Aggressive prolactinoma in a child related to germline mutation in the ARYL hydrocarbon receptor interacting protein (AIP) gene
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Published on: March 7, 2017
Luciana Ansaneli Naves1, Marie-Lise Jaffrain-Rea, Sergio Alberto Cunha Vêncio
1Endocrinology Unit, Universidade de Brasília, DF, Brazil. draluciananaves@gmail.com
Insights
A familial screening identified a pituitary tumor gene mutation (AIP) in a child with aggressive prolactinoma. This AIP gene mutation may predispose young patients to developing aggressive pituitary adenomas.
Area of Science:
- Endocrinology
- Genetics
- Pediatric Oncology
Background:
- Pituitary adenomas are rare in children, and aggressive forms present unique challenges.
- Familial screening for genetic predispositions is crucial for understanding tumor pathogenesis.
Observation:
- A 12-year-old boy presented with a large, aggressive pituitary macroadenoma causing visual deficits and hormonal imbalances.
- The tumor showed resistance to standard treatment (cabergoline), necessitating multiple surgeries and radiotherapy.
- Immunohistochemical analysis and genomic DNA sequencing were performed on the patient and 48 relatives.
Findings:
- A germline A195V mutation in the Aryl hydrocarbon receptor-Interacting Protein (AIP) gene was identified in the patient.
- The same AIP mutation was found in five asymptomatic relatives, suggesting a hereditary predisposition.
- This mutation was linked to the aggressive nature of the prolactinoma in the pediatric patient.
Implications:
- Germline AIP mutations may play a significant role in the development of aggressive pituitary adenomas in young individuals.
- Identifying AIP mutations can aid in early diagnosis and risk assessment for familial pituitary tumor syndromes.
- Understanding the genetic basis of aggressive pituitary tumors can inform targeted therapeutic strategies.
Abstract:
The objective of this study was to describe a familial screening for AIP mutations in the context of aggressive prolactinoma in childhood. A 12-year-old boy, presented headaches and bilateral hemianopsia. He had adequate height and weight for his age (50(th) percentile), Tanner stage G1 P1. His bone age was 10 years. Prolactin was 10.560 ng/mL (3-25), FSH and LH were undetectable, IGF-1, TSH, Free T4, ACTH, and cortisol were within normal ranges. MRI showed a pituitary macroadenoma, 5.3 X 4.0 X 3.5 cm with compression of the optic chiasm, bilateral cavernous sinus invasion, encasement of carotids, and extension to clivus. Surgical debulking was performed. Resistance to cabergoline was characterized and he was submitted to two surgeries and radiotherapy. Immunohistochemical evaluation included prolactin, ACTH, GH, FSH, LH,AIP, c-erb B2, Ki-67, and p53. Genomic DNA was isolated from the index case and 48 relatives, PCR and sequencing were performed.A germline A195V mutation in AIP was identified in the index case and in five asymptomatic relatives. Germline mutations in the AIP gene may be involved in the predisposition to pituitary adenoma formation, as cause or co-factor in pathogenesis of aggressive tumors in young patients.
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