ESPE2018 Poster Presentations Adrenals and HPA Axis P3 (32 abstracts)
Presenting Features, Clinical Characteristics and Follow up of Familial Isolated Glucocorticoid Deficiency (FGD) due to Mutations in MC2R and MRAP Genes
Mehmet Nuri Ozbek a , Nezehat Doğan Karaşin a , Huseyin Demirbilek b , Meliha Demiral a , Rıza Taner Baran c & Tülay Güran d
aClinics of Paediatric Endocrinology, Diyarbakir Children State Hospital, Diyarbakır, Turkey; bDepartment of Pahediatric Endocrinology, Hacettepe University Faculty of Medicine, Ankara, Turkey; cClinics of Paediatric Endocrinology, Antalya Training and Research Hospital, Antalya, Turkey; dDepartment of Paediatric Endocrinology, Marmara University School of Medicine, İstanbul, Turkey
Objectives: Familial glucocorticoid deficiency (FGD) is a rare autosomal recessive disorder characterized with isolated glucocorticoid deficiency. Melanocortin receptor 2 (MC2R) mediates the functions of adrenocorticotropic hormone (ACTH) in the adrenal cortex. MC2R accessory protein (MRAP), a transmembrane protein, involves in the trafficking of MC2R to the cell surface. Mutations in MC2R and MRAP genes cause FGD type 1 and 2. Herein, we evaluate the clinical characteristics and follow-up of 6 cases with FGD due to mutations in MC2R and MRAP.
Patients and method: Data of 6 cases with FGD (5 with MC2R and one with MRAP mutations) followed at our pediatric endocrine center was collected from hospital files. Diagnosis of FGD was considered in case of elevated ACTH, inappropriately low cortisol and exclusion of other etiologies. Hydrocortisone was commenced as standard therapy. The results of molecular genetic analysis of the cases were already reported elsewhere*.
Results: Case characteristics, mutations and follow-up features are summarized in Table 1. During 26 to 115 months follow-up, case 2, 4 and 6 had neurodevelopmental delay (NDD), while the other 3 patients had completely normal neurodevelopment.
Conclusion: In this series evaluating a small number of FGD cases due to MC2R and MRAP mutations, early diagnosis and adherence to the hydrocortisone therapy found related to normal neurodevelopment, while, delay in diagnosis and poor compliance was associated with severe hypoglycemic convulsions and subsequent NDD.
*Guran T, et al., JCEM 2015.
| At presentation | At latest follow-up visit | |||||||||||
| Age (month)/sex | Complaints | Mutation | Cortisol (mcg/dL) | ACTH (pg/mL) | Weight (SDS) | Height (SDS) | Age (month) | ACTH (pg/mL) | Weight (SDS) | Height (SDS) | Additional findings | |
| Case1 | 4/F | Hyperpigmentation HypoglycemiaConvulsion | MC2R(560delT) | 0.04 | >1500 | 4.9 (−0.51) | 6 (−2) | 61 | 132 | 17.8 (−0.31) | 103 (−1.33) | – |
| Case2 | 12/F | Hyperpigmentation HypoglycemiaConvulsion IUGR | MC2R(560delT) | 0.6 | 2000 | 12.7 (2.58) | 92.2 (5.98) | 46 | 2000 | 16 (0.11) | 108 (1.53) | NDD Spasticity |
| Case3 | 9/M | Hyperpigmentation HypoglycemiaConvulsion | MC2R(A233P) | 0.3 | 2000 | 10.7 (1.45) | 76.5 (1.78) | 66 | 6.48 | 20.8 (0.41) | 109.3 (−0.88) | – |
| Case4 | 18/F | Hyperpigmentation HypoglycemiaHypothyroidism | MC2R(G226R) | 1.0 | >1250 | 18.3 (4.67) | 96.6 (4.63) | 106 | 19.3 | 67 (4.07) | 138.2 (1.19) | Primary hypo-thyroidism Obesity NDD |
| Case5 | 5days/F | Hyperpigmentation Hypoglycemia Convulsion Respiratory distress | MC2R(560delT) | 0.26 | 826 | 2.3 (−2.61) | 48 (−0.93) | 26 | 4.49 | 9.5 (−2.09) | 78.5 (−2.75) | – |
| Case6 | 34/F | Hyperpigmentation Hypoglycemia Convulsion Hyperbilirubinemi | MRAP(IVS3ds+1delG) | <1.0 | >1250 | 19.7 (2.99) | 102.2 (2.03) | 115 | 38.4 | 61.3 (3.18) | 136.5 (0.15) | NDD Obesity Epilepsy |
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