Sarah Castets1,2, Florence Roucher-Boulez3,4,5, Alexandru Saveanu6,7, Delphine Mallet-Motak3,4, Olivier Chabre8, Patrizia Amati-Bonneau9,10, Dominique Bonneau9,10, Celine Girardin11, Yves Morel3,5, Carine Villanueva12,4, Thierry Brue6,7, Rachel Reynaud6,7, Marc Nicolino12,4,5. 1. Hospices Civils de Lyon, Hôpital Femme Mère Enfant, Service d'Endocrinologie Pédiatrique, Bron, France, sarah.castets@gmail.com. 2. Aix-Marseille Université, AP-HM, Centre de Référence des Maladies Rares D'origine Hypophysaire HYPO, Marseille, France, sarah.castets@gmail.com. 3. Hospices Civils de Lyon, Groupement Hospitalier Est, Laboratoire de Biochimie et Biologie Moléculaire Grand Est, UM Pathologies Endocriniennes Rénales Musculaires et Mucoviscidose, Bron, France. 4. Centre de Référence du Développement Génital: du Fœtus à l'Adulte, Filière Maladies Rares Endocriniennes, Bron, France. 5. Univ Lyon, Université Claude Bernard Lyon 1, Lyon, France. 6. Aix-Marseille Université, AP-HM, Centre de Référence des Maladies Rares D'origine Hypophysaire HYPO, Marseille, France. 7. Aix Marseille Université, INSERM, MMG, U 1251, Marseille, France. 8. CHU de Grenoble Alpes et Université Grenoble Alpes, CS 10217 38043, Service d'Endocrinologie, Grenoble, France. 9. MitoLab Team, UMR CNRS 6015 - INSERM U1083, Institut MitoVasc, Université et Hôpital d'Angers, Angers, France. 10. Département de Biochimie et Génétique, Université et Hôpital d'Angers, Angers, France. 11. Hôpitaux Universitaires de Genève, Endocrinologie Pédiatrique, Genève, Switzerland. 12. Hospices Civils de Lyon, Hôpital Femme Mère Enfant, Service d'Endocrinologie Pédiatrique, Bron, France.
Abstract
BACKGROUND: FOXL2 is the gene involved in blepharophimosis, ptosis, and epicanthus inversus syndrome (BPES). There have been few single case reports of growth hormone deficiency (GHD) with this syndrome, and Foxl2 is known to be involved in pituitary development in mice. Our aim was to analyze the prevalence of FOXL2 gene alteration in a series of patients with congenital hypopituitarism and eyelid anomalies. METHODS: FOXL2 was analyzed in 10 patients with hypopituitarism (ranging from isolated GHD to complete pituitary hormone deficiency) and eyelid anomalies (typical BPES in 4 patients and milder anomalies in 6 patients). In patients with an FOXL2 mutation, we ruled out other possible molecular explanations by analyzing a panel of 20 genes known to be associated with hypopituitarism, and a candidate gene approach was used for patients without an FOXL2mutation. RESULTS: Three patients had an FOXL2mutation. All 3 had typical BPES. Their pituitary phenotype varied from GHD to complete pituitary hormone deficiency and their pituitary morphology ranged from normal to an interrupted pituitary stalk. No mutations were found in genes previously associated with hypopituitarism. CONCLUSION: Our study shows that some patients with BPES have hypopituitarism with no molecular explanation other than FOXL2 mutation. This points toward an involvement of FOXL2 in human pituitary development.
BACKGROUND:FOXL2 is the gene involved in blepharophimosis, ptosis, and epicanthus inversus syndrome (BPES). There have been few single case reports of growth hormone deficiency (GHD) with this syndrome, and Foxl2 is known to be involved in pituitary development in mice. Our aim was to analyze the prevalence of FOXL2 gene alteration in a series of patients with congenital hypopituitarism and eyelid anomalies. METHODS:FOXL2 was analyzed in 10 patients with hypopituitarism (ranging from isolated GHD to complete pituitary hormone deficiency) and eyelid anomalies (typical BPES in 4 patients and milder anomalies in 6 patients). In patients with an FOXL2 mutation, we ruled out other possible molecular explanations by analyzing a panel of 20 genes known to be associated with hypopituitarism, and a candidate gene approach was used for patients without an FOXL2mutation. RESULTS: Three patients had an FOXL2mutation. All 3 had typical BPES. Their pituitary phenotype varied from GHD to complete pituitary hormone deficiency and their pituitary morphology ranged from normal to an interrupted pituitary stalk. No mutations were found in genes previously associated with hypopituitarism. CONCLUSION: Our study shows that some patients with BPES have hypopituitarism with no molecular explanation other than FOXL2 mutation. This points toward an involvement of FOXL2 in human pituitary development.