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An Intronic Growth Hormone Receptor Mutation Causing Activation of a Pseudoexon Is Associated with a Broad Spectrum of Growth Hormone Insensitivity Phenotypes

Centre for Endocrinology (A.D., C.C.-H., F.M.-M., S.A.A., A.J.L.C., M.O.S., L.A.M.), William Harvey Research Institute, Barts and the London, Queen Mary, University of London, London EC1M 6BQ, United Kingdom; Pediatric Endocrinology Division (A.B., S.T.), Infant’s and Children’s Hospital of Brooklyn at Maimonides, Brooklyn, New York 11219; Department of Paediatrics (S.J.R.), Heartlands Hospital, Birmingham B9 5SS, United Kingdom; Department of Paediatrics (G.E.B.), Leeds General Infirmary, Leeds LS1 3EX, United Kingdom; and Endocrine Science Research Group (P.E.C.), School of Medicine, University of Manchester, Manchester M13 9PT, United Kingdom

Address all correspondence and requests for reprints to: Dr. L. A. Metherell, Centre for Molecular Endocrinology, First Floor North, John Vane Building, Charterhouse Square, London EC1M 6BQ, United Kingdom. E-mail: l.a.metherell{at}qmul.ac.uk.

Context: Inherited GH insensitivity (GHI) is usually caused by mutations in the GH receptor (GHR). Patients present with short stature associated with high GH and low IGF-I levels and may have midfacial hypoplasia (typical Laron syndrome facial features). We previously described four mildly affected GHI patients with an intronic mutation in the GHR gene (A_-1G_-1 substitution in intron 6), resulting in the activation of a pseudoexon (6) and inclusion of 36 amino acids.

Objective: The study aimed to analyze the clinical and genetic characteristics of additional GHI patients with the pseudoexon (6) mutation.

Design/Patients: Auxological, biochemical, genetic, and haplotype data from seven patients with severe short stature and biochemical evidence of GHI were assessed.

Main Outcome Measures: We assessed genotype-phenotype relationship.

Results: One patient belongs to the same extended family, previously reported. She has normal facial features, and her IGF-I levels are in the low-normal range for age. The six unrelated patients, four of whom have typical Laron syndrome facial features, have heights ranging from –3.3 to –6.0 SD and IGF-I levels that vary from normal to undetectable. We hypothesize that the marked difference in biochemical and clinical phenotypes might be caused by variations in the splicing efficiency of the pseudoexon.

Conclusions: Activation of the pseudoexon in the GHR gene can lead to a variety of GHI phenotypes. Therefore, screening for the presence of this mutation should be performed in all GHI patients without mutations in the coding exons.

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