Home Clinical and molecular characterization of five Spanish kindreds with X-linked adrenal hypoplasia congenita: atypical findings and a novel mutation in NR0B1
Article
Licensed
Unlicensed Requires Authentication

Clinical and molecular characterization of five Spanish kindreds with X-linked adrenal hypoplasia congenita: atypical findings and a novel mutation in NR0B1

  • Amaia Rodríguez Estévez , Gustavo Pérez-Nanclares , Joaquin Fernández-Toral , Francisco Rivas-Crespo ORCID logo , Juan P. López-Siguero , Ignacio Díez , Gema Grau and Luis Castaño EMAIL logo
Published/Copyright: May 30, 2015

Abstract

Background: X-linked adrenal hypoplasia congenita (AHC) is caused by NR0B1 (DAX1) gene mutations. Affected male children suffer from adrenal insufficiency, leading to a salt-wasting crisis in early infancy and hypogonadotropic hypogonadism in adulthood.

Objective: To characterize clinically and at the molecular level a cohort of Spanish patients with AHC.

Patients and methods: Nine boys (from five families) with AHC were screened for NR0B1 mutations. Clinical and endocrine evaluations were recorded.

Results: NR0B1 gene mutations were found in all analyzed patients, one of them being novel (p.Gln305*). One patient presented with preserved hypothalamic-pituitary-gonadal axis. Salt-wasting episodes, delayed puberty, and hypogonadotropic hypogonadism were common, although no association was observed between AHC phenotype and genetic mutations. None of the patients has had descendants.

Conclusions: AHC phenotype cannot be predicted based on genetic results as there is no definite genotype-phenotype relationship, including intrafamilial variability. Nevertheless, genetic testing for NR0B1 mutations is indicated if there is a suspicion of an X-linked adrenal insufficiency in order to proceed with the appropriate therapy and genetic counseling.


Corresponding author: Dr. Luis Castaño, Endocrinology and Diabetes Research Group, BioCruces Health Research Institute, Hospital Universitario Cruces, CIBERER, CIBERDEM, UPV-EHU, Plaza de Cruces s/n, Barakaldo, Basque Country, Spain, E-mail:
aThese authors contributed equally to this work and should be considered joint first authors.

References

1. Reutens AT, Achermann JC, Ito M, Ito M, Gu WX, et al. Clinical and functional effects of mutations in the DAX-1 gene in patients with adrenal hypoplasia congenita. J Clin Endocrinol Metab 1999;84:504–11.10.1210/jc.84.2.504Search in Google Scholar

2. Phelan JK, McCabe ER. Mutations in NR0B1 (DAX1) and NR5A1 (SF1) responsible for adrenal hypoplasia congenita. Hum Mutat 2001;18:472–87.10.1002/humu.1225Search in Google Scholar

3. Peter M, Viemann M, Partsch CJ, Sippell WG. Congenital adrenal hypoplasia: clinical spectrum, experience with hormonal diagnosis, and report on new point mutations of the DAX-1 gene. J Clin Endocrinol Metab 1998;83:2666–74.10.1210/jcem.83.8.5027Search in Google Scholar

4. Mantovani G, Ozisik G, Achermann JC, Romoli R, Borretta G, et al. Hypogonadotropic hypogonadism as a presenting feature of late-onset X-linked adrenal hypoplasia congenital. J Clin Endocrinol Metab 2002;87:44–8.10.1210/jcem.87.1.8163Search in Google Scholar

5. Ozisik G, Mantovani G, Achermann JC, Persani L, Spada A, et al. An alternate translation initiation site circumvents an amino-terminal DAX1 nonsense mutation leading to a mild form of X-linked adrenal hypoplasia congenital. J Clin Endocrinol Metab 2003;88:417–23.10.1210/jc.2002-021034Search in Google Scholar

6. Brown P, Scobie GA, Townsend J, Bayne RA, Seckl JR, et al. Identification of a novel missense mutation that is as damaging to DAX-1 repressor function as a nonsense mutation. J Clin Endocrinol Metab 2003;88:1341–9.10.1210/jc.2002-021560Search in Google Scholar

7. Tabarin A, Achermann JC, Recan D, Bex V, Bertagna X, et al. A novel mutation in DAX1 causes delayed-onset adrenal insufficiency and incomplete hypogonadotropic hypogonadism. J Clin Invest 2000;105:321–8.10.1172/JCI7212Search in Google Scholar

