title: Polycythemia and paraganglioma with a novel somatic HIF2A mutation in a male.
abstract: Recently, a new syndrome of paraganglioma, somatostatinoma, and polycythemia has been discovered (known as Pacak-Zhuang syndrome). This new syndrome, with somatic HIF2A gain-of-function mutations, has never been reported in male patients. We describe a male patient with Pacak-Zhuang syndrome who carries a newly discovered HIF2A mutation. Congenital polycythemias have diverse etiologies, including germline mutations in the oxygen-sensing pathway. These include von Hippel-Lindau (Chuvash polycythemia), prolyl hydroxylase domain-containing protein-2, and hypoxia-inducible factor-2α (HIF-2α). Somatic gain-of-function mutations in the gene encoding HIF-2α were reported in patients with paraganglioma and polycythemia and have been found exclusively in female patients. Through sequencing of the HIF2A using DNA from paraganglioma in 15-year-old male patient, we identified a novel mutation of HIF2A: a heterozygous C to A substitution at base 1589 in exon 12 of HIF2A. The mutation was not found in germline DNA from leukocytes. The C1589A mutations resulted in substitution of alanine 530 in the HIF-2α protein with glutamic acid. This mutation is undoubtedly associated with increased HIF-2α activity and increased protein half-life, because it affects the vicinity of the prolyl hydroxylase target residue, proline 531. To our knowledge, this is the first report describing Pacak-Zhuang syndrome with somatic gain-of-function mutation in HIF2A in a male patient. Congenital polycythemia of unknown origin should raise suspicion for the novel disorder Pacak-Zhuang syndrome, even in male patients.
authors.affiliation: Departments of Pediatrics, htoyoda@clin.medic.mie-u.ac.jp.
authors.forename: Hidemi
authors.initials: H
authors.lastname: Toyoda
authors.affiliation: Departments of Pediatrics.
authors.forename: Jyunya
authors.initials: J
authors.lastname: Hirayama
authors.affiliation: Hematology and Oncology, and.
authors.forename: Yuka
authors.initials: Y
authors.lastname: Sugimoto
authors.affiliation: Gastrointestinal and Pediatric Surgery, Mie University Graduate School of Medicine, Tsu, Japan; and.
authors.forename: Keiichi
authors.initials: K
authors.lastname: Uchida
authors.affiliation: Transfusion Service, Mie University Hospital, Tsu, Japan.
authors.forename: Kohshi
authors.initials: K
authors.lastname: Ohishi
authors.affiliation: Departments of Pediatrics.
authors.forename: Masahiro
authors.initials: M
authors.lastname: Hirayama
authors.affiliation: Departments of Pediatrics.
authors.forename: Yoshihiro
authors.initials: Y
authors.lastname: Komada
mesh_terms: D000008:Abdominal Neoplasms / Q000175:diagnosis* / Q000235:genetics* / Q000473:pathology / Q000601:surgery; D000293:Adolescent; D051792:Basic Helix-Loop-Helix Proteins / Q000235:genetics*; D003937:Diagnosis, Differential; D003952:Diagnostic Imaging; D004906:Erythrocyte Count; D004921:Erythropoietin / Q000097:blood; D005500:Follow-Up Studies; D006580:Genetic Carrier Screening; D006452:Hemoglobinometry; D006801:Humans; D008297:Male; D009378:Neoplasms, Multiple Primary / Q000175:diagnosis* / Q000235:genetics* / Q000473:pathology / Q000601:surgery; D009638:Norepinephrine / Q000097:blood; D010235:Paraganglioma / Q000175:diagnosis* / Q000235:genetics* / Q000473:pathology / Q000601:surgery; D011086:Polycythemia / Q000097:blood / Q000175:diagnosis* / Q000235:genetics*; D013577:Syndrome; D000099162:Endothelial PAS Domain-Containing Protein 1
chemical_list: D051792:Basic Helix-Loop-Helix Proteins; D004921:Erythropoietin; D009638:Norepinephrine; D000099162:Endothelial PAS Domain-Containing Protein 1
keywords: HIF2A; hypoxia-inducible factor-2α; paraganglioma; polycythemia; somatic mutation