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Strategies for the Characterization of Disorders in Cortisol Sensitivity

Departments of Internal Medicine (H.R., P.S., E.F.C.v.R., E.L.T.v.d.A., F.H.d.J., J.W.K., S.W.J.L.) and Reproduction and Development (A.O.B.), Erasmus MC, University Medical Center Rotterdam, 3000 CA Rotterdam, The Netherlands; and Department of Internal Medicine (L.J.M.d.H.), Medical Center Leeuwarden, 8901 BR Leeuwarden, The Netherlands

Address all correspondence and requests for reprints to: Jan W. Koper, Erasmus MC, Department of Internal Medicine, Room Ee585b, Dr. Molewaterplein 40, P.O. Box 2040, 3000 CA Rotterdam, The Netherlands. E-mail: f.koper{at}erasmusmc.nl.

Context: The clinical presentation of abnormalities in glucocorticoid (GC) sensitivity is diverse, and therefore it is difficult to diagnose this condition.

Objective and Design: The objective of the study was to develop strategies for the characterization of GC sensitivity disorders.

Setting: The study was conducted in an outpatient clinic.

Patients: Nine patients with GC sensitivity disorders participated.

Interventions: Sequence analysis of the GC receptor (GR), determination of GR number per cell, GR ligand-binding affinity, and GR splice regulation were performed in freshly prepared peripheral blood mononuclear lymphocytes and Epstein-Barr virus-transformed lymphoblasts. Cellular GC sensitivity was determined ex vivo by measuring the effect of dexamethasone on GC-induced leucine-zipper and IL-2 mRNA levels and on cell proliferation.

Results: Differences in GR number per cell, GR affinity, GR splice variants, and effects on transactivation or transrepression of GC-sensitive genes were observed between patients and controls. Epstein-Barr virus transformation of lymphoblasts had no influence on GR affinity but increased the GR number 5-fold in healthy controls. In patients diagnosed as cortisol resistant, however, GR number after transformation was increased significantly less than 5-fold, whereas a higher GR number was observed in a patient suspected of cortisol hypersensitivity.

Conclusion: This study illustrates several strategies to define abnormalities in GC sensitivity by describing nine patients with affected GC sensitivity, all with a unique clinical course and background.