Journal Article Landscape of familial isolated and young-onset pituitary adenomas : prospective diagnosis in AIP mutation carriers

Hernández-Ramírez, Laura C.  ,  Gabrovska, Plamena  ,  Dénes, Judit  ,  Stals, Karen  ,  Trivellin, Giampaolo  ,  Tilley, Daniel  ,  Ferraù, Francesco  ,  Evanson, Jane  ,  Ellard, Sian  ,  Grossman, Ashley B.  ,  Roncaroli, Federico  ,  Gadelha, Mônica R.  ,  Korbonits, Márta  ,  The International FIPA Consortium,

100 ( 9 )  , pp.E1242 - E1254 , 2015-09
Context : Familial isolated pituitary adenoma (FIPA) due to aryl hydrocarbon receptor interacting protein (AIP) gene mutations is an autosomal dominant disease with incomplete penetrance. Clinical screening of apparently unaffected AIP mutation (AIPmut) carriers could identify unapparent disease.Objective : To determine AIP mutational status of FIPA and young pituitary adenoma patients, analyzing their clinical characteristics, and to perform clinical screening of apparently unaffected AIPmut carrier family members.Design : Observational, longitudinal study, 2007-2013.Setting : International collaborative study, referral centers for pituitary diseases.Participants : FIPA families (n=216) and sporadic young-onset (≤30 years) pituitary adenoma patients (n=404).Interventions : Genetic screening of patients for AIPmuts, clinical assessment of their family members and genetic screening for somatic GNAS1 mutations and the germline FGFR4 p.G388R variant.Main Outcome Measure(s) : Clinical disease in mutation carriers, comparison of characteristics of AIPmut positive and negative patients, results of GNAS1 and FGFR4 analysis.Results : Thirty-seven FIPA families and 34 sporadic patients had AIPmuts. Patients with truncating AIPmuts had a younger age at disease onset and diagnosis, compared to patients with non-truncating AIPmuts. Somatic GNAS1 mutations were absent in tumors from AIPmut positive patients, and the studied FGFR4 variant did not modify the disease behavior or penetrance in AIPmut positive individuals. A total of 164 AIPmut positive unaffected family members were identified; pituitary disease was detected on 18 of those who underwent clinical screening.Conclusions : A quarter of the AIPmut carriers screened were diagnosed with pituitary disease, justifying this screening and suggesting a variable clinical course for AIPmut positive pituitary adenomas.

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