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Isolated Autosomal Dominant Growth Hormone Deficiency: An Evolving Pituitary Deficit? A Multicenter Follow-Up Study

Paediatric Endocrinology (P.E.M., S.S., A.E., A.B., J.-M.V., J.D.), University Children’s Hospital, Inselspital, CH-3010 Bern, Switzerland; National Institute for Medical Research (I.C.A.F.R.), London NW7 1AA, United Kingdom; Department of Paediatric Endocrinology and Diabetology (D.S., P.C.), Hôpital Robert Debré, F-75019 Paris, France; and University-Children’s Hospital and Growth Research Center (G.B.), D-72076 Tübingen, Germany

Address all correspondence and requests for reprints to: Professor Primus E. Mullis, M.D., Pediatric Endocrinology, Diabetology, and Metabolism, University Children’s Hospital, Inselspital, CH-3010 Bern, Switzerland. E-mail: primus.mullis{at}insel.ch.

Four distinct familial types of isolated GH deficiency have been described so far, of which type II is the autosomal dominant inherited form. It is mainly caused by mutations within the first 6 bp of intervening sequence 3. However, other splice site and missense mutations have been reported. Based on in vitro experiments and transgenic animal data, there is strong evidence that there is a wide variability in phenotype in terms of the severity of GH deficiency. Therefore, we studied a total of 57 subjects belonging to 19 families suffering from different splice site as well as missense mutations within the GH-1 gene. The subjects presenting with a splice site mutation within the first 2 bp of intervening sequence 3 (5'IVS +1/+2 bp) leading to a skipping of exon 3 were found to be more likely to present in the follow-up with other pituitary hormone deficiencies. In addition, although the patients with missense mutations have previously been reported to be less affected, a number of patients presenting with the P89L missense GH form, showed some pituitary hormone impairment. The development of multiple hormonal deficiencies is not age dependent, and there is a clear variability in onset, severity, and progression, even within the same families. The message of clinical importance from these studies is that the pituitary endocrine status of all such patients should continue to be monitored closely over the years because further hormonal deficiencies may evolve with time.

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