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An Atypical Case of Familial Glucocorticoid Deficiency without Pigmentation Caused by Coexistent Homozygous Mutations in MC2R (T152K) and MC1R (R160W)

CONTEXT: Familial glucocorticoid deficiency (FGD) is a rare autosomal recessive disorder characterized by isolated cortisol deficiency. Mutations in the gene encoding the ACTH receptor (MC2R) account for 25% of cases. One significant feature is generalized skin hyperpigmentation, which is thought to...

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Autores principales: Turan, Serap, Hughes, Claire, Atay, Zeynep, Guran, Tulay, Haliloglu, Belma, Clark, Adrian J. L., Bereket, Abdullah, Metherell, Louise A.
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Endocrine Society 2012
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3396854/
https://www.ncbi.nlm.nih.gov/pubmed/22337906
http://dx.doi.org/10.1210/jc.2011-2414
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author Turan, Serap
Hughes, Claire
Atay, Zeynep
Guran, Tulay
Haliloglu, Belma
Clark, Adrian J. L.
Bereket, Abdullah
Metherell, Louise A.
author_facet Turan, Serap
Hughes, Claire
Atay, Zeynep
Guran, Tulay
Haliloglu, Belma
Clark, Adrian J. L.
Bereket, Abdullah
Metherell, Louise A.
author_sort Turan, Serap
collection PubMed
description CONTEXT: Familial glucocorticoid deficiency (FGD) is a rare autosomal recessive disorder characterized by isolated cortisol deficiency. Mutations in the gene encoding the ACTH receptor (MC2R) account for 25% of cases. One significant feature is generalized skin hyperpigmentation, which is thought to be due to elevated ACTH acting on the melanocortin 1 receptor (MC1R). OBJECTIVE: The aim of the study was to determine the cause of a nonhyperpigmented case of FGD. PATIENTS: The patient presented at 4 yr of age with hypoglycemia after prolonged fasting during a respiratory tract infection. She had further hypoglycemic attacks and was diagnosed with isolated glucocorticoid deficiency at 6 yr of age. Her parents were consanguineous, and she had two unaffected sisters. Her physical examination was normal, except that her height and weight were greater than the 97th centile for a sex- and age-matched reference population. Interestingly, she had no hyperpigmentation despite very high ACTH levels. RESULTS: Nucleotide sequence analysis revealed homozygous mutations c.478C>T in MC1R and c.455C>A in MC2R leading to R160W and T152K changes in the amino acid sequences, respectively. The R160W MC1R change has previously been implicated in a red hair/pale skin phenotype, and MC2R -T152K is trafficking defective. Both parents and two unaffected sisters were heterozygous for the MC1R mutation; additionally, one unaffected sister was heterozygous for the MC2R mutation, and the other was wild-type. CONCLUSION: We report an unusual case of FGD without hyperpigmentation due to coexistent MC1R/MC2R mutations. This case is important because it demonstrates for the first time that the assumption that the action of ACTH on MC1R causes skin hyperpigmentation is correct.
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spelling pubmed-33968542012-07-16 An Atypical Case of Familial Glucocorticoid Deficiency without Pigmentation Caused by Coexistent Homozygous Mutations in MC2R (T152K) and MC1R (R160W) Turan, Serap Hughes, Claire Atay, Zeynep Guran, Tulay Haliloglu, Belma Clark, Adrian J. L. Bereket, Abdullah Metherell, Louise A. J Clin Endocrinol Metab JCEM Online: Brief Reports CONTEXT: Familial glucocorticoid deficiency (FGD) is a rare autosomal recessive disorder characterized by isolated cortisol deficiency. Mutations in the gene encoding the ACTH receptor (MC2R) account for 25% of cases. One significant feature is generalized skin hyperpigmentation, which is thought to be due to elevated ACTH acting on the melanocortin 1 receptor (MC1R). OBJECTIVE: The aim of the study was to determine the cause of a nonhyperpigmented case of FGD. PATIENTS: The patient presented at 4 yr of age with hypoglycemia after prolonged fasting during a respiratory tract infection. She had further hypoglycemic attacks and was diagnosed with isolated glucocorticoid deficiency at 6 yr of age. Her parents were consanguineous, and she had two unaffected sisters. Her physical examination was normal, except that her height and weight were greater than the 97th centile for a sex- and age-matched reference population. Interestingly, she had no hyperpigmentation despite very high ACTH levels. RESULTS: Nucleotide sequence analysis revealed homozygous mutations c.478C>T in MC1R and c.455C>A in MC2R leading to R160W and T152K changes in the amino acid sequences, respectively. The R160W MC1R change has previously been implicated in a red hair/pale skin phenotype, and MC2R -T152K is trafficking defective. Both parents and two unaffected sisters were heterozygous for the MC1R mutation; additionally, one unaffected sister was heterozygous for the MC2R mutation, and the other was wild-type. CONCLUSION: We report an unusual case of FGD without hyperpigmentation due to coexistent MC1R/MC2R mutations. This case is important because it demonstrates for the first time that the assumption that the action of ACTH on MC1R causes skin hyperpigmentation is correct. Endocrine Society 2012-05 2012-02-15 /pmc/articles/PMC3396854/ /pubmed/22337906 http://dx.doi.org/10.1210/jc.2011-2414 Text en Copyright © 2012 by The Endocrine Society This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0/us/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.
spellingShingle JCEM Online: Brief Reports
Turan, Serap
Hughes, Claire
Atay, Zeynep
Guran, Tulay
Haliloglu, Belma
Clark, Adrian J. L.
Bereket, Abdullah
Metherell, Louise A.
An Atypical Case of Familial Glucocorticoid Deficiency without Pigmentation Caused by Coexistent Homozygous Mutations in MC2R (T152K) and MC1R (R160W)
title An Atypical Case of Familial Glucocorticoid Deficiency without Pigmentation Caused by Coexistent Homozygous Mutations in MC2R (T152K) and MC1R (R160W)
title_full An Atypical Case of Familial Glucocorticoid Deficiency without Pigmentation Caused by Coexistent Homozygous Mutations in MC2R (T152K) and MC1R (R160W)
title_fullStr An Atypical Case of Familial Glucocorticoid Deficiency without Pigmentation Caused by Coexistent Homozygous Mutations in MC2R (T152K) and MC1R (R160W)
title_full_unstemmed An Atypical Case of Familial Glucocorticoid Deficiency without Pigmentation Caused by Coexistent Homozygous Mutations in MC2R (T152K) and MC1R (R160W)
title_short An Atypical Case of Familial Glucocorticoid Deficiency without Pigmentation Caused by Coexistent Homozygous Mutations in MC2R (T152K) and MC1R (R160W)
title_sort atypical case of familial glucocorticoid deficiency without pigmentation caused by coexistent homozygous mutations in mc2r (t152k) and mc1r (r160w)
topic JCEM Online: Brief Reports
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3396854/
https://www.ncbi.nlm.nih.gov/pubmed/22337906
http://dx.doi.org/10.1210/jc.2011-2414
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