8. Yang F, Hanaki K, Kinoshita T, Kawashima Y, Nagaishi J, et al. Late-onset adrenal hypoplasia congenita caused by a novel mutation of the DAX-1 gene. Eur J Pediatr 2009;168:329–31.10.1007/s00431-008-0779-xSearch in Google Scholar

9. Muscatelli F, Strom TM, Walker AP, Zanaria E, Récan D, et al. Mutations in the DAX-1 gene give rise to both X-linked adrenal hypoplasia congenita and hypogonadotropic hypogonadism. Nature 1994;372:672–6.10.1038/372672a0Search in Google Scholar

10. Achermann JC, Meeks JJ, Jameson JL. Phenotypic spectrum of mutations in DAX-1 and SF-1. Mol Cell Endocrinol 2001;185:17–25.10.1016/S0303-7207(01)00619-0Search in Google Scholar

11. Iyer AK, McCabe ER. Molecular mechanisms of DAX1 action. Mol Genet Metab 2004;83:60–73.10.1016/j.ymgme.2004.07.018Search in Google Scholar PubMed

12. Nakae J, Tajima T, Kusuda S, Kohda N, Okabe T, et al. Truncation at the C-terminus of the DAX-1 protein impairs its biological actions in patients with X-linked adrenal hypoplasia congenita. J Clin Endocrinol Metab 1996;81:3680–5.Search in Google Scholar

13. Bardoni B, Zanaria E, Guioli S, Floridia G, Worley KC, et al. A dosage sensitive locus at chromosome Xp21 is involved in male to female sex reversal. Nat Genet 1994;7:497–501.10.1038/ng0894-497Search in Google Scholar PubMed

14. Domenice S, Latronico AC, Brito VN, Arnhold IJ, Kok F, et al. Adrenocorticotropin-dependent precocious puberty of testicular origin in a boy with X-linked adrenal hypoplasia congenita due to a novel mutation in the DAX1 gene. J Clin Endocrinol Metab 2001;86:4068–71.10.1210/jcem.86.9.7816Search in Google Scholar PubMed

15. Loke KY, Poh KS, Walker AP, Tan JA, Tay AH. An atypical kindred with X-linked adrenal hypoplasia congenita, normal puberty, and normal Dax-1 promoter and coding sequence. J Pediatr Endocrinol Metab 2000;13:29–36.10.1515/JPEM.2000.13.1.29Search in Google Scholar

16. Sanz-Ruiz I, Bretón-Martínez JR, Del Castillo-Villaescusa C, Casanovas-Martínez A, Martínez-Castellano F, et al. Contiguous gene deletion syndrome in Xp21: an unusual form of presentation. Rev Neurol 2009;49:472–4.Search in Google Scholar

17. Pantoja-Martínez J, Martínez-Castellano F, Tarazona-Casany I, Buesa-Ibáñez E, Ardid-Encinar M, et al. Contiguous gene deletion syndrome in Xp21: the association between glycerol kinase deficiency, congenital suprarenal hypoplasia and Duchenne’s muscular dystrophy. Rev Neurol 2007;44:606–9.Search in Google Scholar

18. Loke KY, Poh LK, Lee WW, Lai PS. A case of X-linked adrenal hypoplasia congenita, central precocious puberty and absence of the DAX-1 gene: implications for pubertal regulation. Horm Res 2009;71:298–304.10.1159/000208804Search in Google Scholar PubMed

19. Vilain E, Le Merrer M, Lecointre C, Desangles F, Kay MA, et al. IMAGe, a new clinical association of intrauterine growth retardation, metaphyseal dysplasia, adrenal hypoplasia congenita, and genital anomalies. J Clin Endocrinol Metab 1999;84:4335–40.10.1210/jcem.84.12.6186Search in Google Scholar PubMed

20. Balasubramanian M, Sprigg A, Johnson DS. IMAGe syndrome: case report with a previously unreported feature and review of published literature. Am J Med Genet A 2010;152A:3138–42.10.1002/ajmg.a.33716Search in Google Scholar PubMed

21. Binder G, Wollmann H, Schwarze CP, Strom TM, Peter M, et al. X-linked congenital adrenal hypoplasia: new mutations and long-term follow-up in three patients. Clin Endocrinol (Oxf) 2000;53:249–55.10.1046/j.1365-2265.2000.01038.xSearch in Google Scholar PubMed

22. Guoying C, Zhiya D, Wei W, Na L, Xiaoying L, et al. The analysis of clinical manifestations and genetic mutations in Chinese boys with primary adrenal insufficiency. J Pediatr Endocrinol Metab 2012;25:295–300.10.1515/jpem-2011-0362Search in Google Scholar PubMed

