Corticotropinoma as a component of carney complex

Laura C. Hernández-Ramírez, Christina Tatsi, Maya B. Lodish, Fabio R. Faucz, Nathan Pankratz, Prashant Chittiboina, John Lane, Denise M. Kay, Nuria Valdés, Aggeliki Dimopoulos, James L. Mills, Constantine A. Stratakis

Research output: Contribution to journalArticlepeer-review

20 Scopus citations

Abstract

Known germline gene abnormalities cause one-fifth of the pituitary adenomas in children and adolescents, but, in contrast with other pituitary tumor types, the genetic causes of corticotropinomas are largely unknown. In this study, we report a case of Cushing disease (CD) due to a loss-of-function mutation in PRKAR1A, providing evidence for association of this gene with a corticotropinoma. A 15-year-oldmale presentingwith hypercortisolemiawas diagnosed withCD.Remissionwas achieved after surgical resection of a corticotropin (ACTH)-producing pituitary microadenoma, but recurrence 3 years later prompted reoperation and radiotherapy. Five years after the original diagnosis, the patient developed ACTH-independent Cushing syndrome, and a diagnosis of primary pigmented nodular adrenocortical disease was confirmed. A PRKAR1A mutation (c.671delG, p.G225Afs*16) was detected in a germlineDNA sample fromthe patient, which displayed loss of heterozygosity in the corticotropinoma. No other germline or somatic mutations of interest were found. As corticotropinomas are not a known component of Carney complex (CNC), we performed loss of heterozygosity and messenger RNA stability studies in the patient's tissues, and analyzed the effect of Prkar1a silencing on AtT-20/D16v-F2 mouse corticotropinoma cells.NoPRKAR1Adefectswere found among 97 other pediatricCDpatients studied.Our clinical case and experimental data support a role for PRKAR1A in the pathogenesis of a corticotroph cell tumor. This is a molecularly confirmed report of a corticotropinoma presenting in association with CNC. We conclude that germline PRKAR1A mutations are a novel, albeit apparently infrequent, cause of CD.

Original languageEnglish (US)
Pages (from-to)918-925
Number of pages8
JournalJournal of the Endocrine Society
Volume1
Issue number7
DOIs
StatePublished - Jul 2017

Bibliographical note

Publisher Copyright:
© 2017 Endocrine Society.

Copyright:
Copyright 2020 Elsevier B.V., All rights reserved.

Keywords

  • Carney complex
  • Cushing disease
  • Genetics
  • Pituitary tumor
  • Protein kinase A

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