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Recessive Isolated Growth Hormone Deficiency and Mutations in the Ghrelin Receptor

INSERM (J.P., M.L., M.-P.V.-L., S.A.), U933, 75011 Paris, France; Centre Hospitalier Universitaire de Rennes (S.N.), Unité d’Endocrinologie Pédiatrique, 35056 Rennes, France; INSERM (S.M.), U573, 75014 Paris, France; AP-HP (Y.L.B.), Hôpital Armand Trousseau, Service d’Explorations Fonctionnelles Endocriniennes, 75771 Paris, France; and INSERM (J.E.), U549, 75014 Paris, France

Address all correspondence and requests for reprints to: Jacques Pantel, Department of Molecular Physiology and Biophysics, 702 LH Vanderbilt Medical Center, 2215 Garland Avenue, Nashville, Tennessee 37232. E-mail: jacques.pantel{at}vanderbilt.edu.

Context: Both GH releasing- and orexigenic properties of the gut-to-brain hormone ghrelin are mediated by the GH secretagogue receptor (GHSR). Recently in several patients, a missense mutation (p.A204E) resulting in a complete loss of GHSR constitutive activity has been implicated in short stature with dominant transmission.

Objective: The objective of the study was to describe the phenotype associated with partial isolated GH deficiency of a young patient born to unrelated parents and identify the molecular basis of his disease.

Results: The growth delay (–3.0 SD) was associated with recurrent episodes of abdominal pain, vomiting, ketosis, hypoglycemia, and a low body mass index. GHSR sequencing revealed that the patient was compound heterozygous for two new defects: 1) an early occurring transition predicting a premature stop codon (c.6G>A, p.W2X) inherited from his unaffected father, therefore strongly arguing against haploinsufficiency as a disease mechanism, and 2) a missense mutation (c.709A>T, p.R237W) inherited from his healthy mother, involving an evolutionary invariant residue from the third intracellular loop. In vitro experiments showed that the p.R237W mutation would result in a partial loss of constitutive activity of the receptor, whereas both its ability to respond to ghrelin and its cell surface expression are preserved.

Conclusion: These data, which describe the first case of recessive partial isolated GH deficiency due to GHSR mutations and emphasize the physiological importance of the GHSR in somatic growth, are discussed in light of the dominantly expressed p.A204E mutation.