23. Wiltshire E, Couper J, Rodda C, Jameson JL, Achermann JC. Variable presentation of X-linked adrenal hypoplasia congenital. J Pediatr Endocrinol Metab 2001;14:1093–6.10.1515/jpem-2001-0804Search in Google Scholar PubMed

24. Krone N, Riepe FG, Dörr HG, Morlot M, Rudorff KH, et al. Thirteen novel mutations in the NR0B1 (DAX1) gene as cause of adrenal hypoplasia congenita. Hum Mutat 2005;25:502–3.10.1002/humu.9331Search in Google Scholar PubMed

25. Lee MM, Rajagopalan L, Berg GJ, Moshang T Jr. Serum adrenal steroid concentrations in premature infants. J Clin Endocrinol Metab 1989;69:1133–6.10.1210/jcem-69-6-1133Search in Google Scholar PubMed

26. Verrijn Stuart AA, Ozisik G, de Vroede MA, Giltay JC, Sinke RJ, et al. An amino-terminal DAX1 (NR0B1) missense mutation associated with isolated mineralocorticoid deficiency. J Clin Endocrinol Metab 2007;92:755–61.10.1210/jc.2005-2429Search in Google Scholar PubMed

27. Seminara SB, Achermann JC, Genel M, Jameson JL, Crowley WF Jr. X-linked adrenal hypoplasia congenita: a mutation in DAX1 expands the phenotypic spectrum in males and females. J Clin Endocrinol Metab 1999;84:4501–9.10.1210/jc.84.12.4501Search in Google Scholar

28. Landau Z, Hanukoglu A, Sack J, Goldstein N, Weintrob N, et al. Clinical and genetic heterogeneity of congenital adrenal hypoplasia due to NR0B1 gene mutations. Clin Endocrinol (Oxf) 2010;72:448–54.10.1111/j.1365-2265.2009.03652.xSearch in Google Scholar PubMed

29. Sekiguchi Y, Hara Y, Matsuoka H, Hayashi Y, Katsumata N, et al. Sibling cases of Addison’s disease caused by DAX-1 gene mutations. Intern Med 2007;46:35–9.10.2169/internalmedicine.46.6082Search in Google Scholar PubMed

30. Achermann JC, Silverman BL, Habiby RL, Jameson JL. Presymptomatic diagnosis of X-linked adrenal hypoplasia congenita by analysis of DAX1. J Pediatr 2000;137:878–81.10.1067/mpd.2000.108567Search in Google Scholar PubMed

31. Lalli E, Bardoni B, Zazopoulos E, Wurtz JM, Strom TM, et al. A transcriptional silencing domain in DAX-1 whose mutation causes adrenal hypoplasia congenita. Mol Endocrinol 1997;11:1950–60.10.1210/mend.11.13.0038Search in Google Scholar PubMed

32. Zazopoulos E, Lalli E, Stocco DM, Sassone-Corsi P. DNA binding and transcriptional repression by DAX-1 blocks steroidogenesis. Nature 1997;390:311–5.10.1038/36899Search in Google Scholar PubMed

33. Byers PH. Killing the messenger: new insights into nonsense-mediated mRNA decay. J Clin Invest 2002;109:3–6.10.1172/JCI0214841Search in Google Scholar

34. Raffin-Sanson ML, Oudet B, Salenave S, Brailly-Tabard S, Pehuet M, et al. A man with DAX1/NR0B1 mutation, normal puberty, and an intact hypothalamic-pituitary-gonadal axis but deteriorating oligospermia during long-term follow-up. Eur J Endocrinol 2013;168:K45–50.10.1530/EJE-12-1055Search in Google Scholar PubMed

35. Toulis KA, Iliadou PK, Venetis CA, Tsametis C, Tarlatzis BC, et al. Inhibin B and anti-Müllerian hormone markers of persistent spermatogenesis in men with non-obstructive azoospermia: a meta-analysis of diagnostic accuracy studies. Hum Reprod Update 2010;16:713–24.10.1093/humupd/dmq024Search in Google Scholar PubMed

36. Wang CL, Fen ZW, Liang L. A de novo mutation of DAX1 in a boy with congenital adrenal hypoplasia without hypogonadotropic hypogonadism. J Pediatr Endocrinol Metab 2014;27:343–7.10.1515/jpem-2013-0260Search in Google Scholar PubMed

