Hormonios e Genetica Molecular LIM/42, Faculdade de Medicina da Universidade de Sao Paulo, São Paulo, Brazil. lucpbrito@gmail.com
authors.forename: Luciana Pinto
authors.initials: LP
authors.lastname: Brito
authors.forename: Antonio Marcondes
authors.initials: AM
authors.lastname: Lerário
authors.forename: Marcello Delano
authors.initials: MD
authors.lastname: Bronstein
authors.forename: Iberê Cauduro
authors.initials: IC
authors.lastname: Soares
authors.forename: Berenice Bilharinho
authors.initials: BB
authors.lastname: Mendonca
authors.forename: Maria Candida Barisson Villares
authors.initials: MC
authors.lastname: Fragoso
mesh_terms: D049913:ACTH-Secreting Pituitary Adenoma / Q000175:diagnosis / Q000235:genetics / Q000601:surgery; D000293:Adolescent; D000328:Adult; D019943:Amino Acid Substitution / Q000235:genetics; D001120:Arginine / Q000235:genetics; D002648:Child; D005260:Female; D015870:Gene Expression / Q000502:physiology; D005998:Glycine / Q000235:genetics; D006801:Humans; D007016:Hypophysectomy; D008297:Male; D008875:Middle Aged; D047748:Pituitary ACTH Hypersecretion / Q000175:diagnosis / Q000235:genetics* / Q000601:surgery; D010911:Pituitary Neoplasms / Q000175:diagnosis / Q000235:genetics / Q000601:surgery; D020641:Polymorphism, Single Nucleotide / Q000502:physiology; D011379:Prognosis; D051499:Receptor, Fibroblast Growth Factor, Type 4 / Q000235:genetics* / Q000502:physiology; D012008:Recurrence; D012189:Retrospective Studies; D016896:Treatment Outcome; D055815:Young Adult
chemical_list: D001120:Arginine; D051499:Receptor, Fibroblast Growth Factor, Type 4; D005998:Glycine