Molecular and clinical evidence for an ARMC5 tumor syndrome: concurrent inactivating germline and somatic mutations are associated with both primary macronodular adrenal hyperplasia and meningioma

Ulf Elbelt, Alessia Trovato, Michael Kloth, Enno Gentz, Reinhard Finke, Joachim Spranger, David Galas, Susanne Weber, Cristina Wolf, Katharina König, Wiebke Arlt, Reinhard Büttner, Patrick May, Bruno Allolio, Jochen G Schneider

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Abstract

CONTEXT: Primary macronodular adrenal hyperplasia (PMAH) is a rare cause of Cushing's syndrome, which may present in the context of different familial multitumor syndromes. Heterozygous inactivating germline mutations of armadillo repeat containing 5 (ARMC5) have very recently been described as cause for sporadic PMAH. Whether this genetic condition also causes familial PMAH in association with other neoplasias is unclear.

OBJECTIVE: The aim of the present study was to delineate the molecular cause in a large family with PMAH and other neoplasias.

PATIENTS AND METHODS: Whole-genome sequencing and comprehensive clinical and biochemical phenotyping was performed in members of a PMAH affected family. Nodules derived from adrenal surgery and pancreatic and meningeal tumor tissue were analyzed for accompanying somatic mutations in the identified target genes.

RESULTS: PMAH presenting either as overt or subclinical Cushing's syndrome was accompanied by a heterozygous germline mutation in ARMC5 (p.A110fs*9) located on chromosome 16. Analysis of tumor tissue showed different somatic ARMC5 mutations in adrenal nodules supporting a second hit hypothesis with inactivation of a tumor suppressor gene. A damaging somatic ARMC5 mutation was also found in a concomitant meningioma (p.R502fs) but not in a pancreatic tumor, suggesting biallelic inactivation of ARMC5 as causal also for the intracranial meningioma.

CONCLUSIONS: Our analysis further confirms inherited inactivating ARMC5 mutations as a cause of familial PMAH and suggests an additional role for the development of concomitant intracranial meningiomas.

Original languageEnglish
Pages (from-to)E119-28
JournalThe Journal of clinical endocrinology and metabolism
Volume100
Issue number1
Early online date3 Oct 2014
DOIs
Publication statusPublished - Jan 2015

Keywords

  • Adrenal Cortex Diseases
  • Adult
  • Cushing Syndrome
  • Female
  • Germ-Line Mutation
  • Humans
  • Hyperplasia
  • Male
  • Meningeal Neoplasms
  • Meningioma
  • Pedigree
  • Tumor Suppressor Proteins

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