37. Bernard P, Ludbrook L, Queipo G, Dinulos MB, Kletter GB, et al. A familial missense mutation in the hinge region of DAX-1 associated with late-onset AHC in a prepubertal female. Mol Genet Metab 2006;88:272–9.10.1016/j.ymgme.2005.12.004Search in Google Scholar PubMed

Received: 2014-11-20
Accepted: 2015-4-9
Published Online: 2015-5-30
Published in Print: 2015-9-1

©2015 by De Gruyter

Articles in the same Issue

  1. Frontmatter
  2. Highlight: Growth hormone
  3. Growth hormone and growth hormone deficiency – still a lot to learn
  4. Dynamic changes in the hypothalamic- pituitary-adrenal axis during growth hormone therapy in children with growth hormone deficiency: a multicenter retrospective study
  5. Pituitary gland size is a useful marker in diagnosing isolated growth hormone deficiency in short children
  6. Carotid intima-media thickness in children treated with growth hormone
  7. The c.301_302delAG PROP1 gene mutation in Romanian patients with multiple pituitary hormone deficiency
  8. Growth impairment and growth hormone-IGF-1 axis in infantile anorexia nervosa
  9. Growth hormone deficiency in a patient with mitochondrial disease
  10. Perrault syndrome with growth hormone deficiency: a rare autosomal recessive disorder
  11. Review articles
  12. Phosphate homeostasis and genetic mutations of familial hypophosphatemic rickets
  13. Gonadal malignancy risk and prophylactic gonadectomy in disorders of sexual development
  14. Original articles
  15. Carotid intimal medial thickness and its relation to endothelial dysfunction and echocardiographic changes in adolescents with type 1 diabetes
  16. Insulin dynamics and biochemical markers for predicting impaired glucose tolerance in obese Thai youth
  17. Effects of adolescence-onset hypogonadism on metabolism, bone mineral density and quality of life in adulthood
  18. Spectrum of clinical presentations and endocrinological findings of patients with septo-optic dysplasia: a retrospective study
  19. Role of circulating adipocytokines vaspin, apelin, and visfatin in the loss of appetite in underweight children: a pilot trial
  20. Protein-induced hyperinsulinaemic hypoglycaemia due to a homozygous HADH mutation in three siblings of a Saudi family
  21. Waist-to-height ratio as a screening measure for identifying adolescents with hypertriglyceridemic waist phenotype
  22. Assessment and relation of total and regional fat mass with bone mineral content among Indian urban adolescents
  23. Evaluation of the relationship between serum adropin levels and blood pressure in obese children
  24. Swallowed glucocorticoid therapy for eosinophilic esophagitis in children does not suppress adrenal function
  25. Response of vitamin D binding protein and free vitamin D concentrations to vitamin D supplementation in hospitalized premature infants
  26. Can school health check-ups serve as screening tool for growth anomalies and obesity in children?
  27. The spectrum of 46XY disorders of sex development in a University centre in Saudi Arabia
  28. Clinical and molecular characterization of five Spanish kindreds with X-linked adrenal hypoplasia congenita: atypical findings and a novel mutation in NR0B1
  29. Clinical characteristics of children referred for signs of early puberty before age 3
  30. Effects of GnRH analogue treatment on anterior pituitary hormones in children with central precocious puberty
  31. Anti-Müllerian hormone in children: a ten-year prospective longitudinal study (EarlyBird 39)
  32. Patient reports
  33. A rare cause of fatal pulmonary alveolar proteinosis: Niemann-Pick disease type C2 and a novel mutation
  34. Migratory polyarthritis as an adverse effect of thiamazole use in a 13-year-old girl with Graves’ disease
  35. Dyshormonogenesis seems to be more frequent in a group of Cameroonian children with congenital hypothyroidism
  36. Primary systemic carnitine deficiency: a Turkish case with a novel homozygous SLC22A5 mutation and 14 years follow-up
  37. Cerebral infarction and femoral venous thrombosis detected in a patient with diabetic ketoacidosis and heterozygous factor V Leiden G1691A and PAI-1 4G/5G mutations
  38. Combined adrenal failure and testicular adrenal rest tumor in a patient with nicotinamide nucleotide transhydrogenase deficiency
  39. Short communication
  40. Tamoxifen-associated hirsutism: an unusual side effect in a 5-year-old girl with McCune-Albright syndrome
  41. Letters to the Editor
  42. Psychiatric disorders are associated with increased risk for developing hyponatraemia in children
  43. Rett syndrome and precocious puberty association
Downloaded on 1.12.2025 from https://www.degruyterbrill.com/document/doi/10.1515/jpem-2014-0472/html
Scroll to top button