Journal
JOURNAL OF CLINICAL ENDOCRINOLOGY & METABOLISM
Volume 100, Issue 1, Pages E119-E128Publisher
ENDOCRINE SOC
DOI: 10.1210/jc.2014-2648
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Funding
- le Plan Technologies de la Sante par le Gouvernment du Grand-Duche de Luxembourg through the Luxembourg Centre for Systems Biomedicine, University of Luxembourg
- Wilhelm Sander-Stiftung [2012.095.1]
- German Research Foundation [DFG Schn683/3-1]
- European Union [CIG303683]
- Fonds Nationale de la Recherche de Luxembourg
- MRC [G0801473] Funding Source: UKRI
- Cancer Research UK [15622] Funding Source: researchfish
- Medical Research Council [G0801473] Funding Source: researchfish
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Context: Primary macronodular adrenal hyperplasia (PMAH) is a rare cause of Cushing's syndrome, which may present in the context of different familial multitumor syndromes. Heterozygous inactivating germline mutations of armadillo repeat containing 5 (ARMC5) have very recently been described as cause for sporadic PMAH. Whether this genetic condition also causes familial PMAH in association with other neoplasias is unclear. Objective: The aim of the present study was to delineate the molecular cause in a large family with PMAH and other neoplasias. Patients and Methods: Whole-genome sequencing and comprehensive clinical and biochemical phenotyping was performed in members of a PMAH affected family. Nodules derived from adrenal surgery and pancreatic and meningeal tumor tissue were analyzed for accompanying somatic mutations in the identified target genes. Results: PMAH presenting either as overt or subclinical Cushing's syndrome was accompanied by a heterozygous germline mutation in ARMC5 (p.A110fs*9) located on chromosome 16. Analysis of tumor tissue showed different somatic ARMC5 mutations in adrenal nodules supporting a second hit hypothesis with inactivation of a tumor suppressor gene. A damaging somatic ARMC5 mutation was also found in a concomitant meningioma (p.R502fs) but not in a pancreatic tumor, suggesting biallelic inactivation of ARMC5 as causal also for the intracranial meningioma. Conclusions: Our analysis further confirms inherited inactivating ARMC5 mutations as a cause of familial PMAH and suggests an additional role for the development of concomitant intracranial meningiomas.
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